Barnsley CCG Mins 12 April 12.pdf - NHS Rotherham

NHS BARNSLEY 

Minutes of the meeting of the BARNSLEY INTERIM COMMISSIONING 

ADVISORY COMMITTEE held on Thursday, 12 April 2012 in the Boardroom at 

Longfields Court, Carlton, Barnsley 

PRESENT: 

Mr G Dalton (Chairman) 

Mrs P Acklam 

Ms F Carey 

Mrs S Johnson 

Mrs M Kitching 

Dr K McDonald 

Mr S Wainwright 

Mrs G White 

- Lay Member 

- Lay Member 

- Chief Finance Officer 

- Lay Member 

- Nurse Director 

- Medical Director 

- Chief Operating Officer 

- Lay Member 

IN ATTENDANCE: 

Mr S Broughton 

- Assistant Chief Operating Officer - Contracting 

Mrs J Finch 

- Assistant Chief Operating Officer – Corporate 

Governance & Patient Safety 

Ms E Shassere 

- Director of Public Health 

Mrs G Stansfield - Assistant Chief Operating Officer – Service 

Improvement 

Mr A J Thorpe 

- Principal Administrator 

Mrs S West 

- Assistant Chief Operating Officer – Performance & 

Primary Care 

ACTION 

BCAC 12/53 

DECLARATIONS OF INTEREST 

There were no items raised under this heading. 


MINUTES OF THE PREVIOUS MEETING 

The minutes of the previous meeting held on 

8 March 2012 were approved as a correct record. 


MATTERS ARISING 



INTEGRATED PERFORMANCE REPORT 

The Chief Operating Officer introduced the Integrated 

Performance Report which provided an update in 

relation to key performance indicators, finance, 

contracts and patient safety. The Committee was 

L:\Cluster Board\Cluster Board 2012\2012 05 21\19 - Barnsley CCG Mins 12 April 12.doc 

NHS Barnsley, local leader of the NHS. The legal name of NHS Barnsley is Barnsley Primary Care Trust. 

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assured that NHS Barnsley was on track to deliver 

against its year-end targets in relation to performance 

and finance. 

56.1 Key Performance Indicators – 2011/12 Operating 

Framework Measures 

The Assistant Chief Operating Officer – Performance 

and Primary Care drew particular attention to the 

information relating to Accident and Emergency waiting 

times performance at Barnsley Hospital. The four-hour 

waiting time target had been met in February 2012 and 

on the basis of preliminary information so far available 

it appeared that the target for both Quarter 4 and the 

year-end had been met. 

The total numbers waiting at the end of January 2012 

on an incomplete referral to treatment pathway were 

above the target level and the position had further 

deteriorated when compared to the previous month’s 

performance. However there was confidence that the 

year-end target would be met. The Committee noted 

that performance against this indicator reflected the 

total commissioning position across all providers. 

Performance against the indicator relating to the 

proportion of people with depression referred for 

psychological therapy receiving treatment was below 

target for the period December 2011 to February 2012. 

The position was under review and it appeared that the 

under performance was related to staffing and 

recruitment issues. 

The indicator relating to the percentage of eligible 

people offered screening for the early detection of 

diabetic retinopathy in the previous twelve months 

remained below target although performance to the 

end of February 2012 reflected an improvement on the 

previous position. 

56.2 Finance 

The Chief Finance Officer referred to the summary of 

the financial position for NHS Barnsley for the first ten 

months of the financial year. This confirmed that the 

PCT continued to be on track to achieve all financial 

duties and its planned surplus of £3M for 2011/12. 

56.3 Patient Safety 



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The Assistant Chief Operating Officer – Corporate 

Governance and Patient Safety referred to the 

information relating to health care acquired infections. 

Whilst the PCO total target for C.difficile infections in 

2011/12 could not be met the Committee noted that 

BHNFT would meet its own target. 

For 2012/13 the North of England SHA had set an 

unchanged target for C.difficile; the target for MRSA 

would be zero. 

In conclusion the Chief Operating Officer confirmed 

that overall, NHS Barnsley was on track to meet its 

performance targets for 2011/12. This reflected the 

strength of the organisation and demonstrated that the 

PCT was able to effectively manage performance. The 

Chairman endorsed this view and expressed 

appreciation on behalf of the Committee for the work of 

all staff in the organisation. 


TELE-HEALTH/SELF-DIRECTED CARE 

The Nurse Director referred to her report which 

provided an update to the Committee on the work of 

the People in Control Programme Board which had 

responsibility to take forward the personalisation 

agenda across Barnsley. The Board was a multiagency 

body in its second year of operation whose 

primary purpose was to deliver the health and social 

care strategic vision concerning the personalisation 

agenda. The Board had a number of specific projects 

which were interdependent and were aligned to the 

strategic aims of the programme. These were as 

follows:- 

Tele-Health Care; 

Universal Information and Advice; 

People Development; 

Pathways including Personal Health Budgets. 

The report specifically addressed the work of the Tele- 

Health Care Project and the Personal Health Budgets 

Project. 

57.1 Tele-Health Care 



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NHS Barnsley had pursued the development of Tele- 

Health Care solutions in response to the challenge to 

meet local health needs and improve the quality of 

services within a financially constrained environment. 

The commitment had been reinforced through various 

NHS Barnsley policy documents including the Five- 

Year Commissioning Strategy and the Single 

Integrated Plan. 

The Project sought to achieve the following objectives:- 

The industrialisation and exploitation of the Tele- 

Health Care Centre model across all care 

pathways; 

Delivery of a common and integrated pathway 

for all physical, mental and social care wellbeing 

delivery; 

Provision of appropriate access to support for 

citizens through a variety of service delivery 

channels. 

The Tele-Health Care Centre which was currently 

located at Beevor Court undertook a number of core 

functions. Tele-Monitoring involved the remote review 

and sharing of data between a patient and a 

medical/nursing and social care team. Care 

Navigation involved the provision of telephone advice, 

support and information on a broad range of health and 

social care services. Health coaching involved the use 

of motivational interviewing and behaviour change 

techniques to promote self-care and self-management. 

Post discharge and crisis support involved the 

promotion of effective transition of patients from 

secondary into community based services. 

During the course of discussion the Nurse Director 

explained that the project would run only to the end of 

2012/13 and a full specification had been issued to 

SWYPFT. Performance monitoring would be carried 

out through the contract review process. The 

effectiveness of the integrated service model would be 

monitored through a group involving representatives 

from both Sheffield Universities. Phase 1 of the 

process, which was already underway, focused on cost 

effectiveness, patient experience interviews and 

behaviour change. Phase 2 would focus on post crisis 



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support. In response to a question it was confirmed 

that the care navigators were involved in a programme 

of visits to GP Practices to promote the project. 

57.2 Personal Budgets 

Personal budgets were established in 2008 with a 

target of providing every service user with a budget by 

2013. The budgets were allocations of funding given to 

users after an assessment of their needs. Users could 

either take a personal budget as a direct payment or, 

whilst choosing how their care needs would be met, 

would leave local authorities and health commissioners 

with the responsibility to commission the services on 

their behalf. 

Personal health budgets were currently being piloted in 

the NHS in England. In October 2011 the Secretary of 

State for Health had announced that subject to 

evaluation of the pilot, everyone in receipt of NHS 

Continuing Healthcare would have a right to request a 

personal health budget by April 2014. This would form 

part of a broader rollout of personal health budgets to 

people with long-term health conditions. 

NHS Barnsley was currently in the process of 

becoming a pilot site for personal health budgets for 

people with CHC needs. It had not been possible to 

offer direct payments in the past but the pilot would 

enable the PCT to extend an offer of personal health 

budget to include direct payments. Within NHS South 

Yorkshire and Bassetlaw Doncaster PCT was a first 

wave pilot site and it would therefore be possible to 

secure advice and support from that source. In 

addition, the options and potential benefits of a Clusterwide 

approach to the pilot were being considered. 

The Committee agreed to note the position and 

support the developments being progressed through 

the People in Control Programme Board. 

MK 


ASSURANCE FRAMEWORK – END OF YEAR 

ANNUAL REVIEW 

The report of the Assistant Chief Operating Officer – 



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Corporate Governance and Patient Safety confirmed 

that the NHS Barnsley Assurance Framework had 

been reviewed and updated to reflect the outcome of 

Internal Audit work and other local, regional and 

national developments. The Framework had also been 

reviewed by members of the Governance Risk and 

Audit Group, together with senior managers within the 

organisation. 

A number of specific actions had been undertaken in 

line with the NHS South Yorkshire and Bassetlaw 

Assurance Framework. In particular, it was noted that 

the format of the NHS Barnsley Framework had been 

adjusted to reflect the template developed across the 

Cluster. All of the NHS Barnsley objectives had been 

mapped to those agreed by NHS South Yorkshire and 

Bassetlaw. The risk matrix had been reviewed and 

minor changes made to ensure consistency across the 

Cluster. The risk matrix formed part of the recently 

updated Risk Management Strategy. The Risk 

Register had been updated to reflect this change. 

Since the previous internal audit review of the 

Assurance Framework in May 2011 a number of 

substantial organisational and accountability changes 

had taken place. A range of specific actions had been 

undertaken in line with the recommendations of the 

Internal Audit Report. In view of the emerging 

organisational changes within the NHS each risk had 

been aligned to the new NHS configuration. 

The revised Assurance Framework was appended to 

the report together with a schedule detailing a number 

of risks which had been identified for removal. 

The Committee agreed to:- 

Receive and approve the year-end review of 

the NHS Barnsley Assurance Framework; 

Note the assurances on controls; 

Approve the risks for removal from the 

Assurance Framework. 

JF 


CONTRACT UPDATE 



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The Assistant Chief Operating Officer – Contracting 

referred to the contract update report which explained 

that the Department of Health Operating Framework 

for 2012/13 outlined the key objectives, priorities and 

planning framework requirements for NHS 

organisations. The 2012/13 NHS Standard Contract 

was a single agreement for use by commissioners 

when contracting with providers seeking to deliver NHS 

funded secondary and community services. Contracts 

generally would be limited to twelve months duration 

but from 2013/14 the contracts would revert to a three 

year duration. 

NHS Barnsley held a portfolio of contracts and acted 

as lead commissioner for contracts with BHNFT and 

SWYPFT respectively. NHS Barnsley was an 

associate commissioner in relation to a number of 

other contracts. As previously reported to the 

Committee a key requirement for 2012/13 was that 

contracts were required to be agreed and signed off by 

both parties by no later than 15 March 2012. Contracts 

with both BHNFT and SWYPFT had been finalised in 

accordance with this deadline. Where other contracts 

had not been signed by the deadline date activity and 

financial values had been agreed and outstanding 

signatures had all been completed by 31 March 2012. 

Activity plans had been agreed with providers and 

established as part of rigorous modelling exercises. 

The Chief Operating Officer indicated that in the light of 

the tight timeframes for contract finalisation the NHS 

Barnsley Contracting Team had performed well in 

completing the process. This had been assisted 

through the PCT’s good working relationships with 

BHNFT. Mrs Acklam indicated that at a recent meeting 

of the BHNFT Governing Council the Chief Executive 

had made reference to the transparent and positive 

contract negotiations which had taken place with NHS 

Barnsley. 

It was noted that the Contracting Team had taken a 

pragmatic view in establishing the planned contracted 

activity levels which were based on the forecast outturn 

for 2011/12. This involved some element of risk arising 

from the reduced ability of NHS Barnsley to provide inyear 

support from commissioning reserves to meet the 

cost of unplanned activity. 



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The Commissioner for Quality Improvement 

Framework would continue to operate in 2012/13 and 

the report listed the value of CQUINS Schemes agreed 

with each provider. 

It was emphasised that the robust monitoring 

arrangements already in place with BHNFT and 

SWYPFT would continue during 2012/13 based on 

monthly contract review meetings. 


NHS BARNSLEY SINGLE INTEGRATED PLAN 

The Assistant Chief Operating Officer – Service 

Improvement referred to the update report relating to 

the Single Integrated Plan which had been submitted 

to the NHS South Yorkshire and Bassetlaw Cluster in 

March 2012. 

The SIP incorporated the national requirements set out 

in the Department of Health Operating Framework for 

2012/13 together with NHS Barnsley’s local strategic 

goals. The document was supported by a suite of 

supporting submissions as follows:- 

QIPP, including organisational transition milestones; 

Workforce; 

Finance; 

Activity; 

Operating Framework Outcomes Trajectories; 

Plan on a Page. 

Particular attention was drawn to the Plan on a Page 

appended to the report. This identified the specific 

actions within the Plan which it was proposed to 

pursue in 2012/13 in respect of the seven specific 

initiatives on which the Plan was based. This 

represented the key actions to be taken by NHS 

Barnsley in conjunction with partner organisations to 

improve quality and deliver the 2012/13 QIPP 

Programme. 

The second draft of the SIP had been submitted to the 

Cluster and would form part of the NHS South 

Yorkshire and Bassetlaw SIP submission to the North 

of England SHA. Feedback on the second draft was 

currently awaited. 



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In response to a question the Director of Public Health 

explained that the Public Health Transition Plan had 

been submitted to the North of England SHA at the end 

of March 2012. This had been favourably received and 

the next stage would be to develop a project initiation 

document and establish a Project Team and structure. 

The first phase of this work would deal with operational 

aspects of the transfer of Public Health to the Local 

Authority, including accommodation and finance; the 

second phase would address strategy and 

commissioning issues. The aim would be to ensure 

the wider involvement of Public Health across the full 

range of Local Authority work programmes to address 

the health needs of the local population. 

It was confirmed that a report on the transition plan 

would be made to the next meeting of the Health and 

Wellbeing Board. 

BCAC 12/61 STAFF ALIGNMENT AND VOLUNTARY 

REDUNDANCY SCHEME 

Further to previous reports made to the Committee the 

Chief Operating Officer confirmed that the Cluster wide 

voluntary redundancy scheme was nearing completion. 

It would then be possible to finalise a full list of the 

local staff leavers. It was anticipated that by late April/ 

early May 2012 it would be possible to provide more 

information to individual members of staff regarding 

their personal alignment to the new NHS structure. 

It was also confirmed that NHS Barnsley was likely to 

achieve its £25 per head running cost target for 

2012/13. This would be subject to a further 

assessment by the Chief Finance Officer and her 

Team. 


COMMISSIONING SUPPORT SERVICES 


Chief Operating Officer indicated that the NHS South 

Yorkshire and Bassetlaw Outlined Business Case for 

the Commissioning Support Service had been 

submitted to the SHA at the end of March 2012. The 



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Business Case would be evaluated centrally. 

Interim Senior Management arrangements for the 

Commissioning Support Service had been agreed as 

follows:- 

Interim Managing Director 

Interim Commissioning Services 

Director 

Interim Business Development 

Director 

– Debbie Hilditch 

– Jackie Pederson 

– Brian Hughes 

In response to a question it was explained that the 

national configuration of Commissioning Support 

Services was not yet clear. There could be no 

assumption that Commissioning Support Services 

would be coterminous with the existing boundaries of 

PCT Clusters. 

BCAC 12/63 CLINICAL COMMISSIONING GROUP 

DEVELOPMENT 


Chief Operating Officer confirmed that following the 

passage of the Health and Social Care Act the 

configuration requirements for Clinical Commissioning 

Groups were now clear. There was now acceptance 

that Barnsley would be served by a single CCG and 

the NHS South Yorkshire and Bassetlaw Chief 

Executive had arranged a further meeting to take place 

on 18 April 2012 to pursue progress. 

It was evident that difficulties remained to be resolved 

before a conclusion could be reached in Barnsley. The 

timetable already set for the CCG authorisation 

process would mean that considerable progress would 

have to be made in a relatively short period to enable 

the Barnsley CCG to be established, albeit with a 

reduced level of authority and devolution of powers by 

the NHS Commissioning Board. 

It was noted that the Cluster Chief Executive had also 

written direct to all Barnsley GPs requesting face-toface 

meetings. Practices within the Barnsley People’s 

First Consortium had declined this invitation but 

arrangements were already underway to meet with all 

Practices in the Barnsley Commissioning Consortium 



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and Barnsley North Consortium. 

BCAC 12/64 FINANCIAL PLAN AND BUDGET BOOKLET – 

2012/13 

The Chief Finance Officer referred to her report which 

provided the Committee with the opening 

commissioning budgeted financial position for 2012/13. 

This had been developed through the planning process 

and reflected the levels of commissioned outcomes as 

described in the PCT Commissioning Strategy and the 

Medium Term Financial Plan. The report appended a 

reconciliation between 2012/13 initial resource limits 

and budgeted expenditure; a high level summary of the 

budget areas and financial values; a detailed 

breakdown of the budget areas containing financial 

values and budgeted staffing establishments and the 

delegation limits of budget holders. 

The PCT had managed its finances effectively in 

2011/12 which had provided a strong platform for the 

continued development of the local health and social 

care economy. NHS Barnsley had received a 3% 

increase in its recurrent settlement for 2012/13, 

including funding for re-ablement. The level of 

financial growth equated to £13.2M. Whilst the 

financial plan covered only one year it was considered 

important to create a financial environment which 

would be sustainable in the future. Therefore, NHS 

Barnsley had established contingency reserves to help 

mitigate some of the financial risk. 

The Chief Operating Officer referred to the NHS 

Barnsley QIPP Programme for 2012/13 which required 

the delivery of an additional £6M recurrent savings to 

roll forward into 2013/14. Discussions had already 

been held with partner organisations to discuss further 

efficiencies in the system. 

BCAC 12/65 SEASONAL INFLUENZA IMMUNISATION 

CAMPAIGN – 2011/12 

The report of the Director of Public Health provided the 

Committee with an evaluation of the 2011/12 Seasonal 

Influenza Vaccination Programme and made 

recommendations for Winter 2012/13. 

The report confirmed that the degree of influenza 



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circulating during the 2011/12 Winter had been 

comparatively low. However the priority for NHS 

Barnsley was to ensure that an effective Seasonal Flu 

Vaccination Programme continued to be in place and 

targeted at improving the uptake of the vaccine in 

those groups most at risk of health complications. 

In Barnsley three separate groups had responsibility for 

elements of seasonal flu planning. The Health and 

Social Care Emergency Resilience Group was 

responsible for ensuring that plans were in place and 

for the overall co-ordination and whole systems 

approach to the management of service interruption. 

The Clinical Executive Committee was responsible for 

providing clinical and professional advice within an 

ethical framework to the Health and Social Care 

Emergency Resilience Group. In 2011/12 for the first 

time a Seasonal Flu and Winter Clinical Operational 

Group had been established on a time-limited multi 

agency basis and chaired by the Assistant Director of 

Public Health (Health Protection). The report set out in 

detail the role and purpose of the Operational Group 

which was noted by the Committee. 

The Planning Framework described in the report had 

enabled NHS Barnsley to effectively manage the 

2011/12 winter season and the report recommended 

that the arrangements should continue with appropriate 

adjustments to take account of the emerging new NHS 

structures. Based on the evaluation of the winter it 

was identified that the cost of implementing the 

2012/13 Seasonal Flu and Winter Well Programme 

was likely to be £100,000 with firm proposals to be 

presented to the management team meeting for 

approval before the end of June 2012, to be funded 

from in-year non-recurrent monies. This reflected the 

winter commissioning priorities described in the report. 

The report contained a detailed analysis, in graph form 

of the uptake of flu vaccine in clinical risk groups in 

defined age categories and also for pregnant women. 

It further described the comparative uptake of vaccine 

by NHS frontline staff. The Nurse Director emphasised 

that one of the commissioning priorities for 2012/13 

would be to influence providers to ensure that staff 

uptake was maximised. It was confirmed that this 

issue could be incorporated within the periodic contract 

review meetings with both BHNFT and SWYPFT. In 

response to a question the Director of Public Health 



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agreed to provide more details on the spread of 

immunisation across staff groups in 2011/12. It was 

also suggested that the names of Barnsley GP 

Practices, rather than the Practice Codes should be 

included in the vaccine uptake data. 

ES 


SHADOW HEALTH AND WELLBEING BOARD 

The Committee received and noted the minutes of the 

Shadow Health and Wellbeing Board meeting held on 

16 February 2012. 

BCAC 12/67 YORKSHIRE AND HUMBER SPECIALISED 

COMMISSIONING OPERATIONAL GROUP 

The Committee received and noted the minutes and 

decision summary of the Yorkshire and Humber 

Specialised Commissioning Operational Group 

meeting held on 24 February 2012. 


INDIVIDUAL FUNDING REQUEST PANEL 

The Committee received and noted the minutes of the 

Individual Funding Request Panel meeting held on 

20 March 2012. Mrs White, as Chairman of the Panel 

referred to the difficulty of securing public health 

representation at Panel meetings. The Director of 

Public Health confirmed that because of staff capacity 

issues within the Public Health Department the 

problem had been reported to the Professional 

Executive Committee as a risk and logged in the Risk 

Register relating to the Public Health Transition Plan. 

The risk would also be reflected to NHS South 

Yorkshire and Bassetlaw which was undertaking a 

review of how IFR Panels were supported across the 

Cluster. 


IDENTIFICATION OF POTENTIAL RISKS 



DATE AND TIME OF NEXT MEETING 

The next meeting would be held on Thursday, 

10 May 2012 at 9.30am in the Boardroom at Longfields 

Court, Carlton, Barnsley. 



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