LEICESTER CITY PRIMARY CARE TRUST - NHS

NHS LEICESTER CITYMEETING: TRUST BOARD MEETING PAPER X to ZDATE: 24 September 2009REPORT TITLE: Minutes of Sub-Committees and PartnershipMeetingsSECTION:PublicREPORT BY:PRESENTER:Mr Philip Parkinson, ChairmanMr Philip Parkinson, ChairmanEXECUTIVE SUMMARYThe purpose of this report is to share with Board members the followingminutes from sub-committees of NHS Leicester City and partnershipmeetings; Minutes of the Commissioning Executive Meeting held on 6 August 2009(Paper X) Minutes of the Board of Leicester City Community Health Service held on27 May 2009 and 14 July 2009 (Paper Y) Minutes of the East Midlands Specialist Commissioning Group held on 31July 2009 (Paper Z)RECOMMENDATIONThe Board is requested to:NOTE the content of the minutes

Paper XNHS Leicester City Board Meeting24 September 2009Stage Review programme, at both local and regional tiers (asattached in Minute book – Appendix number CE/08/09/C).It was RESOLVED- to note this report.- that PBC leads will receive a list of areas that require clinicalrepresentation and encourage clinicians to put their namesforward.C/09/48Innovation for a Healthier FutureMr Martin Flannagan, Assistant Director Planning provided a reportoutlining the measures launched by the Department of Health tostimulate innovation under the banner “Innovation for a HealthierFuture” (as attached in Minute book – Appendix numberCE/08/09/D).It was RESOLVED- to note the contents of the report;- to consider how PBC groups can stimulate local innovation;- to agree the next steps to promoting innovation in LeicesterCity.- PBC leads to discuss at consortia meetings- to clarify by the September meeting the process andtimescales for the bidsC/09/49Commissioning Intentions – Transforming Community HealthServicesMr Jim Bosworth, Assistant Director of Adults and Older Peoplepresented NHSLC commissioning intentions to help shape andinform the provider market (as attached in Minute book – Appendixnumber CE/08/09/E).It was RESOLVED- to agree the approach being taken in determining futurecommissioning intentions for Community Health Services;4

Paper XNHS Leicester City Board Meeting24 September 2009- to comment on the initial Commissioning Intentions draftpaper;- to note a draft of the paper will be submitted to the StrategicHealth Authority and shared with relevant providerorganisations in August 2009.- to receive a list of the 20 questionnaire respondents.- that Mr Rideout will explore how to engage with LeicesterCity Council on the commissioning intentions.CE/09/50Capital Investment Case of Need for Southfields Health and SocialCare CentreMr Toby Sanders, Director of Primary and Community Carepresented the strategic case of need for providing a Health andSocial Care Centre in the Southfields area of the City (as attachedin Minute book – Appendix number CE/08/09/F).It was RESOLVED- to approve the Capital Investment Case of Need for theSouthfields Health and Social Care Centre.- that Mr Sanders will bring the Stage 1 Business Case backto the Commissioning Executive in March 2010.CE/09/512009/10 Local Operating Plan ImplementationMr Martin Flannagan, Assistant Director Planning provided a paperto update the Commissioning Executive on the implementation ofthe 2009/10 Local Operating Plan, with particular reference tophase one of the review of all outstanding Cases of Need (asattached in Minute book – Appendix number CE/08/09/G).It was RESOLVED- to receive and note the progress of 2009/10 LOPImplementation;- to approve the recommendations on progressing outstandingcases of need.5

Paper XNHS Leicester City Board Meeting24 September 2009CE/09/52Report from the July Core Planning GroupMr Martin Flannagan, Assistant Director Planning provided a paperto brief the Commissioning Executive on the work undertaken bythe Planning Department and Core Planning Group in July (asattached in Minute book – Appendix number CE/08/09/H).It was RESOLVED- to approve the planning work plan;- to receive and note the prioritisation process;- to approve the revised Core Planning Group terms ofreference, subject to the requested amendments regardinginterface between the Commissioning Executive and ClinicalCabinet.CE/09/53Date of Next MeetingThe next meeting of the Commissioning Executive will take placeon Thursday 3 September 2009 commencing at 1.00 p.m. in TimRideout’s office, 8 th Floor, St Johns House, 30 East Street,Leicester, LE1 6NB.6

Paper YNHS Leicester City Board Meeting24 September 2009Minutes of the Board ofLeicester City Community Health ServiceHeld on 27 May 2009 at 1.45 pmIn the Health Promotion Room, Westcotes Health Centre,LeicesterPresent:Patricia Mansfield (Chair) Non-Executive DirectorPaul MillerManaging DirectorBrian WilsonNon-Executive DirectorPatsy Roseblade Associate Director of FinanceJayshree RavalCorporate Service ManagerKam KotechaAssociate Director of HumanResourcesJane HolroydAssociate Director of Adult ServicesAnne-Maria Olphert Associate Director of Children’sHealth ServicesApologies: David Podbury Associate Director of Quality andDevelopmentKeith GibbsInformation and PerformanceManagerGill BrigdenNon-Executive DirectorCarolyn JonesUnion RepresentativeIn Attendance: Carrie Armitage Programme DirectorKate HamillPA to Paul Miller, Managing DirectorPS/09/56To Receive Questions From Members of the PublicNo members of the public were in attendance.PS/09/57Apologies for AbsenceApologies for absence were received from David Podbury, AssociateDirector of Quality and Development, Keith Gibbs, Information andPerformance Manager and Gill Brigden, Non-Executive Director.PS/09/58Declarations of Interest on Agenda TopicsNo declarations of interest were noted.It was agreed to take the agenda item PS/09/69, Highlight Report on the ProviderServices Separation project first.PS/09/69To Receive A Highlight Report on the Provider ServicesSeparation ProjectCarrie Armitage updated the Board on the progress of the providerservices separation project. Key deliverables including the business1

Paper YNHS Leicester City Board Meeting24 September 2009case, staff and stakeholder communications, staff endorsement andBoard/SHA approval were discussed.PS/09/59Minutes from the Provider Services Board Meeting Held On21 April 2009The minutes of the Provider Services Board meeting held on 21 April2009 were read and accepted as a correct record of the proceedings.PS/09/60Matters Arising From The MinutesPS/09/45 To Receive The Financial Report For Month 11Tele Health – Community Matrons (£50k) this has been returnedas the service has been unable to implement tele health duringthe current year. It has been allocated recurrently from 2009/10.The circumstances regarding the inability to implement telehealth were explained to the Board. A bid, led by Mark Piercehad been successful, however, Mark had identified problemswith the products and had since left to take up a post inCommissioning. Kay Atkinson had been appointed to thepost and would be taking this forward.PS/09/50To Receive a Report on Safeguarding and HealthVisitingMrs Olphert had re-calculated the figures in her report and adapted theinformation to reflect resources within the health visiting service as awhole and not solely health visitors.Paul Miller advised that Corinne Green and Mags Lewis had beencommissioned to undertake a review of the health visiting service,following the brief that Anne-Maria Olphert had supplied. A reportwould be presented at the Board on 14 July 09.PS/09/61Notification of Any Other BusinessOne item of additional business was notified to Mrs Mansfield andwould be taken at the end of the meeting.REPORTSPS/09/62To Receive The Chairman’s ReportMrs Patricia Mansfield advised that she had visited a GP practicerecently which had been a positive, informative meeting.PS/09/63To Receive the Managing Director’s ReportMr Paul Miller up-dated Board members on recent activities:-2

Paper YNHS Leicester City Board Meeting24 September 20091. Swine FluAs a major provider of health care services, LCCHS has participatedfully in recent activity across health and social care organisations torespond to the threat of a swine flu pandemic. Action is co-ordinated bythe multi-agency local resilience forum, via a number of groups whichLCCHS senior clinicians and managers have attended. LCCHS willcontinue to participate in local planning to deal with a flu pandemic andprepare for the potential demands on its services later in the year. MrsOlphert requested that the hard work and commitment of Kim Wildingbe noted by the Board. Mrs Wilding had worked exceptionally hard forthe organisation and for everyone involved.2. Heatwave Plan 2009The Department of Health has reissued its heatwave plan for England.The plan is designed to enhance resilience of local services in theevent of a heatwave and is a component of emergency planning as awhole. LCCHS will incorporate the plan into its emergency planningarrangements.3. LCCHS Annual Review Report 2008/09Work will begin shortly on the LCCHS Annual Review Report 2008/09which will be published at the annual meeting due to take place beforethe end of September 2009. Members of the Board were asked toconsider its preferences regarding the location(s) and format of theannual meeting.Brian Wilson reported that NHSLC was holding a joint AGM with UHLand asked if this was something LCCHS may consider. Members ofthe Board agreed that, following the success of last years health fair, aseparate event would be preferred.4. East Midlands Health and Social Care AwardsThe regional Health and Social Care Awards event is being held at theWalkers Stadium on Thursday 21 May 2009. LCCHS has twoservices/projects which have made it through to the final stage; CRAFTand the Homeless Primary Care Service.5. LCCHS Staff NewsletterThe second edition of the LCCHS staff newsletter was publishedelectronically to all staff week commencing 11 May 2009. A smallsupply of a printed version will also be distributed to LCCHS premises.3

Paper YNHS Leicester City Board Meeting24 September 20096. Communications EventsThe lead up to the summer holiday period is turning out to be extremelybusy with a number of staff communication events. Paul Miller advisedthe Board of forthcoming events:-1 st to 5 th June: a series of 10 briefing events for all staff regardingthe future of LCCHS.17 th June: regular quarterly staff briefing.29 th June: launch of the LCCHS Nursing Strategy.30 th June: Gipsy Roma Traveller History Month.PERFORMANCE7. Corporate ObjectivesThe corporate objectives agreed by the Board at its April meeting arenow being disseminated to teams via the line management structure.All LCCHS staff teams are required by 19 June, to have a set of teamobjectives designed to support the corporate objectives and incorporatelocally generated service of locality objectives.PS/09/64To Receive a Summary Report on Performance as at March/April2009 for Leicester City Community Health ServiceIn the absence of Keith Gibbs, Paul Miller updated Board members onindicator & activity performance as at March/April 09 for Leicester CityCommunity Health Services (LCCHS).Paul Miller advised the Board that he had recently met with DebWatson and explained the need to know what LCCHS’s role is in termsof achieving targets. This has also been discussed at contractsmeetings but has proved difficult to ascertain. Mrs Patsy Rosebladehas a further meeting planned in 2/3 weeks and she will address thisissue then.Data relating to childhood obesity was discussed, how this is measuredand whether an action plan is in place.IT WAS RESOLVED:- to note the contents of the report- to note the progress in activity and performance against targetswhere applicable- to note the development work ongoing within the communityservices to ensure that the report is timely and robust, and toensure that all indicators are relevant to the community services4

Paper YNHS Leicester City Board Meeting24 September 2009PS/09/65 To Receive the Financial Report for Month 1Mrs Patsy Roseblade reported that LCCHS is reporting an under spendof £13k for the year to date ending April 2009. The year end forecastposition is break-even.The allocations from NHS Leicester City that relate to developmentfunding approved for 2008/09 and included in the 2009/10 openingbaseline were reported as:-o Health Visiting £563ko School Nursing fye £127ko SUDIC fye £94ko 18 Weeks Medical & Therapy £450ko Aiming High £110ko MARAC £51ko Inflation £613ko Accelerated depreciation £297ko Adult Therapy£1.82mDeferred income has not yet been agreed by external Auditors.Assuming all deferrals are accepted, budget holders have beenrequested to submit spending plans for this income, some of which hasbeen deferred for several years. Patsy Roseblade recommended that ifthis funding is not used or robust plans submitted, the funds should beremoved and used for corporate purposes.Funding secured from the DoH for individual projects was discussedand the need to ensure that spending plans/audit trails were in placewas highlighted.Reporting areas have been changed to more accurately reflect theservices and Associate Director responsibility. This change has not yetbeen reflected in the ledger but is expected to be changed for month02.Brian Wilson requested that income be allocated on a separate linewithin the report.Jane Holroyd agreed to supply up-to-date information to Brian Wilson inrelation to the vacancies within adults services.ACTION: Patsy Roseblade to adjust report to reflect Brian Wilson’srequest. Jane Holroyd to supply up-date information to BrianWilson relating to vacancies.IT WAS RESOLVED:- to note the year to date position5

Paper YNHS Leicester City Board Meeting24 September 2009- to agree the recommendation regarding the withdrawal ofdeferred incomePS/09/66 To Receive LCCHS Budget Report for 09/10GOVERNANCEMrs Roseblade informed the Board that the Leicester City PCT AnnualOperating Planning process had been completed with the final paperbeing approved by the PCT Board on 26 March 2009. Leicester CityCommunity Health Service (LCCHS) agreed the baseline Service LevelAgreement (SLA) at the end of February with NHS LC but with severalitems listed on the finance schedule as ‘To Be Confirmed’. As at 19 thMay 2009 only 3 non-recurrent items remain unconfirmed.It was explained that NHS Leicestershire County and Rutland (NHSLCR) are acting as an Associate Commissioner to NHS LC; thiseffectively means all negotiations take place with NHS LC who act onbehalf of NHS LCR. The NHS LCR contract covers Children’sServices, Travelling Families and TB Services with a total value of£5.7m. This does not, at this stage, include any development fundingalthough it is likely that NHS LCR will support Respite Care in 2009/10It is expected that the contract with LCR Community Services will bediscussed and signed over the coming weeks.Settlement details were relayed to members of the Board. LCCHShave not been requested to submit any business cases for newdevelopments for 2009/10. Instead the commissioning arm of the PCTwill invite tenders when specifications have been completed. Thetiming and services to be tendered are currently unconfirmed however,from other documentation available LCCHS can anticipate being invitedto tender for an extension to intermediate care services and diabetesservices. Inflation and budget setting exercises were also discussed.Mrs Roseblade clarified the current position of LCCHS regardingestates/buildings issues and responsibilities within the City. This is anarea that needs to be addressed within the transforming communityservices plan.IT WAS RESOLVED:- to note the SLA settlement- to note the level of inflation, CQUIN requirement and budgetsetting methodologyPS/09/67To Receive a Report on the Quality Schedule and Commissioningfor Quality and Innovation (CQUIN) Schedule for 2009/10Paul Miller described the Quality Schedule and Commissioning forQuality and Innovation (CQUIN) Schedule which has been agreed as6

Paper YNHS Leicester City Board Meeting24 September 2009part of the 2009/10 contract between Leicester City Community HealthService and NHS Leicester City.In the Quality Schedule for 2009/10 LCCHS has made an undertakingto meet a range of nationally agreed priorities and standards. Thereare twenty eight key performance indicators and LCCHS will berequired to provide evidence of its performance against these indicatorsthrough routine meetings with and regular reports to thecommissioners.Although CQUINs are not mandatory for community providers until2010/11 the Strategic Health Authority has asked primary care trusts inthe East Midlands to develop CQUINs with all providers this year. For2009/10, eight CQUIN indicators have been agreed by LCCHS.Achievement of the performance targets set out in the CQUIN schedulewill attract a payment of £180,000 which will be paid by instalmentssubject to evidence of compliance with the key performance indicatorsagreed.The Quality Schedule and CQUIN schedule have been the subject ofextensive negotiation between LCCHS and the PCT’s commissioners.Combined, they present LCCHS with a framework of challenging butachievable quality targets for 2009/10. LCCHS will apply robustarrangements for managing its progress and for ensuring that itsperformance withstands external scrutiny. There is good evidence thatLCCHS is well-placed to meet all the key performance indicatorscontained in the Quality Schedule and that through its performance itwill be able to fully secure the £180,000 attached to the CQUIN.IT WAS RESOLVED:- to note the report- to request a mid-year progress report in October 2009PS/09/68To Receive a Report on the Workforce ProfileMr Kam Kotecha provided the Board with an overview of the workforceprofile and monitoring information for the period April 2008 to March2009, allowing the year to date position to be viewed against the SHAtarget.A detailed appendix of tables and charts was discussed by members ofthe Board. Topics covered included ethnicity, disability, gender, age,sexual orientation, sickness absence, recruitment, grievance anddisciplinary procedures, training and education etc.Areas for action were highlighted as follows:-- Plans are underway for positive action to address underrepresentationof the workforce in terms of ethnicity, to include7

SERVICE DELIVERYPaper YNHS Leicester City Board Meeting24 September 2009actions aimed specifically at the under-representation amongstsenior pay grades.- To overhaul the recruitment process ensuring that the ‘BestCandidate’ for the post is culturally capable to meet the needs of thepopulation of Leicester and recognises our organisational values.This will be done through a number of activities:‣ Redesigning job adverts with an emphasis on de-cluttering themand clearly stating the points the organisation wants to make.‣ Designing and implementing an organisational value-basedrecruitment process from advert to appointment; to include thechallenge for an interview only entry for senior managers into theorganisation.- To review the staff appraisal process to ensure it is aligned with theorganisational values and ensuring staff are rewarded andrecognised in line with those values.- To invest greater emphasis on developing and promoting our ownBME staff and those from the local community; to include amentoring scheme by the Senior Management Team.- To address succession planning due to the number of staffeligible for retirement within the next 10 years.- To complete an analysis of data on sexual orientation, faith,belief and religion once ESR data validation exercise iscompleted.The high number of admin/clerical staff was noted by the Board and thereasons for this considered. Paul Miller had commissioned a piece ofwork to look at this during the move from St John’s House to BridgePark Plaza.ACTION: Kam Kotecha to supply a breakdown of the admin andclerical staff group to Board members.IT WAS RESOLVED:- to note the report and the actions being taken.PS/09/70To Receive an Update Report on the Development and Launch ofthe Nursing Strategy 2009 – 2014Jane Holroyd provided the Board with an overview of the developmentof the nursing strategy document to be formally launched on 29th June2009 at the Marriott Hotel Leicester. The seven themes identified bystaff as important to nursing over the next five years were introduced8

Paper YNHS Leicester City Board Meeting24 September 2009as; patient involvement, patient safety, clinical pathways, staffwellbeing, innovation, managing the talent and the environment. Withfour key enablers for success being good leadership, quality,productivity, and communication.The methodology relating to the development of the strategy, with afocus on ‘Every Nurse Matters’ was explained to the Board. Acommitment to involve every single nurse from band two upwards incontributing had been made and this theme is picked up and translatedthroughout the nursing strategy document as ‘Every Person Matters’,every nurse, every patient, every carer, every family.Mrs Holroyd advised that it was decided early on that the strategyneeded to be a celebration for community nursing in the city, to putLeicester on the map, to let all our stakeholders know our commitmentto providing the very best services and to being the very best provider.There are a number of planned actions to carry forward with staff beingencouraged to volunteer to progress the agreed activities.Another integral theme will be the development of Q-set methodologywhich is the ongoing quality self evaluation tool developed by the RoyalCollege of Speech and Language. This tool will be adapted by thecommunity nurses to provide a robust means of measuring evidence ofeffectiveness; identifying their improvement and communicating thevalue of activities to commissioners.This approach will allow the pledges made in the Nursing Strategy to betested annually over the next five years.IT WAS RESOLVED:MINUTES FOR NOTING- to note the contents of the update reportPS/09/71Minutes of the Health and Safety, Fire and Security CommitteeMeeting held on 26 th March 2009The following items were referred to from the above minutes:-Page 4 of 6/Item 10/Risk RegisterBrian Wilson asked whether we received this register. Paul Millerconfirmed that this was in development and would be brought to thismeeting upon completion.Page 5 of 6/Item 11/Policies and ProceduresBrian Wilson sought clarity on progress with policy reviews relating toAsbestos; Water Management and Codes of Practice from CommunityTeam.9

ANY OTHER BUSINESSPaper YNHS Leicester City Board Meeting24 September 2009ACTION: Paul Miller to request an up-date on this from DipakChauhan, Health, Safety and Security Manager.Minutes of the Clinical Governance Committee Meeting held on26 th February 2009No matters were discussed.PS/09/61NHS Litigation Authority Risk AssessmentCopies of the above document were disseminated to members of theBoard. Brian Wilson briefed the Board on options available to LCCHSto participate in the NHS Litigation Authority Risk ManagementAssessment process. The benefits of having an assessment would bethat LCCHS would receive external objective assurance in relation to itsrisk management systems. It was acknowledged that a significantamount of effort would be involved in working with the assessors andacting on any proposals during a year when LCCHS has many otherprojects to undertake. LCCHS has the option of volunteering for anassessment, however the decision is required by 29 May 2009.ACTION: Paul Miller and the senior management team wouldconsider further and advise Daljit Kaur Baines of decisionaccordingly.DATE OF NEXT MEETINGPS/09/72 The date of the next Board Meeting will be Tuesday 14 July 2009commencing at 1.45 pm in the Estates Board Room, Bridge ParkPlaza, Thurmaston, Leicester.10

Minutes of the Board ofLeicester City Community Health ServiceHeld on 14 July 2009 at 1.45 pmIn the Estates Board Room, Bridge Park Plaza,LeicesterPaper YNHS Leicester City Board Meeting24 September 2009Present:Patricia Mansfield (Chair) Non-Executive DirectorPaul MillerManaging DirectorPatsy Roseblade Associate Director of FinanceJayshree RavalCorporate Service ManagerCarolyn JonesUnion RepresentativeKam KotechaAssociate Director of HumanResourcesKeith GibbsInformation and PerformanceManagerApologies: Brian Wilson Non-Executive DirectorJane HolroydAssociate Director of Adult ServicesAnne-Maria Olphert Associate Director of Children’sHealth ServicesDavid PodburyAssociate Director of Quality andDevelopmentGill BrigdenNon-Executive DirectorIn Attendance: Kate Hamill PA to Paul Miller, Managing DirectorJacqueline Burden Joint Head of Quality AssuranceNichola Douglas Joint Head of Quality AssuranceTeresa SmithClinical Service ManagerJanet HarrisonService Manager – Speech andLanguage TherapyPS/09/73To Receive Questions From Members of the PublicNo members of the public were in attendance.PS/09/74Apologies for AbsenceApologies for absence were received from Jane Holroyd, Associate Director ofAdult Services, David Podbury, Associate Director of Quality and Development,Gill Brigden, Non-Executive Director, Brian Wilson, Non-Executive Director, Anne-Maria Olphert, Associate Director of Children’s Services and Ross Willmott, Non-Executive Director.PS/09/75Declarations of Interest on Agenda TopicsNo declarations of interest were noted.PS/09/76 Minutes from the Provider Services Board Meeting Held On 27 May 2009The minutes of the Provider Services Board meeting held on 27 May 2009 wereread and accepted as a correct record of the proceedings.The attendance was adjusted to reflect that Carolyn Jones had not been present.1

PS/09/77Matters Arising From The MinutesPaper YNHS Leicester City Board Meeting24 September 2009PS/09/50To Receive a Report on Safeguarding and Health VisitingPaul Miller advised that a review of health visiting had been commissioned whichwas taking longer than anticipated and a progress report would be provided at theAugust 2009 Board meeting.PS/09/68To Receive a Report on the Workforce ProfileKam Kotecha provided a breakdown of the admin and clerical staff group to Boardmembers.Action:PS/09/71Kate Hamill to email copy of breakdown of admin and clericalstaff to Brian Wilson and Gill Brigden.Minutes of the Health and Safety, Fire and Security CommitteeMeeting held on 26 th March 2009Page 5 of 6/Item 11/Policies and ProceduresBrian Wilson sought clarity on progress with policy reviews relating to Asbestos;Water Management and Codes of Practice from Community Team.Paul Miller reported that the above draft policies had been circulated and it washoped that they would be ratified at the next meeting of the Health and Safety,Fire and Security Committee.PS/09/78Notification of Any Other BusinessNo other business was identified, therefore none would be taken.REPORTSPS/09/79To Receive The Chairman’s ReportMrs Patricia Mansfield advised that she had attended the launch of the nursingstrategy event on 29 th June 2009 at the Marriott Hotel. She had enjoyed thesession immensely and found the speaker to be inspirational. The strategy itselfwas reported to be very good and easy to understand. Mrs Mansfield requestedthat her congratulations be conveyed to everyone involved in the event.PS/09/80To Receive the Managing Director’s ReportMr Paul Miller up-dated Board members on recent activities:-Staff Briefing80 staff attended the regular quarterly staff briefing session on 17 th June 2009held at the Merlyn Vaz Health Centre. Brief updates on a variety of matters andpresentations on the LCCHS Volunteer Service, the Child Death Review processand the CRAFT service were provided. The next quarterly briefing session will beheld on Wednesday 16 th September 2009.2

Office MovesPaper YNHS Leicester City Board Meeting24 September 2009On 3 rd June 2009, a number of LCCHS staff moved from St John’s House toBridge Park Plaza. All LCCHS functions except finance and human resources arenow based at Bridge Park Plaza. Work is underway to relocate the finance teamto Bridge Park Plaza in the next few weeks. Unfortunately, there is insufficientspace available to relocate the human resources team until more space ready foroccupation becomes available.NHS Leicester City is negotiating additional space in the Bridge Park Plazacomplex for LCCHS which will allow for its long awaited re-furbishment. The refurbishmentwill take between 9 – 12 months and will be carried out in two or threephases. The target date for completion is June 2010.Transforming Community Services Quality FrameworkOn 24 th June 2009, the Department of Health (DoH) published as planned, aquality framework for community services. The framework is aimed at bothcommissioners and providers and sets out steps to improve services in keepingwith the overall approach to quality described in High Quality Care for All (the finalreport in the Next Stage Review led by Lord Darzi).Considerable further work is required however, to describe accurately what highquality community services look like and to identify the indicators to monitorimprovement. The framework introduces 76 proposed indicators and the DoH isseeking comments about them so they can be refined in July and August thisyear. Many of the indicators measure inputs, volumes and patient experience withvery few measuring effectiveness or health outcomes. LCCHS will consider andcomment on the proposed indicators.Health Visiting ReviewAs previously reported, health visiting services are being reviewed currently andthe brief has been expanded after discussion with NHS Leicester City. The reviewteam has interviewed a number of health visitors and commissioning colleaguesand the team are visiting a sample of GP practices. In the meantime, the teamleaders are contacting every practice and meeting with practice staff to agreearrangements for liaison including a routine presence of a health visitor in thepractice e.g. a weekly or fortnightly session. The outcome of all these discussionswill be reported to the Board and commissioners.GP Practice VisitsMr Paul Miller has visited 30 GP practices in the City to date. The visits arebeneficial in making relationships, dealing with areas for improvement andreceiving positive comments about LCCHS services.Swine FluLCCHS staff have been centrally involved in responding to the spread of swine flu,which is beginning to generate considerable additional demands on the urgentcare centre. LCCHS community nurses have been swabbing patients for3

PERFORMANCEPaper YNHS Leicester City Board Meeting24 September 2009suspected swine flu until Wednesday 1 st July when the requirement to do so waswithdrawn by the health protection agency.The approach is now to provide anti-viral medication to patients presenting withsymptoms of possible swine flu. The urgent care centre is the focal point fordistributing the anti-viral medication and additional staff are being brought in tohelp meet the demand. During June, attendance at the centre during weekday,daytime hours increased by 40% and during the out of hours period (evenings,night-time and weekends) has increased by 20%. The situation is monitored on adaily basis and LCCHS is working closely with the emergency department (ED) atUHL. In partnership with the ED, LCCHS is operating a flu assessment centre atthe weekends at the LRI site to take pressure off the space available at the UCCand ED. Demand on the UCC is increasing daily and is expected to remain highfor the next few weeks. Waiting times for patients are increasing and this isexpected to have an impact on the number of complaints received. Approximately60 – 70% of patients were travelling from the Highfields area of the City and it waslikely that another centre in the area would be opened in the next few weeks.IT WAS RESOLVED:-- to note the reportPS/09/81To Receive a Summary Report on Performance as at May/June 2009 forLeicester City Community Health ServiceKeith Gibbs updated Board members on indicator & activity performance as atMay 09 for Leicester City Community Health Services (LCCHS).Mrs Mansfield was disappointed to note that re-apportioning of shared targets hadyet to be completed. Discussion ensued relating to:-- Shared targets;- Complaints; Jacqueline Burden reported that LCCHS were being measuredagainst the old 25 day target and the new national complaints guidancerequired NHS organisations to work to a deadline agreed with thecomplainant.- Sickness/absence rates and the possible affect swine flu will have onthese; Pg 19 of 35 – sickness absence action plan – detail relates toappraisals and not sickness absence.ACTION:Keith Gibbs to check the 25 day target in relation to complaints.IT WAS RESOLVED:-- to note the contents of the report- to note the progress in activity and performance against targets whereapplicable4

Paper YNHS Leicester City Board Meeting24 September 2009- to note the development work ongoing within the community services toensure that the report is timely & robust, and to ensure that all indicatorsare relevant to the community servicesPS/09/82 To Receive The Financial Report For Month 2Mrs Patsy Roseblade reported on the financial performance of Leicester CityCommunity Health Service (LCCHS) for the period ended 31 May 2009.LCCHS is reporting an under spend of £58k for the year to date ending May 2009,compared to an under spend of £13k for April 2009. This is a favourablemovement of £45k. The year end forecast position is break-even.The following allocations from NHS Leicester City for month 02 have been made:-o Tissue Viability Nurse £43ko Releasing Time To Care (non recurrent) £12kManaged Practices budgets have been reset and funding from the ‘Fit forPurpose’ monies has been allocated to the Quality Directorate for posts nowrecruited to.Accruals and prepayments have been included in month 02 reports for invoicesexpected but not yet received, utilities and other areas as agreed with managersand deemed appropriate by finance. A full list of accruals will be sent to all budgetholders for agreement.Children’s Community Health Services is reporting an under spend of £186k,compared to an under spend of £153k for month 01. Deferred income amounts to£163k and expenditure has been included in non pay for the whole amount inanticipation of plans being received. Plans for spending the deferred income aredue in by the end of July, once received budgets will be set accordingly. Thereare a number of staff vacancies being recruited to, some of which are currentlybeing filled by temporary staff, hence the under spend in this area of £186k.In Adults Services there is an under spend of £302k, compared to £146k formonth 01. This is a favourable movement of £156k.Support Services are reporting an over spend of £217k, compared to an overspend of £130k for month 01. This is due primarily to the Merlyn Vaz Health andSocial Care Centre. Whilst a value has been agreed with NHS LC, the budgetallocation was not completed for month 02, but may be finalised for month 03.Mrs Roseblade will clarify this at the next contracts meeting. Many of the healthcentre budgets were historically set on estimates, these budgets will be subject toa thorough review over the coming weeks.The Quality Directorate is reporting an under spend of £5k, compared to an overspend of £15k for month 01. This favourable variance of £20k is due to budgetsbeing transferred from the Fit for Purpose funding received in 2008/09.5

GOVERNANCEPaper YNHS Leicester City Board Meeting24 September 2009Headquarters is reporting an over spend of £206k, compared to an over spend of£92k for month 01. This includes 2 months of the £500k savings target allocatedto LCCHS for 2009/10.Human Resources is reporting an over spend of £12k, compared to £49k formonth 01. Managed Practices is reported in this area and is currently over spentby £58k, compared to £81k for month 01. With the assistance of the ServiceManager, Managed Practices budgets’ were reorganised for month 02.IT WAS RESOLVED:-- to note the year to date positionPS/09/83To Receive an Update Report on the Future of LCCHSPaul Miller updated the Board on progress to date:The exploration of the feasibility of LCCHS becoming a stand alone organisationhas largely focused on it becoming a social enterprise. However, NHS LeicesterCity did express an interest in Community Foundation Trust (CFT) status forLCCHS but this was not supported by the SHA. It has been reported previously tothe Board that although not published formally, the criteria for communityfoundation trusts indicate they will be significantly larger than LCCHS (in revenue,staff and geographical terms) and likely to cover two or more health communities.It is also worth noting that as yet there are no community foundation trusts inexistence and that none of the six pilot areas, which have been running for overtwo years, has achieved CFT status.In order to explore fully the feasibility of becoming a social enterprise organisation,three critical elements had to be in place before any consultation with staff:Reward packages for new starters; Members of the LCCHS seniormanagement team have been in regular contact with the Social Enterprise Unit atthe DoH and also met with the unit on two occasions. The unit has commissionedwork on reward packages for new starters and indicated the results would beavailable by the end of April 2009. The results are still awaited at the time ofwriting.Financial viability; LCCHS commissioned KPMG to conduct a financial viabilityexercise by taking the 2008/09 accounts and re-working them as a socialenterprise. KPMG were asked to identify additional costs incurred and savingsmade taking into account corporation tax, VAT, regulatory frameworks, overheadsetc. This exercise revealed a considerable input VAT liability in the region of 1.2 –1.5m, based on a 15% VAT rate. Therefore, a substantial part of any productivitygain generated by the social enterprise model would go to pay the VAT bill ratherthan for re-investment in health services.Service portfolio and length of contract; Outline discussions have taken placein respect of the LCCHS service portfolio and contract length. There is an inprinciple agreement on a contract of 3 – 5 years.6

Paper YNHS Leicester City Board Meeting24 September 2009The current position is that the Provider Services Separation Board hasconsidered the findings of the KPMG work on financial viability and begunconsideration of a comprehensive options appraisal of possible organisationalforms, taking into account the timescales for implementing DoH policy. Thisrequires PCTs as a minimum to achieve autonomous provider status by October2009.The options appraisal has been informed by the results of eleven briefing sessionsattended by over 800 LCCHS staff in June 2009. The options were explained tostaff, including the impact of VAT on the social enterprise option, and their viewssought. The outcome of these sessions is set out in the options appraisaldocument and advised to staff in the July LCCHS newsletter.The Provider Services Separation Board next meets on 16 July 2009 when it willfinalise its recommendations on the future of LCCHS for consideration by the NHSLeicester City Board at its meeting on 30 th July 2009. The outcome of thatmeeting will be reported to this Board.IT WAS RESOLVED:-- to note the reportPS/09/84To Receive an Update Report on the Audit ProgrammeNichola Douglas up-dated the Board on the audit programme for LCCHS in2009/10. The key audits to be undertaken, local leadership arrangements and thetimescales for completing the audits were described.The successful implementation of the audit programme is essential on a numberof grounds which were noted as follows:-- It provides vital assurance for the Provider Services Board, seniormanagers and practitioners that the organisation is delivering serviceswhich comply with legal requirements, national standards and theorganisation’s own policies.- It provides an evidence base for the scrutiny and validation of theorganisation’s performance by independent bodies such as the CareQuality Commission, NHSLA and Audit Commission.- It will enhance patient and public confidence in the servicesprovided by Leicester City Community Health Services (LCCHS).- It will provide LCCHS with a systematic basis for planning serviceimprovements year on year.LCCHS performance in implementing the Audit Plan will be closely monitored bythe Clinical Audit, Standards and Effectiveness sub-committee of the ClinicalGovernance Committee; and reports on progress, learning and priorities forimprovement will continue to be reported to that committee.The Audit Programme forms a part of the Quality Schedule agreed withcommissioners; and LCCHS progress will also be reported to the QualitySchedule Review Group on a regular basis throughout the year. It was agreedthat updates to the Board should be provided on a quarterly basis.7

Paper YNHS Leicester City Board Meeting24 September 2009Paul Miller thanked both Jacqueline Burden and Nichola Douglas for their hardwork and commitment to this and the excellent progress they had made so far.IT WAS RESOLVED:-- to approve the LCCHS Audit Programme for 2009/10PS/09/85 To Receive a Report on the Infection Control Programme for 2009/10Jacqueline Burden, LCCHS Infection Control Lead updated the Board about thearrangements for infection prevention control in Leicester City Community HealthService (LCCHS) in 2009/10. The programme of work and the audit plan wereexplained in detail to members of the Board.On April 1 2009 The Health and Social Care Act (2008): Code of Practice for theNHS on the prevention and control of healthcare associated infections came intoforce. The Code sets out how the Care Quality Commission assessescompliance with the requirements described in the Health and Social Care Act(2008) and provides guidance on how providers can meet the registrationrequirements relating to healthcare associated infections in the Act.As part of its development as an arms length provider of NHS Leicester City,LCCHS has introduced a number of significant changes to ensure a more robustsystem for the management of infection prevention and control; the Head ofQuality Assurance has become the infection control lead for LCCHS. Expertisein this area has also been bolstered by the appointment of infection controlmatrons in the adults and children’s services teams; an Infection Control SubCommittee of the Clinical Governance Committee was established in December2008 which will routinely monitor the organisation’s progress and report this tothe Clinical Governance Committee, the Provider Services Board and thecommissioner’s Quality Schedule Review Group.As the LCCHS lead for infection control the Head of Quality Assurance is requiredto report directly to the Provider Services Board at intervals agreed by the Board.It is proposed that the Board receives such reports on a quarterly basis during2009/10 and in addition when required on an exception basis. It was noted thatLCCHS has had no cases of MRSA or CDT this financial year.IT WAS RESOLVED:-- to note the internal and external drivers which require LCCHS to have itsown Infection Prevention and Control Programme and Annual InfectionPrevention and Control Programme of Audit- to approve the infection prevention control programme for 2009/10- to approve the annual infection and prevention programme of audit- to receive infection control reports on a quarterly basis during 2009/10 andmore frequently in exceptional circumstances8

Paper YNHS Leicester City Board Meeting24 September 2009- to recognise the Head of Quality Assurance as the LCCHS Lead forInfection Control, with the Associate Director of Quality and Developmentbeing the Executive LeadPS/09/86 To Receive the Incidents Report for 2008/09Jacqueline Burden provided an update on the incident reporting activity inLeicester City Community Health Service (LCCHS) in 2008/09. The major themesemerging and the key learning points for the organisation were discussed.Responsibility for managing incidents in the provider arm of the primary care trusttransferred in full to LCCHS on 1 May 2009; and this is the first annual incidentsreport that the Provider Services Board has received since the organisationbecame arms length in 2008. The incidents reporting systems established byNHS Leicester City is being utilised and it draws upon data generated by DATIXthe incidents reporting software package used by both the primary care trust andby LCCHS. It has been, on occasions, difficult to retrieve meaningful data due tothe way the system has been set up.The introduction of a new and updated version of DATIX to LCCHS will provide anopportunity for re-configuring the incidents reporting system to improve the qualityof coding and this in turn will enable the organisation to monitor and analyseincidents more effectively for the future.Incidents will continue to be reviewed by the Risk Management sub-committee ofLCCHS and regular reports on incidents levels and the associated learning will bereported to both the Clinical Governance Committee and the Quality ScheduleReview Group led by commissioners.IT WAS RESOLVED:-- to note the report- to receive incident reports on a quarterly basis during 2009/10PS/09/87To Receive a Report on Patient and Public InvolvementIn David Podbury’s absence, Nichola Douglas presented the Patient and PublicInvolvement Plan for Leicester City Community Health Service in 2009/10. Thereport set out the organisation’s commitment to delivering best practice in thisarea in the coming year.The plan will ensure that LCCHS:- Develops a systematic approach to patient and public involvement- Delivers best practice in line with national policy and guidance- Listens and acts upon the views of patients and the public in the planning,delivery and development of services- Engages with seldom heard (harder to reach) communities- Uses the patient experience to deliver service improvements9

Paper YNHS Leicester City Board Meeting24 September 2009A statement (pledge) which is intended to underline the organisation’scommitment to patient and public engagement is included in the plan and wasendorsed by the Board.SERVICE DELIVERYIT WAS RESOLVED:-- to note the work being undertaken in regard to patient & public involvement- to endorse the action plan- to consider and agree the content and publication of the document “Patientand Public Involvement Our Pledge”PS/09/88To Receive a Report on the Adult Community Nursing Services IntegrationProgramme – Update and Introduction to Phase IITeresa Smith updated the Board on the achievements of phase I of the adultcommunity nursing services integration programme and described the next stage,phase II of the project.Phase I concentrated on integrating mainstream community nursing services toprovide a more responsive provision matched to patient need across the twentyfour hour period. The background, project and outcomes were relayed to thegroup. All of the intended outputs were achieved, with the main examples being:-- Single Point of Access (SPA)- Three Localities- Extended Nursing Service- Development of a Rapid Intervention Team- Development of an Intravenous Antibiotic Service for Cellulitis- Implementation of System One- Customer Care TrainingPhase II will develop this project to integrate adult therapies (podiatry,occupational and physiotherapists) and specialist nursing (heart failure respiratorynurses and community matrons) provision within mainstream community servicesand align these with the new ways of working achieved in phase I.It is proposed that the project is developed with the same rigorous PRINCE IIapproach as Phase I; lasting 9 months. The project will incorporate and focus ongreater productivity and quality and will include an evaluation and review of thewhole combined integration programme. It will also take into account the recentlypublished DoH guidance on the community services quality framework, inparticular the individual clinical areas covered by adult services.Mrs Smith reported that there was still a lot of hard work to be done, andconfirmed that patients would see the benefits in improved continuity of care, inparticular for palliative care patients, patients with catheters and patients withblocked catheters.10

IT WAS RESOLVED:-Paper YNHS Leicester City Board Meeting24 September 2009- to note the achievements made with phase I of the adult community nursingintegration project and to support the progression of phase II of theprogrammePS/09/89To Receive a Report on the Use of Sensory Integration Approach withinChildren’s Community Health ServiceJanet Harrison outlined the current issues relating to the expectations of internaland external agencies regarding the provision of Occupational TherapyIntervention using a Sensory Integration approach. Mrs Harrison described theSensory Integration approach, a theory based on behaviours seen in somechildren with poor registration of sensory information that affects behaviour andmotor skills. Recent research suggests that there are gaps within the sensoryprocessing disorder for children. Careful assessment carried out by appropriatelytrained therapists is required in several settings, who can then find the problemand then use appropriate treatment through consultation in order to achieve apositive response by the child.Mrs Harrison highlighted the need to discuss the use of this approach withinCommunity Children’s Health Services (CCHS) which has become increasinglynecessary due to:- A significant increase in requests for Occupational Therapy to providereports and assessments to Special Educational Needs tribunals, in relationto sensory integration intervention being named on the statement of specialeducational needs. The amount of treatment suggested by CCHSOccupational Therapists and privately commissioned therapists has beendisputed, and challenged.- CCHS receives referrals from Occupational Therapy colleagues withinChild and Adolescent Mental Health Services (CAMHS) who haveundergone training courses and this includes a request for ‘sensory’interventions.- An increase in referrals from other professionals within CCHS who suspectsensory processing or sensory difficulties such as physical defensivenessare referred to Occupational Therapy for further assessment andassistance with diagnosis.The service currently provides a limited service provision based on the knowledgeand experience of Occupational Therapy Staff, and capacity within the service,and available facilities within Leicester and Leicestershire. It is becomingincreasingly necessary to assess where sensory integration is appropriate andprovide high quality service where this is indicated. In order to provide thisChildren’s Community Health Service require a highly trained workforce, effectivereferral and intervention pathways, and appropriate facilities in order to offer highlyspecialised intervention.Mr Paul Miller considered this a very interesting paper and agreed that appropriatefacilities would be ideal. Further consideration needs to be given to a specification11

Paper YNHS Leicester City Board Meeting24 September 2009for the space required. Routes in which to proceed with this request wereconsidered. Involvement of the capital team would be appropriate and Countyshould be made aware of this issue through the contracting process.Paul Miller advised that he is meeting with Rachel Dickinson, the newly appointedDirector of Children’s Services for Leicester City Council on 12 th August 2009 andwill discuss this issue.ACTION:Janet Harrison to provide brief regarding space/facilitiesrequired prior to 12 th August.IT WAS RESOLVED:- to note the increase in demand for Occupational Therapy to provideSensory Integration therapy as an intervention- to support the development of a business case for appropriate facilities toprovide 1:1 therapy within the city and countyPS/09/90To Receive the Annual Report (2008/09): Health Report for Children In CareFostering and AdoptionJanet Harrison presented the annual report which has been produced inpartnership with the three Local Authority Children and Young People Services.The commitment from both health and social care staff to improve localperformance around the uptake of heath assessments and dental checks forchildren in care was highlighted. The Board were advised that the report has beenshared with partner agencies for comments and review.IT WAS RESOLVED:MINUTES FOR NOTING- to note the reportPS/09/91Minutes of the Health and Safety, Fire and Security Committee Meetingheld on Tuesday 19 th May 2009Minutes of the Clinical Governance Committee Meeting held on 21 st May2009The above minutes were noted.DATE OF NEXT MEETINGPS/09/92 The date of the next Board Meeting will be Tuesday 25 th August 2009commencing at 1.45 pm in the Conference Room, St John’s House, EastStreet, Leicester.12

Paper ZNHS Leicester City Board Meeting24 September 2009EAST MIDLANDS SPECIALISED COMMISSIONING GROUPDRAFT MINUTES OF THE BOARD MEETINGFRIDAY 31 JULY 2009, 9:30-12:30CONFERENCE ROOM 1, LEICESTERSHIRE COUNTY & RUTLAND PCT, LEICESTERItem Discussion Action By WhomPRESENTIN ATTENDANCEMiss Catherine Griffiths, NHS LeicestershireCounty & Rutland (Chair)Mr Paul Carney, NHS Derbyshire CountyMr Andrew Rixom, NHS NottinghamMr John Tomlinson, NHS NottinghamshireCountyMrs Kath Murphy, EMSCGMs Sue Sims, NHS Derby CityMr Alan Burbank, Bassetlaw PCTMrs Kate Caston, EMSCGMr Paul Thefaut, EMSCGMs Cheryl Davenport, NHS LeicestershireCounty & RutlandDr David Black, NHS Derbyshire CountyMrs Gill Scoular, NHS NorthamptonshireMiss Vikki Taylor, NHS Leicester CityMr Andy Magee, NHS East MidlandsMs Dawn Atkinson, NHS East MidlandsMr Andrew Rix, NHS LincolnshireMr Dave Giffard, EMSCGAPOLOGIES FORABSENCEMr Martin McShane, NHS Lincolnshire (ViceChair)Dr Chris Kenny, NHS Nottinghamshire CountyMs Louise Newcombe, Bassetlaw PCTMr Peter Huskinson, NHS LeicestershireCounty & RutlandMs Avril Johns, NHS East MidlandsMr David Sharpe, NHS Derbyshire CountyMr Angus Maitland, NHS Derby City1

Paper ZNHS Leicester City Board Meeting24 September 2009Item Discussion Action By Whom1. ROUTINE BUSINESS1.2 REGISTER OFINTERESTS ANDDECLARATION OFINTERESTS1.3 MINUTES OFPREVIOUS MEETINGHELD ON 5.06.09There were no declarations of interestreceived.The minutes from the previous meeting held on6 June 2009 were agreed and accepted as acorrect record of proceedings.AccuracyAndy Magee to be added on to the attendancelist for the 6 June meeting.On the attendance list to remove “PCT” and toreplace with “NHS” all except Bassestlaw PCTThe Board acknowledged that the minutes fromthe 6 June 2009 meeting were improved intheir presentation and content.1.4 ACTIONS FROMTHE PREVIOUSMEETING HELD ON 5JUNE 2009All immediate actions were completed.1.5 MATTERS ARISING Risk RegisterThe Board were asked to receive the summaryreport of risks rated at 15 or above (red rated)along with the supporting information andaction plans. The total risk register for EMSCGidentifies 52 risks of which 10 are rated at 15 orabove. The main risks identified affecting allPCTs are; Swine Flu 18w-Differential waiting times Medium Secure Services Impact of HRG4 New NICE HCDsWithin the summary report it identified specificrisks for 5 PCT, controls and assurances havebeen put into place to begin to reduce the levelof risk.Gill Scoular agreed to provide a brief toEMSCG Finance Committee on the NUHposition.Cervical Cancer ScreeningThe Board agreed to defer any decision to theSeptember Board.Gill Scoular toprovide EMSCGFinanceCommittee with abriefA paper is to besubmitted to theSeptember BoardGill ScoularDavidSharpe2

Paper ZNHS Leicester City Board Meeting24 September 2009Item Discussion Action By Whom2. DIRECTORSREPORTAppointment of Lay MembersFollowing some discussion the Board agreed inprinciple to the appointment of lay memberssubject to a clear job description and job role.Kate Caston agreed to discuss the processwith the Appointment Commission and SCGcolleagues across the country. An update is tobe brought to the September Board.To discuss therecruiting processwith theAppointmentCommission andSCG colleaguesKateCastonNational Specialised Commissioning Team(NSCT)The NSCT are discussing the possibility ofmoving away from a straight capitation basedsystem to a split funding model which wouldbetter reflect actual utilisation. It is to bediscussed at the SCG Directors meeting inSeptember; Kate Caston agreed to keep theBoard informed.If there are anyfurtherdevelopments apaper is to besubmitted to theSeptember BoardKateCastonThe National specialised commissioning groupare planning to review the cost effectiveness ofenzyme replacement therapy, Malcolm Qualie;Head of Health Policy for EMSCG is to takepart in the review.Commercial Support UnitEMSCG have begun working with David Sykesto scope a specification for the work beingtaken forward.EMSCG may be able to access national moneyas it is expected that the NSCT are to refundover-charged allowances to PCTs. The Boardwere asked if they would support the moneybeing used to pump prime this process.The Board agreed in principle to using thefunds to support the CSU development subjectto a business case being produced for theSeptember Board. The Board requested thatthe paper identifies what the benefits would be,as well as outlining the process.A paper is to besubmitted to theSeptember Boarddetailing theprocess andbenefitsPaulThefautSustainabilityThe Board gave their support for a consistentand joined up response.The Board were asked to forward to KateCaston the details of their Productivity LeadKate Caston tabled a draft letter to be sent toProvider Chief Executives highlighting theincremental impact of Market Forces Factor onTo forward detailsof the ProductivityLeads within thePCTsBoardmembers3

Paper ZNHS Leicester City Board Meeting24 September 2009Item Discussion Action By Whomspecialised costs. The Board were asked tocontact Kate Caston outside of the meeting tosay if they were happy with the content of theletter prior to it being sent out.To contact KateCaston outside ofthe meeting.BoardMembers3. CORPORATE ISSUES3.1 STRATEGICPARTNERSHIPSThe Board gave their approval for a formalapproach to be made to the identified providersand supported the pilot work sponsored by theNHS Institute for Innovation and Improvement.A letter is to be sent out to both the providersand PCT Chief Executives requesting theestablishment of a process to take forward.A letter is to besent out to boththe provider andPCT Chiefexecutives.KathMurphy3.2 PUBLIC HEALTHFUNCTIONThe Board agreed to the proposed structurebeing taking forward and the establishment ofthe steering group to ensure the function is fullydeveloped and its impact evaluated.The piece of work will test whether adisseminated approach involving collaborationacross all 9 East Midlands PCTs can providethis function rather than directly employingisolated public health physicians. The projectwill run for 11 months, an individual has beenidentified to lead the project. Discussions havetaken place with Directors of Public Healthacross the East Midlands and it has beenagreed that 4 of the Director’s of Public Healthwill form a steering group to over see thedevelopment of the clinical advisory function.A letter was sent out to PCTs asking them toidentify a sessional commitment or financialsupport to EMSCG. Board members wereasked to provide the information if not alreadydone so.To providesessions orfinancial supportBoardMembers3.3 CLINICALENGAGEMENTSTRATEGYThe Board gave their support on the proposedapproach to clinical engagement as set outwithin the submitted Clinical engagementstrategy.The Clinical engagement strategy submittedbuilds on existing structures and sets out howthe EMSCG will lead continuous andmeaningful engagement with clinicians acrossthe East Midlands.The Board agreed to Andy Magee, NHS EastMidlands providing contact information on thealready established Regional ClinicalTo provideinformation on thealreadyestablishedRegional ClinicalReferenceGroups.AndyMagee4

Paper ZNHS Leicester City Board Meeting24 September 2009Item Discussion Action By WhomReference Groups to sit as an appendix to theclinical engagement strategy.3.4 NICE GUIDANCE The report provided the Board with an updateon developments in NICE Guidance relevant tospecialised services.The Board welcomed the report and liked therating system used for highlighting theimportance and impact on EMSCG.The Board agreed to receive a report at eachmeeting. The Board requested that a paper sitas a supplement showing the relevant spend.A report to besubmitted to eachBoard along witha supportingpaper showingthe relevantspend.MalcolmQualie3.5 RESPONSE TONICE GUIDANCEThe paper presented to the Board provided anoptions table with arguments for and againstsuggested alternatives for fundingimplementation of NICE recommendations.The Board accepted the suggested process fortaking forward an East Midlands approach toimplementing NICE Guidance across theregion, with the understanding that a legal viewwould be sought.The Board requested a paper for theSeptember Board that identified the process foreach “TAG” and defines what the processwould be if a “ninety day rule” was applied.4. OPERATIONAL PERFORMANCE4.1 PERFORMANCE The report provided a summary on theREPORT – PROVIDER performance of EMSCG providers for theREPORTperiod May 2009.Within the report a “heat map” was presentedwhich identified the overall performance ofEMSCG providers. Any issues within the heatmap have been raised directly withcommissioners as well as through theestablished mechanisms. The Board requestedthat a brief definition on the “heat map” beincluded within the report.The Board received the paper acknowledgingthat the process is still developing andA legal view is tobe soughtPaper for theSeptember Boarddefining theprocess for each“TAG” and toinclude how theinformation is tobe disseminatedacross the EastMidlandsA definition to beincluded into thepaper defining the“Heat Map”MalcolmQualieMalcolmQualiePaulThefaut5

Paper ZNHS Leicester City Board Meeting24 September 2009Item Discussion Action By Whomwelcomed the evidence.4.2 PERFORMANCEREPORT- FINANCIALREPORTThe report provided a summary on the keyprovider and financial issues for the period toMonth 2. EMSCG’s position at the end ofMonth 2 is £1.11 million over plan with apotential over performance of £10 million for2009/10 if the first 2 months are representative.EMSCG are in the process of ensuring thatoutstanding contract issues are resolved withclear mitigation plans in place to ensuredelivery of targets.4.3 PRODUCTIVITYAND EFFICIENCYThe Board accepted the paper and requestedthat the Finance Committee subgroup submit apaper identifying the concerns and action plansfor the September Board meeting.The paper presented to the Board identified astructure and process to develop and deliverproductivity and efficiency programmes toensure ongoing sustainability and delivery ofsavings for the East Midlands PCTs.A productivity and efficiency formal sub groupof the Board is to be established. Vikki Taylorand Paul Carney volunteered to join the group.The Board acknowledged that the paper iswork in progress and requested an update atthe September Board.4.4 FLU PLANS The Board noted EMSCG’s plans and progressin respect of pandemic influenza.A paper to besubmitted to theSeptember Boardmeetingidentifying theconcerns andaction plansDates of meetingsof the group alongwith terms ofreference to becirculatedAn update is to bepresented at theSeptember BoardPaulThefautPaulThefautPaulThefaut5. GOVERNANCE5.1 BOARD PLANNINGCALENDARThe Board requested that Kate Caston contactPhil DSilva, NHS East Midlands and SueShepherd, EMAS to request a copy of theinformation submitted to them from both PCTsand providers across the East Midlands.In line with the recommendations from therecent review of EMSCG a time table waspresented. The Board requested that wherepossible the timetable could highlight what theintention is of EMSCG to the Board.The Board approved the timetable and askedTo contact NHSEast Midlandsand EMAS torequest a copy ofthe informationsubmittedTo highlightwhere possiblewhat the issue/request will be forthe Board toKateCastonSerinaKorol6

Paper ZNHS Leicester City Board Meeting24 September 2009Item Discussion Action By Whomthat it be updated and submitted quarterly.Board members agreed to share the time tablewith their PEC Boards and to discuss locally.consider.5.2 QUALITYFRAMEWORKThe Board received the quality framework andagreed that it was a significant step forward inensuring the quality of all specialised servicesfor the East Midlands. The purpose of thequality framework is to ensure there areappropriate internal and external governancearrangements in place. The challenge forEMSCG is to ensure both provider and PCTinformation is shared with EMSCG on a regularbasis and that the information is collected atindividual specialised service level.The quality framework was circulated to Boardmembers prior to the meeting for comment; theBoard were asked to provide comments if notdone so already.The Board agreed that pending all commentsthe sign off would take place out side of themeeting.Kate Caston agreed to discuss the work beingtaken forward by EMSCG with Dame CatherineElecoat, Chair of the Directors of Quality, NHSEast Midlands.Board memberswere asked tosubmit commentson the QualityFrameworkKate Caston tocontact DameCatherine ElecoatBoardMembersKateCaston5.3 IMPLEMENTATIONOF AN EASTMIDLANDS IFR POLICYThe Board signed off the policy in June 2009PCTs have been asked to share their “go live”date. The policy is to go through both a clinicaland contract pathway within the PCTs.The purpose of the report presented to theBoard outlined the key steps required for theimplementation of the IFR policy.The Board gave their approval for thedevelopment of a regional induction trainingprogramme and gave their support as aconcept to the feasibility of a central web baseddatabase for regional monitoring and audit ofthe IFR policy.The Board agreed to the development of aregional communication strategy to be led bythe PCT Directors of Communication withsupport provided by EMSCG. Kate Castonagreed to discuss the process with SteveO’Neil, NHS East Midlands.To discuss theprocess for PCTDirectors ofCommunicationtaking thisforward.KateCaston7

Paper ZNHS Leicester City Board Meeting24 September 2009Item Discussion Action By WhomThe Board formally thanked Tim Daniel and theClinical Priorities Advisory Group for the hugeamount of work that had taken place leading toan East Midlands IFR policy.5.4 EAST MIDLANDSSCREENINGADVISORY GROUP6. NSR UPDATES6.1 SERVICES FORCHILDRENThe Board approved the terms of reference forthe East Midlands Screening Advisory Group.The paper provided an update on the projectsbeing taken forward within specialisedchildren’s services.Neonatal Intensive Care stand alonetransport systemThe project is proceeding according to theschedule along with workforce skill mix beingdiscussed. A detailed project plan is to bepresented to the September Board foragreement. The Board agreed to receive theproject plan for comment prior to theSeptember Board.Children’s Cancer servicesThe Leicestershire Overview and ScrutinyCommittee felt that there is no need to gothrough a formal public consultation on the newmodel.Paediatric SurgeryEMSCG has commissioned a baseline analysisof trends in surgery on children across theregion. A draft project plan is to be presentedto the September Board.A detailed projectplan to besubmitted to theSeptember BoardA draft projectplan is to bepresented to theSeptember Board.Julia GraceJulia Grace6.2 MENTAL HEALTHSERVICESThe Board received the update.The report submitted provided an update onthe work streams being taken forward.Steering groups have been established foreach of the NSR mental Health work streamsalong with clear terms of reference.Discussions are being held regarding PCTinvolvement in the work streams.The Board received the paper.7. SERVICE UPDATE7.1 MORBID OBESITY A paper submitted to the Board proposed aninterim provider solution for bariatric surgery inthe East Midlands.8

Paper ZNHS Leicester City Board Meeting24 September 2009Item Discussion Action By WhomThe Board supported the Clinical PrioritiesAdvisory Group’s recommendation that gastricband surgery referrals are to be made to DerbyFoundation Trust instead of Leeds Nuffield onan interim basis.The Board agreed to receive outside themeeting a copy of the McKinsey deep divereport on Morbid Obesity.The Board agreed to receive a market analysisreport at the September Board8. POLICIES FOR RATIFICATION8.1 HIPThe Board gave their support for the interimARTHROSCOPY recommendations to support the decisionmaking process for Hip Arthroscopy and for thedevelopment of a regional policy.The Board asked that on page 4 under section1. Position, last paragraph, “on this basisEMSCG would not routinely support hiparthroscopy”, the Board agreed to delete“routinely”.The Board agreed that it would be useful tohave a clause in place within the contracts.A Market analysisreport to besubmitted to theSeptember BoardThe statement tobe changed toreflect the view ofthe BoardDaveGiffardJonCurrington8.2 COSMETICSURGERYThe report submitted provided the Boardinformation on the progress to date indeveloping a single regional adult cosmeticsurgery policy.The Board supported the proposal to delegateresponsibility to the Clinical Priorities AdvisoryGroup (CPAG) a formal sub group of the Boardin order that a majority voting process can beused to resolve the remaining issues that arepreventing the completion of the policy.8.3HYDROXYCARBAMIDEThe paper submitted to the Board highlighted apotential cost implication for the East Midlands.The paper was discussed at CPAG in Junewhere it was agreed that EMSCG should notendorse the use of the new product given thecost implications. EMSCG have received legaladvice.Kate Caston agreed to submit a paper to theEast Midlands Management Board (EMMBo)meeting regarding the potential cost implicationfor the East Midlands.Kate Caston issubmit a paper toEMMBoKateCaston9

Paper ZNHS Leicester City Board Meeting24 September 2009Item Discussion Action By WhomThe Board approved the policy9. FURTHER MATTERS TO NOTE9.1 POLICIES FORCONSULTATION ONWEBSITE –GENDER DYSPHORIA9.2 CONTRACTAWARD APPRAISALGUIDANCEThe policy is currently out to public consultationthe policy is to be presented at the SeptemberBoard meeting.The Board supported EMSCG inviting DavidLock to attend the September Board to provideclear legal advice on the policy.The Board agreed for the policy to bediscussed early on the agenda in September.The information received regarding the contractaward for technology appraisal guidance (TAG)support to all PCTs received from NHSBirmingham East and North is to be circulatedto Board members for information.Policy to bepresented at theSeptember BoardDavid Lock to beinvited to attendthe SeptemberBoard.To be early on theagenda.Information to becirculated toBoard MembersMalcolmQualieMalcolmQualieSerinaKorolSerinaKorol9.3 CLINICALPRIORITIES ADVISORYGROUP (CPAG)Andrew Rixom agreed to be put forward to siton the TAG Board. Kate Caston agreed todiscuss with Andrew outside of the meeting.The Board received the minutes from theCPAG meeting held on 26 June 2009.To discuss withAndrew Rixomoutside of themeetingKateCaston10