Tuesday, 17 December 2013

Surrey Downs CCG board meeting

 On the 29th November I attended the Surrey Downs CCG board meeting at Leatherhead Leisure Centre. This was the first of their meetings that I had attended since their decision to pull out of the BSBV programme so it was much anticipated! The Board meeting was very promising and I look forward to hearing more about their plans to improve and integrate services at Epsom Hospital.

Governing Body Meeting: 29th November 2013, 2.30pm
The Tylney Room Leatherhead Leisure Centre Guildford Rd, Fetcham, Leatherhead, Surrey KT22 9BL
For details of the meeting and general information about Surrey Downs CCG visit our website www.surreydownsccg.nhs.uk
Governing Body Business
Welcome and introductions. Chairman
To note.
Apologies for absence Chairman
To note.
Register of Members Interests Chairman.
To note.
Att 1
Minutes of the Governing Body Meeting held on 27th September 2013 Chairman
To Agree
Att 2
Matters arising not on the agenda. Chairman
To Advise
Chief Officer’s Report Chief Officer.
To Advise.
Att 3
Governing Body Assurance Framework and Risk Register –– Chief Officer.
To Advise
Att 4Strategy and Commissioning
Better Services Better Value Chief Officer
To Agree
Att 5
Out of Hospital Strategy Chief Operating Officer
To Agree
Att 6
Annual Planning Framework Chief Officer
To Advise
Att 7
Equality Duty Action Plan – Chief Operating Officer
To Agree
Att 8
Locality report Chief Operating Officer
To Advise.
Att 9
Performance Against Delivery Plan Chief Operating Officer.
To Advise
Att 10
Integrated Quality and Performance Report Head of Clinical Quality
To Advise
Att 11
Performance Report Chief Operating Officer
To Advise
Att 12
Finance Report Chief Finance Officer.
To Advise
Att 13
Assurance papers – to note
Audit Committee Minutes - Chair of the Committee.
To Note
Att 14
Quality Committee Minutes - Chair of the Committee.
To Note
Att 15
Remuneration Committee – verbal feedback – Chair of the Committee
To note
Policies and procedures
Policies for agreement Chief Operating Officer
To Agree
Att 16
Personal Health Budgets update Chief Operating Officer
To Agree
Att 17
Other matters
Any other business. Chairman.
To Advise
Questions from the public. Chairman
To Advise
Dates of future Governing Body Meetings
20th December 31st January 28th February 21st March
Seminar Formal in public Seminar Formal in public
To note
In accordance with the CCG’s constitution and Section C3.17 (i) (ii) and Sections 1(2) and 1(8) of the Public Bodies (Admission to Meetings Act 1960), it is resolved that it is necessary for representatives of the press and other members of the public to be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, public discussion of which would be prejudicial to the public interest.
Governing Body members
Dr Claire Fuller
Dr Ibrahim Wali
Dr Mark Hamilton
Miles Freeman
Dr Andrew Sharpe
Gavin Cookman
Karen Parsons
Dr Hazim Taki
Peter Collis
Keith Edmunds
Dr Kate Laws
Denise Crone
Dr Jill Evans
Dr Suzanne Moore
Cliff Bush
Dr Simon Williams
Dr Robin Gupta
Eileen Clark (EC)*
Dr Steve Loveless
Alison Pointu
Nick Wilson (NW)*
* Denotes non-voting member
In attendance: Justin Dix, Governing Body Secretary (Minutes) Important information on the conduct of this meeting
Please note that all timings are indicative
This meeting is being recorded to ensure the accuracy of the minutes.
Freedom of Information Act: Those present at the meeting should be aware that their names and designations may be recorded in the minutes of this meeting, which will be published on the CCG’s web site and otherwise freely available.

Agenda item 8 Attachment
This paper and the decision arising from it have been developed from an agreed decision making framework in the Governing Body on 27th September 2013 (part 2). An appraisal of the future scenarios open to us for driving improvement in acute commissioning has been undertaken, the inputs externally validated and a Governing Body seminar on 22nd October agreed a recommendation to send this information to GPs preparatory to a vote. To allow further debate and full information flow from all parties there was a meeting for all Surrey Downs GPs on the 5th November including representation of the BSBV team and Epsom St Helier NHS Trust. A vote, offered to all GPs working in Surrey Downs CCG, followed and the decision in this paper is driven by the outcome of this vote as administered by the Electoral reform services.
Executive Summary and Key Issues
The Governing Body on 17th May 2013 agreed to nominate three members of the Governing Body to represent the CCG in the joint meeting with other CCGs to determine whether or not to go to consultation on the proposals emerging from the Better Service Better Value (BSBV) programme. The NHS England Assurance process on BSBV was still underway at this point but has now concluded all areas with the exception of requiring assurance of the support of GPs in Surrey Downs.
Given the major changes proposed by BSBV, Surrey Downs CCG offered every GP the opportunity to vote to find out if GPs agreed with the proposals as part of the four tests required to be satisfied before public consultation can begin.
Title of paper:
Better Service Better Value (BSBV)
Governing Body, 29th November 2013
Diane Hedges, BSBV Programme Advisor
Exec Lead:
Miles Freeman, Chief Officer
To Agree
To Advise
To Note
All GPs working in the Surrey Downs CCG area were asked to vote on the question
1Agenda item 8 Attachment
The Governing Body is asked to AGREE to withdraw from the BSBV programme as a vote of the GPs working in Surrey Downs CCG does not evidence support for the proposals.
Attachments: NONE Implications for wider governance
“Do you agree with the BSBV proposals?”
The results of the ballot were as follows;
Number of yes votes – 37 (25%)
Number of no votes – 110 (74.3%)
Number who abstained – 1 (0.7%)
Total votes – 148 (66.7% of eligible voters)
The ballot results demonstrate that Surrey Downs GPs do not agree the BSBV
proposals are right for our Surrey population. The Governing Body expected to act in
line with the results of the GP vote when making a formal decision at this meeting
and so has already announced an intention to withdraw.
What happens now and when?
Our next steps are to make our vision for out of hospital care a reality so patients
benefit from having integrated care delivered more effectively and efficiently. We are
not ruling out service changes in the future but the implication is the Governing Body
would now, together with our partners, focus our work on achieving the
improvements we want to see locally. We will continue to work with Epsom and St
Helier University Hospitals NHS Trust to ensure local people continue to have
access to safe and sustainable services. Part of our out of hospital strategy also
looks to increase community capacity and improve the hospital discharge process,
which will help ensure local patients get the best possible care. Given our patient
flows into South West London we will continue to work closely with our colleagues in
London and ensure we understand and respond appropriately to any emerging
Quality and patient safety: Quality and safety was addressed in the preparatory work for the GP vote.
Patient and Public Engagement: There was an engagement process around BSBV in Surrey Downs leading up to the proposal to move to public consultation. Engagement will now be around developing Surrey Downs future plans as part of our commitment to improve healthcare for local people, working in partnership with clinicians, our partners, local people and patients.
Agenda item 8 Attachment
Equality Duty: There is no significant service change arising from this paper.
Finance and resource: Financial assessment was addressed in the preparatory information for the GP vote.
Conflicts of interest: Dr. Mark Hamilton is a secondary care clinician working at St George’s Hospital. This interest is therefore specifically relevant to the discussion and we confirm Mark has not participated in any vote related to BSBV.
Communications Plan: Stakeholders have been kept informed of the vote and its outcome. This paper is available on the CCG web site.
Legal or compliance issues: Legal advice has previously been sought. If the BSBV programme continues and recommends changes which impact on services in the Surrey Downs area then further legal advice is likely to be sought to assure appropriate action and response.
Risk and Assurance: Risk SD0003 applies (this is now on the assurance framework) and is significantly managed by this recommended decision. If SDCCG exit the BSBV process BSBV may continue but not including Epsom Hospital. There will continue to be some risk emerging until the future direction of services is settled.

Agenda item 9 Attachment
During July and August 2012 clinicians and stakeholders were invited to attend workshops and share their views and local people were invited to complete a questionnaire in which we asked them to rank a series of health priorities and to tell us about any other areas they wanted us to focus on. During this period, we engaged with GP representatives from our 33 member practices, as well as a wide range of stakeholders. We also received more than 400 completed questionnaires from members of the public. We collated this feedback and used it to inform the development of our commissioning priorities.
In April 2013, we built on this work through an intensive 10 week programme that involved more than 160 of our GP members and a broad range of stakeholders to develop an Out of Hospital Strategy that supports wider commissioning plans and focuses on providing more care in the community.
This strategy has been regularly reviewed by the Executive Committee and Governing Body prior to seeking approval.
Executive Summary and Key Issues
The aim of our Out of Hospital Strategy is to deliver more care in community settings and improve quality of care, whilst also ensuring services are sustainable longer term.
This work is happening in parallel to work happening as part of the Better Services Better Value (BSBV) programme which is currently looking at acute care standards
Title of paper:
Out of Hospital Strategy
Governing Body, 29th November 2013
Mark Needham, Head of Service redesign
Exec Lead:
Karen Parsons, Chief Operating Officer
To Agree
To Advise
To NoteAgenda item 9 Attachment
for hospitals in south west London, which includes Epsom Hospital (our local acute hospital) as it is part of a London facing trust. The focus of this strategy is on community services and getting these right now. We believe these improvements need to happen now, regardless of any other changes that are proposed - it does not pre-empt the outcome of the Better Services Better Value review.
The Out of Hospital Strategy strategic framework is based on the premise that primary and community care needs to be transformed in order to achieve the system changes necessary to deliver high quality and safe care, which is appropriate, closer to home and provided by suitably trained professionals. Furthermore, there needs to be integrated care pathways and joint working with acute and mental health providers, local authorities, the voluntary sector and other partner organisations. There also needs to be a drive to improve patient education and the self- management of conditions.
Surrey Downs CCG is an active member of the Surrey Health and Well-being Board and we work closely with Surrey County Council (SCC) to promote good health and well-being within our local population. This Out of Hospital strategy supports the Surrey Health and Well-being Strategy and uses the evidence presented in Surrey’s Joint Strategic Health Needs Assessment (JSNA).
In addition to the headlines above, Surrey Downs also has a number of specific groups with specific health needs that require a more targeted approach. Our commissioning intentions will need to ensure health provision for these groups which include:
Carers: more than 27,500 people of all ages provide unpaid care; 1,500 are over 65 providing more than 20 hours a week just in Mole Valley and Epsom and Ewell
Older people: particularly with the high rate of falls, hip fractures, and increasing impact of excess winter deaths on local populations
Gypsy, Roma and Traveller community: Surrey has the 4th largest gypsy, Roma and traveller community in the country. Surrey Downs CCG has around 7 authorised gypsy, Roma and traveller sites
Prisoners and ex-offenders: Down View women’s prison including the Josephine Butler Unit for female juveniles and High Down men’s prison located in Banstead
Children and young people – ensuring robust safe guarding processes, promoting healthy lifestyles and social engagement and education/training.
Recommendation(s): The Governing Body is asked to AGREE the strategy.
Attachments / references: The full strategy is available on the CCG website at http://www.surreydownsccg.nhs.uk/
Agenda item 9 Attachment
Implications for wider governance
Quality and patient safety: The strategy is based on clinical best practice, clinical audits and robust evidence to ensure the strategic vision was credible, practical and achieves key quality standards for patients in terms of Access; Choice; Experience; Safety; Outcomes.
Patient and Public Engagement: The Strategy has been discussed with the CCG’s Patient Advisory Group, which includes representation from carer, patient and other voluntary sector groups and further discussed are planned to ensure this group is fully engaged with this work moving forwards. As well as seeking their views on our commissioning plans, we will also be engaging them on how we share and communicate our plans and priorities more widely within the local community.
Equality Duty: This strategy has been designed to meet the requirements of the NHS Constitution and as such we believe it meets the requirements of the Equality Act in respect of not discriminating against any groups with protected characteristics.
Finance and resources: Value for money estimates are based on contractual and finance information, which is subject to Key Performance Indicators and contractual adjustments, that may affect the real cost of service provision. Whilst caution should be applied to programme budgeting and financial data, which needs to be explored in more detail, the data suggests there is an opportunity for the CCG to learn from the lower spend, better outcome areas, as to what makes these effective, better quality pathways.
Communications Plan: This strategy will include a communications campaign to raise awareness of the services available out of hours and to reinforce key messages about where to access care locally.
Legal or compliance issues: The strategy meets the requirements of the NHS constitution particularly in relation to access and continuously improving care.
Risk and Assurance: This is item 1.2 in the Governing Body Assurance Framework which sets out the major risks and mitigating actions to this objective.

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