Agenda and minutes

To note any apologies submitted from Members of the Board.

There were no apologies for absence on this occasion.

Board Members to declare any interests which they have in any of the items to be considered as part of the agenda.

Doctor Johnson declared an interest in Item 9 – Multi Speciality Community Provider Update, the nature of the interest being that as a General Practitioner (GP) operating as a Provider in Stockport he had an interest in the developing Multi-Speciality Community Provider and his practice was holder of the contract for intermediate tier care services as referred to in the agenda pack. He also noted that he had been appointed by Viaduct, the federation representing GPs in Stockport as the Lead for his Neighbourhood.

To approve the minutes of the meeting held on 7 September 2016 as a correct record.

The minutes of the meeting held on 7 September 2016 were agreed as a correct record.

To consider and respond to any questions submitted by Members of the Public related to the remit of the Health and Care Integrated Commissioning Board no later than 24 hours prior to the meeting. Questions should be submitted in writing to laura.latham1@nhs.net

*Any questions requiring detailed response will be shared with the Board and responded to following the meeting in writing.

There were none on this occasion.

To receive an update report of the Director of Integrated Commissioning covering the following areas:

•      Multi-Speciality Community Provider Organisational Form

•      Outcomes Framework

•      Progress of Integrated Commissioning

•      Emergency Department Performance

•      Out of Hours Procurement

G Mullins, Director of Integrated Commissioning provided an overview of key activity undertaken within the area of integrated commissioning. She acknowledged the engagement work being undertaken by Providers in developing the proposed preferred option for the Multi-Speciality Community Provider (MCP) organisational form and explained that it would be considered by Commissioners as part of the procurement.

*R Gill joins the meeting.

The Board considered progress in developing the Outcomes Framework and in particular the development of the clinical and person-centred outcome measures which would be included as part of the contracting approach for the MCP. M Chidgey described the engagement approach underpinning the work which included clinicians, care professionals and patients and the support being provided to Stockport by specialists with expertise in commissioning for outcomes. At a recent meeting with NHS England and wider stakeholders he noted that the work to date had been positively received.

G Mullins noted that work was underway in developing the future of integrated commissioning and that a number of joint working initiatives around managing system quality and Delayed Transfers of Care (DTOC) had already proved successful. She noted that the priority areas of focus at the current time were finalising the design and subsequent development and implementation of new models of care and developing a new contractual form to support and incentivise the required transformation across the Stockport health and care system.

Members of the Board considered the current performance against the national NHS 4 Hour Waiting Time Standards for the Emergency Department. G Mullins explained that a single fully agreed Urgent Care Improvement Plan had been implemented and monitoring progress was undertaken at weekly meetings Chaired by NHS England and including the CCG, Stockport Foundation Trust, Stockport Council and NHS Improvement. She highlighted a range of initiatives underway to address the known performance issues, including process improvements and a range of new services including winter specific schemes, intermediate care developments and introduction of a 7 day assessment service. She noted that schemes had started to impact positively but noted the continued focus on embedding change. Stockport was noted to be currently supported by the national Emergency Care Improvement Programme (ECIP) and a diagnostic report was due to be received.

G Mullins requested that the recommendation regarding the Out Of Hours Procurement be amended for the Board to note the decision of the CCG’s Governing Body in order to ensure compliance with the Section 75 agreement in place.

In response to questions, the following elements were clarified:

·         The ECIP support would pick up recommendations and suggested improvement techniques around system flow, assessment and discharge in order to maintain the continued focus on DTOCs.

·         Weekend assessment had continued to be in place from early November 2016 and would be reviewed in light of the ECIP diagnostic.

·         Managing the care home market remained a high priority and joint work to date had proved to have a range of positive impacts.

·         Capacity planning and an agreed plan to manage the festive period and number of Bank Holidays had been submitted to NHS England.

·         G Mullins agreed to confirm whether the discharge ward established as part of the Emergency Department Improvement Plan would remain open over the Festive period.

·         The co-production nature of the Outcomes Framework was confirmed and in particular the requirement to continue to develop the communications strategy underpinning the work to ensure the transformation and behaviour change across all partner organisations and staff was embedded.

·         Public involvement and engagement mechanisms for the whole Stockport Together Programme were highlighted.

Resolved: That the Board:

·         Note the content of the report and the decision of the Governing Body to waive the requirement to undertake a formal procurement process for the Out of Hours Contract.

To consider a report detailing the finances of the Pooled Budget and the related performance indicators and measures.

M Chidgey, Chief Finance Officer provided an overview of the content integrated performance report. He highlighted the performance and improvement elements of the report and the financial management of the pooled budget, including the current £4.1m overspend. He noted that the nature of the funds pooled relating to the over 65 cohort provided greatest opportunity for transformation but this had to be balanced with the level of risk. It was anticipated that newly implemented schemes would impact positively on financial balance but time to embed would be required. Pressures in the Learning Disability Service were also noting to be impacting on the pooled funds in addition to those community / out of hospital and the acute sector. M Cullen, Borough Treasurer confirmed that re-alignment of Council monies in the pool against different points of delivery were for accounting purposes and did not represent reduced funding to service areas.

In response to questions raised, the following areas were clarified:

·         Stockport does benchmark well compared to other Greater Manchester areas for the numbers of social workers based within the acute hospital setting.

·         All Cause All Age Mortality data had been analysed and the Public Health Team had advised that the period between 2008 – 2011 should be treated as abnormally low and treated as an exception. Therefore the trajectory had been steadily decreasing.

·         A continued priority area for joint commissioners was the mortality rates of those with mental illness.

·         Future financial modelling would include a trajectory to reduce deficits in acute spend but this had to be considered from the point of referral onwards and initiatives such as Consultant Connect to enable advice to be easily provided between General Practitioners and Acute Consultants had impacted positively. The NHS Constitutional Standard related to 18 week access to elective surgery was noted to be an integral part of effective system resource and capacity management.

·         The importance of ensuring public understanding and behaviour change was noted to be integral to managing the future sustainability of the health and care system in Stockport. Communicating the case for change and the impact of not changing was noted to be a key message.

·         The importance of the role of the board in leading the system and the redistribution of existing resources to focus on the areas of primary care, community services and mental was acknowledged.

·         Transformation Fund monies were noted to be available to support the transformation in Stockport and in particular periods of transition where double running of existing services was required.

·         The role of the whole workforce in Stockport was noted to be key to transforming the system, including leadership at all levels and the requirement to think innovatively about the future model of care.

Resolved: That the Board:

1.    Note the content and issues raised in the Executive Summary

2.    Approve the increase to the value of the Pool (SMBC contribution of £0.023m

3.    Note the financial position at Q2 deficit of £4.1m