NHS BRADFORD AND AIREDALE
                     MONDAY 21 SEPTEMBER 2009

Present:                        Chris Turner           Chair, Non Executive Director
                                Peter Dickson          Medical Director
                                Pam Essler             Non Executive Director
                                Steve Ingleson         Director of Performance Management
                                Rhys North             Director of Finance
                                Matt Neligan           Director of Strategy

In attendance:                  Lucy Atkin             Note taker
                                Pat Featherstone       For item 4

Apologies:                      Shafiq Ahmed           Non Executive Director


           The minutes of the meeting held on 24 August 2009 were agreed as an accurate

09/66 Update on Continuing Care

           Pat Featherstone advised the main cause for the increased continuing care spend is
           the number of patients eligible having risen - another significant factor being the
           absence of a pricing structure concerning care/nursing home charges. Pat outlined
           the short term and long term recommendations and highlighted the risks.

   (i)        Short term – Care homes asking for more than local authority rate will be asked
              to demonstrate care over and above that rate. The local authority contract lead
              has agreed to monitor costs of continuing health care packages and challenge
              providers where rates are far higher than the local authority rate.

   (ii)       Long term – Establish a fixed price for all care home beds and domiciliary care
              provision, and only in exceptional cases would the PCT pay extra. This fixed
              price would include a quality premium payment ensuring there was clarity for
              care homes and domiciliary care providers concerning expected quality

   (iii)      Setting a fixed pricing structure for older people and end of life patients in care
              homes could release a potential reduction in cost of £750,000 per annum. This is
              based on reducing the average cost of a bed from £656 to £600 for a total of 300
              patients which is the current number of older people and end of life patients
              receiving CHC.

   (iv)       Risks - The potential risk is that there could be adverse media attention if it was
              viewed that NHS Bradford and Airedale was cutting costs for older people’s care.

   (v)        The Committee supported both the short and long term recommendations around
              procuring packages of care for continuing healthcare patients. The report is to
              be developed to include findings from Leeds who have undergone a similar
              exercise and to be expanded to look at a standardised pricing structure for the
              whole of continuing care. The communication team should also be involved from
              the beginning of the process to manage media attention. Chris Turner will
          speak to John Chuter to agree the best way forward to ensure the paper
          receives Board visibility.


       09/48 PBC Financial Performance Reports

       The final PBC financial performance for 2008/09 would be circulated prior to the
       meeting on 26 October to enable discussion at that meeting. ACTION: Rhys North.

       09/60 Performance Report – Cancer pathways

       Peter Dickson advised that comparative 5 year survival rate data as an indication of
       quality of care is available through the Yorkshire Cancer Network and agreed to let
       Pam Essler have details. Peter Dickson.

       09/60 Performance Report – TIA

       Steve Ingleson confirmed that specific clinics were being set up to scan and treat
       patients within 24 hours of suffering TIA attacks in order to meet the trajectory.

       09/63 Any other business - Pharmaceutical shortages

       Peter Dickson confirmed that drug shortages were being reported nationally since
       the number of wholesalers supplying drugs was limited. A helpline has been set up
       with major manufacturers. There are currently no reported shortages with Bradford
       and Airedale.

       09/63 Any other business – Diabetic Retinopathy Screening

       The Diabetic Retinopathy Screening programme is to be restarted with effect from
       the end of the month. The PCT is looking to retender the whole service to find a
       Provider who can manage the delivery of the full programme Following the serious
       untoward incident 250 patients have been audited, 5 were found to have
       deteriorated. A verbal update on procurement would be given at the next meeting.
       Peter Dickson.


       Steve Ingleson drew out the main points from the report as follows:

(i)    Smoking Cessation data for quarter 1 demonstrates positive performance and
       remain well within the Department of Health recommended rates at 46.6%.

(ii)   August performance against the Chlamydia screening target improved to 6.5%
       against a trajectory of 10.5%. Although below target, performance is an improvement
       on the same period last year (4.7%).

       The target has been set at 25% of eligible cohort to receive Chlamydia screen in
       09/10 which has increased from 17% last year (a target we narrowly underperformed
       against at 15.4%). The contract with BACHS is to deliver 9% of the cohort in 09/10, a
       target which at present they are underperforming against but are confident they will
       achieve by the year end. Incentive schemes will be implemented with a range of
       other providers to achieve the remaining 16%.

        The Chair asked what is being done to find out why Leeds labs are advising 50% of
        screens are unsuitable. Steve Ingleson advised as yet no response has been
        received from Leeds Lab and the issue has been escalated to the Yorkshire and
        Humber Screening Programme for advice.          The number reported appeared
        extremely high compared to previous months and would be verified. An update will
        be given at the next meeting. Steve Ingleson.

(iii)   Appendix 1 of the report provides an update on child disability. PCTs are expected
        to prepare a local statement setting out their service plans for children with a
        disability covering short breaks, community equipment, wheelchairs and palliative
        care, as part of the Vital Signs reporting arrangements. This report will be made
        public and shared with our partner organisations to enable all issues to be included
        within the report.

        Pam Essler felt that carers are critical to this piece of work as they have to pick up
        the technical shortfalls some of these services currently have.

(iv)    NHSBA has recently received a letter from the Care Quality Commission (CQC) in
        relation to compliance with C2 Safeguarding Children. This letter indicates that there
        is the potential for the CQC to qualify BACHS declaration of compliance for this
        standard, from ‘Met’ to ‘Not met’. A response has been sent providing evidence to
        demonstrate that this standard has been met and that staff have received the
        appropriate safeguarding training. Although a response has not been received yet
        we had been advised informally that the response appeared to provide sufficient
        evidence to meet the core standard.

(v)     The Bradford LIT Self Assessment Framework 2009 (SAF) has been undertaken
        annually by local health and social care economies (as designated by the Local
        Implementation Teams or LIT) for the last ten years. It is commissioned by the
        Department of Health to map local progress in implementing the National Service
        Framework for Adult Mental Health, as well as subsequently published policies.

        This is the first time that there have been no Red ratings for the Bradford and
        Airedale economy. There are 17 Green ratings and 11 Amber ratings – the best
        performance to date. The assessment provides clear evidence of the progress that
        has been made in ensuring that local service development and improvement has
        delivered real results within Bradford and Airedale. With the exception of Learning
        Disabilities and Mental Health all issues highlighted by the assessment are already
        established as Projects or key issues within the existing Mental Health Programme.

        This assessment signals the end of the 10 year life of the National Service
        Framework and will be the last of these assessments. Once the New Horizons is
        published in the autumn, a new performance framework for mental health will be

        Matt Neligan outlined potential plans to move the management of EIP to Bradford
        District Care Trust as a number of serious untoward incidents have occurred when
        service users have moved from specialists into EIP. A meeting is to be held between
        NHSBA, BDCT and the Local Authority to consider the recent audit report.

(vi)    Appendix 2 shows activity data from the past 5 years. These are the figures that are
        reported to the DH on a monthly and quarterly basis.

        The data shows a significant reduction in inpatient waiting lists over the past 5 years,
        a recent increase in outpatient waiters, and an increase in activity in general.

        However, some of this increase will be as a result of improved reporting from the IS

(vii)   The Committee noted the number of targets being achieved consistently and the
        improvements being made on indicators. Risk was highlighted around the lack of
        actions or plans to improve A&E and non-elective activity and further work is required
        to achieve Chlamydia targets.


        Introducing the report Rhys North informed the Committee whilst the financial
        position continues to note significant levels of risk a breakeven position in line with
        the planned £16m control total continues to be forecast. Concerning this, a
        significant range of actions is in place to manage to the planned year end position.
        Key points were:

(i)     The PCT is continuing to forecast to meet its control total of £16m for 2009/10. The
        main areas adding to the financial pressures are:

              Acute care expenditure, particularly concerning the Bradford Teaching
               Hospitals Foundation Trust (BTHFT). In particular non-elective activity
               pressures have continued to grow and further significant elective activity
               pressures are now forecast with private providers.

              Continuing care overspend has increased by £2.8m over last month.

              Additional savings target required to hit the forecast surplus is £6.5m.

(ii)    The financial risks that will need to be managed to maintain this position are:

              Acute healthcare contracts.

              Primary care prescribing.

              Continuing care.

(iii)   Hospital contracts

        BTHFT - The contract monitoring report produced by the Trust shows a further
        increase in the year to date overspend to July of c.£1m compared to June. Excluding
        SCG activity, the Trust is reporting a year to date overtrade of £3.5m. The reported
        position incorporates the benefit of significant contract queries concerning the
        reported activity in the first quarter.

        AHT - No significant change over last month. The year to date position reflects a
        further month’s shortfall against the activity savings target resulting in an overspend
        of £128k. The full year forecast under spend of £2.3m remains unchanged.

(iv)    A Finance and Efficiency group has been established to review all current and
        planned expenditure and the potential to deliver efficiency savings whilst maintaining
        quality of services. The group membership consists of representatives from the
        Clinical Executive and PBC Alliances as well as Commissioning, Performance,
        Finance and Medical Directorates.

     Pam Essler noted that patient experience could help efficiencies be made and that
     efficiency should be the driver of the group not economy cuts. It was confirmed that
     the group’s focus was on efficiency in line with the Quality, Innovation, Productivity
     and Prevention (QIPP) agenda.

     The Committee noted the finance report and the financial risks requiring
     management to achieve the planned control total. It also noted that a detailed review
     of the financial position would be undertaken with the Board as part of the planned
     development session the following day.


     11.00 am Monday 26 October 2009 in the Board Room, Level 4, Douglas Mill.


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