Agenda and minutes

Apologies for absence were received from Chief Supt Sally Healy (Head of Local Policing Directorate, Leicestershire Police), ), Andy Keeling, Chief Operating Officer, Leicester City Council, Dr Avi Prasad (Co-Chair, Leicester City Clinical Commissioning Group), Councillor Sarah Russell (Assistant City Mayor, Trish Thompson, Locality Director Central NHS England – Midlands & East (Central Midlands).

Members are asked to declare any interests they may have in the business to be discussed at the meeting.

Members were asked to declare any interests they might have in the business to be discussed at the meeting.  No such declarations were made.

The Minutes of the previous meeting of the Board held on 27 October 2015 are attached and the Board is asked to confirm them as a correct record.

RESOLVED:

That the Minutes of the previous meeting of the Board held on 27 October 2015 be confirmed as a correct record subject to Councillor Adam Clarke, Assistant City Mayor being added to the list of those present.   

The Chair to invite questions from members of the public.

There were no questions submitted by members of the public.

To receive a presentation from Kate Shields, Director of Strategy, University Hospitals of Leicester NHS Trust (UHL) on the Trust’s strategic priorities and current challenges.

Kate Shields, Director of Strategy, University Hospitals of Leicester NHS Trust (UHL) gave a presentation on the Trust’s strategic priorities and current challenges.  A copy of the presentation had been previously circulated with the agenda for the meeting.

During the presentation the following comments were noted in relation to the Trust’s plans for the future and the challenges being faced in the current economic climate:-

a)         UHL was the last large acute NHS Trust operating from 3 sites which needed to be addressed as part of the Trusts’ 5 Year Operational Plan, the vision for which was set out in the presentation.

b)         The Trust was a local, regional and national provider of health care services and a third of the Trust’s income came from providing tertiary specialist services.  The Trust was working hard to ensure that hospitals referring patients to the LRI were fully supported so that the Trust could concentrate on providing the specialist tertiary services.

c)         The Trust had made positive changes in a short time to change ‘behavioural issues’ in both staff and patients to drive forward the changes required. The Trust’s beliefs and values fully underpinned the work to support behavioural change.

d)         The Trust’s Quality Commitment was refreshed each year.  Currently the strategic aims were to reduce preventable mortality, to reduce the risk of        error and adverse incidents and to improve patients’ and their carers’ experience of care.

e)         The Life Study funding had recently been withdrawn.

f)          The Estates Reconfiguration Plan would look to reduce inefficiencies of the use of sites over the next 5 years.  The Trust were committing £320m of investment over the next 5 years to provide the Emergency Floor and reconfigure the estate to allow vascular services to move from the LRI to the Glenfield site, and to provide a better co-ordinated approach to general surgery to reduce the number of planned operations being cancelled due to emergency operations.  Also, the Children’s Hospital must be established at the LRI site by 2020 if the Trust was to retain children’s congenital heart surgery.

g)         The Trust had received £10m capital funding for the Emergency Floor this year which was to be welcomed.  However there were increasing pressures on the capital funding nationally as it had been cut by 25% to fund revenue deficits in the NHS.

h)        The Trust’s current budget deficit was reducing and the Trust was confident that it would reduce in future years in accordance with the Trust’s financial plan.  The Trust still spent too much on agency and locum staff and efforts were being directed to making ‘bank nursing’ more attractive to staff in order to reduce the reliance on more expensive agency staff. The Electric Patient Record, when fully introduced, could be the biggest change to improving efficiencies within the hospital; as it would allow the full patient history to be available from primary care records and would enable faster decision making, better care and avoid duplication of recording patients’ details.

Following questions from Members  ...  view the full minutes text for item 30.

To receive a report on the Better Care Fund from Sue Lock, Managing Director, Leicester City Clinical Commissioning Group.

The Board are requested to approve the draft BCF 16/17 template for submission on February 8^th 2016 and to delegate approval of draft narrative plans to the Chair of the JICB and the Strategic Director for Adult Social Care for submission on February 8^th 2016.

The Board received a report on the Better Care Fund (BCF) from Sue Lock, Managing Director, Leicester City Clinical Commissioning Group.

The Board were requested to approve the draft BCF 2016/17 template for submission on February 8th 2016 and to delegate approval of draft narrative plans to the Chair of the JICB and the Strategic Director for Adult Social Care also for submission on February 8th 2016.

It was noted that the format of the template was not an ideal way of presenting the information but it was a prescribed national format.  The template required approval each year as it was a joint plan.  The submission was in two parts, one is the template currently being considered and the second part is a narrative plan which sets out how the joint partners will achieve the trajectories.  This could not been completed until national guidance had been received.

Part 1 of the template showed Better Care Fund expenditure of approximately £22m and represented, at service line level, what the CCG and the Council believed would be the most effective way to integrate services aimed at preventing emergency admissions.  This was based upon the successes of the previous year with an element of expansion in some of those.

There was a high level classification of whether elements were Integrated Care Teams, Support for Carers or Reablement Services etc. with expected expenditure against each one.  There was approximately £190k of recurrent expenditure that would be re-prioritised through the year.  In addition there was a £1m none recurrent carry forward and proposals had been invited for this.

In response to a question on the £1.9m expenditure on the Performance Fund, it was noted that this was an amount of the fund that was payable based upon the performance to reduce none elective emergency admissions.  It was a retrospective payment at the year end.  If the performance did not achieve the intended reductions, the payment went to the acute trust.  If the performance was achieved and the reduced admissions targets were achieved; then the payment was paid into the Better Care Fund in the following year.

It was noted that in putting forward the current proposals, horizon scanning had been carried out to evaluate what had been carried out elsewhere in the country.  Experience of local and national events showed evidence that local practice was effective and robust and this had been mirrored in feedback at national level.  Furthermore, the City’s BCF had been cited as an example of good practice to other bodies including a presentation at the House of Lords.

The Director of Public Health commented that the risk stratification work undertaken for the BCF had potential to be used to great effect outside of the BCF context to consider the benefits that could be achieved through limited resources in preventative initiatives.

The East Midlands Better Care Fund Implementation Manager, NHS England, commented that the City’s BCF was considerably further advanced with its financial information than other Health and Wellbeing Board  ...  view the full minutes text for item 31.

To receive and note the NHS publication ‘Delivering the Forward View: NHS planning guidance 2016/17 – 20120/21 that will have implications for the work of the Board.  Sue Lock, Managing Director, Leicester City Clinical Commissioning Group will introduce the guidance.  

The Board received and noted the NHS publication ‘Delivering the Forward View: NHS planning guidance 2016/17 – 20120/21 that would have implications for the work of the Board.  Sue Lock, Managing Director, Leicester City Clinical Commissioning Group introduced the key elements of the guidance. 

The guidance supported the Government’s NHS Spending Review in England in implementing the 5 year forward view, addressing financial sustainability and increasing the quality of service delivery.

The planning guidance required the production of a local one year Operational Plan to identify what would be done to meet the statutory guidance targets and constitutional standards and how the improved standards would be achieved.

The guidance also required the production of a Sustainability and Transformation Plan (STP) for 2016-2021 written as an overarching place based plan for the local population in relation to the health and social care economy as a whole.  The Plan is required to be submitted by June 2016 and would be formally assessed in July.  It had been agreed that the placed based element would cover the Leicester Leicestershire and Rutland footprint.   In essence, the plan was similar to the Better Care Together but with additional strands covering specialised services, primary care services and a prevention plan element to the STP.

It was very different to the pre consultation business case developed for the

Better Care Together Plan, although the identification of best practice and the relationships formed across the health and social care community for BCT had all helped to put LLR on a good footing for preparing the STP.

It was noted that:-

a)         The funding in 2017/18 would be dependent upon the quality of the STP and the clarity of defining what will be done in the future and this would influence how quickly funds could be accessed.  Further details were awaited on this process.

b)         The Operational Plan had a requirement for 9 ‘must dos’ for 2016/17 and would need to show in detail how the activity and finance would work together to achieve the objectives. 

c)         The CCG had received definite allocations for the next 3 years and indicative allocations for the following 2 years.  Although there was an uplift in allocations received, this did not represent any additional purchasing power in real terms as the cost of purchasing services had also risen.  The CCG had received approximately £12m extra funding but to standstill and buy the same activity would cost approximately £11.8m.

d)         All CCG’s were being encouraged to create stability within providers and £1.8b nationally had been allocated to provide flexibility to providers and to allow the CCGs to work with providers to get some transformation for the following year.   The challenge was to reduce deficit, improve access and progress the transformation. 

e)         The CCG had met with the Chief Executives of UH, and LPT to see what the challenges were for the future, what the improvement trajectories would look like and how to take the process forward within the financial settlements  ...  view the full minutes text for item 32.

To receive a report from the Lead Commissioner – Mental Health & Learning Disabilities on a Mental Health Joint Commissioning Strategy developed by Leicester City Council and the Leicester City Clinical Commissioning Group; which outlines the commissioning intentions for the period 2015-2019.

The strategy has been developed in full consultation with stakeholders, including people with mental health problems and carers of people experiencing poor mental health.

The Board is requested to endorse the Mental Health Joint Commissioning Strategy as part of the sign off process prior to publication.

The Board received a report from the Lead Commissioner – Mental Health & Learning Disabilities on a Mental Health Joint Commissioning Strategy developed by Leicester City Council and the Leicester City Clinical Commissioning Group; which outlined the commissioning intentions for the period 2015-2019.

The strategy has been developed in full consultation with stakeholders, including people with mental health problems and carers of people experiencing poor mental health.

The Board were requested to endorse the Mental Health Joint Commissioning Strategy as part of the sign off process prior to publication.

It was noted that:-

a)         The strategy had been developed in consultation with stakeholders, including people with mental health problems and carers of people experiencing poor mental health.

b)         The strategy was focused on prevention and early help for individuals to avoid them reaching crisis point before engaging with services. The strategy also aimed to build capacity in the community. 

c)         A dashboard had been developed to measure the strategy’s impact on individuals and carers over the life span of the strategy.

d)         The Mental Health Partnership Board would oversee the 2 year delivery plan for the strategy.

e)         The strategy would also be reviewed and updated on an annual basis to take account of changing circumstances or guidance.

Members of the Board commented that:

a)         There were a range of mechanisms within Children’s and Young Peoples Services which should be used to seek the views of children and young people.

b)         The work of Adult Education Centre in providing courses, qualifications and achievements had been shown to have positive benefits for peoples’ mental health and this should be recognised in the strategy.

c)         There was evidence that employers and the Department of Works and Pensions appeared to lack confidence in engaging people with learning difficulties.

d)         That the strategy should deliver real improvements and changes to service users.

The Chair commented that he had held discussions with the Chair of the Leicester and Leicestershire Enterprise Partnership to encourage employers, as part of their initiatives, to support people with mental health and learning difficulties through employment opportunities.  He was also looking at supporting people in the community through the work of the Adult Social Care services provided by the Council.

RESOLVED:

1)         That the Mental Health Joint Commissioning Strategy be endorsed.

2)         That the Mental Health Partnership Board monitors the implementation and performance of the strategy and notifies the Board of any issues which they feel should be brought to its attention.  These issues could be either concerns or items of positive feedback and outcomes.

To receive an update.

The Chair requested an update following the concerns that had been expressed around the two recent closures of GP practices at Marples Surgery and Queens Road Surgery.

Professor Farooqi commented that both practices had been single GP practices and both GPs had submitted their notices to resign from their contracts.  Once it became clear to the CCG that the Marples Surgery premises would not be available for future use as a surgery; the only option available was to disperse patients to other GP practices in the area.  The decision of the GP to resign from his contract at the Queens Road Surgery was unexpected and the patients registered at that practice came from all parts of the City and the county.  There were approximately 2,000 patients involved and these were being dispersed amongst other GP practices within the City.

It was generally acknowledged that there were significant pressures on GP practices; particularly as recent changes in the national funding formula had resulted in practices in the City receiving less funding.  The CCG were working collaboratively with practices in the City to promote forming federations and offering ‘golden hello schemes’ in an attempt to address issues of recruitment and retention.

It was suggested that a 6 month period of notice would be useful to allow more time to make alternative arrangements for patients affected by the closure of a practice.  In response, Professor Farooqi stated that the CCG contract with GPs had a 6 month period of notice.  However, GPs general contracts were negotiated nationally and were subject to a 3 month notice period and could not be changed without further national negotiation and agreement.  However, the CCG would be prepared to explore whether a voluntary agreement could be negotiated locally with single handed GP practices in order to help future planning of services to patients.  This would enable more time to consider alternative options for the continued care of patients, especially in instances where there was a cumulative effect arising from more than one practice closing in the same area of the City within a short time span.

A further suggestion was made to undertake a survey/audit of GP practices to identify any plans to assist future planning provision for GP services; particularly if this was conducted on an annual or biannual basis.  It was also noted that the number of single handed GP practices in the City was gradually diminishing through the promotion of initiatives such as co-operation and federation working.

The Chair of the Council’s Health and Wellbeing Scrutiny Commission stated that the Commission was currently undertaking a Task Group Review of Primary Care Workforce Planning which included both GP and practice nurses recruitment and retention.

RESOLVED:

1)         That the update be noted.

2)         That the CCG’s willingness to explore a voluntary local extension to single handed GPs giving more than the national 3 months’ notice period to resign be welcomed.

3)         That the suggestion to undertake an general audit/survey of GPs to better inform future planning provision  ...  view the full minutes text for item 34.

There were no items to be considered.

The Chair declared the meeting closed at 3.50pm.