Lincolnshire Community Services - PDF

							                                                                     Item 30

          NHS NORTH LINCOLNSHIRE COMMUNITY SERVICES

MINUTES OF THE 18TH COMMUNITY SERVICES COMMITTEE MEETING

                             11th MARCH 2010

           HELD IN ROOM G71 HORKSTOW HOUSE BRUMBY

PRESENT:

Paul Clark          Non-Executive Director (Chair)
Karen Fanthorpe     General Manager Provider Services
Therese Paskell     Deputy Director of Finance
Angie Davies        Chief Nurse of Community Services
Elaine Kemp         Associate Director of Human Resources
Mark Janvier        Associate Director of Performance
Andree Borrett      Head of Service – Podiatry
Bryony Simpson      Head of Service – Speech and Language Therapy
James Marr          Independent Committee Member
Peter Flood         Independent Committee Member
Roni Wilson         “Who Cares” Representative

APOLOGIES:
No apologies received for this meeting.

IN ATTENDANCE:

Antonia Allison     Minutes Secretary
Rebecca O’Neil      Item 13
Mike Griffiths      Item 8

2. DECLARATION OF INTERESTS:

Paul Clark – Commissioning
Therese Paskell – Commissioning
Bryony Simpson – Commissioning/NLaG

3. MINUTES OF THE PREVIOUS MEETNG HELD ON 11th MARCH 2010

The minutes were accepted as a true record.

4. MATTERS ARISING AND ACTIONS UPDATE

KF confirmed that she had formally written to the Chief Executive regarding
the concern that the lack of activity information would prevent signing of the
contract according to the timescale. The issue of service specifications being
outstanding was raised – commissioners have since confirmed that they
would appreciate our input in writing the specifications.
5. GENERAL MANAGERS VERBAL UPDATE

5.1 Transforming Community Services – Two bids have been presented,
RDaSH and the partnership bid from NLaG and Lindsey Health. Further
questions are going to be sent to the bidders. The March PCT Board is likely
to confirm that the model will be vertical integration with a Foundation Trust. It
is probable that an Extraordinary Board meeting will need to be arranged. A
staff briefing was held 9th March 2010 at which the majority of clinical
services were represented although only HR was present from Health Place.
The presentation is to be placed on the intranet for all staff to access. It was
confirmed at JNCC that we have the support of the unions, in terms of the two
potential partners being NHS organisations. The TCS Steering Group is to
reconvene, at which we can restate our concerns about the criteria matrix,
and the impact of delay on key decisions. The Community Services
Committee should also have an opportunity to look at the additional questions
and answers to be provided by the bidders.

5.2 Patient Risk Issues
Wheelchair position – Occupational Therapy Service Manager has risk
assessed the 21 outstanding patients and has been given approval to
proceed with ordering the wheelchairs.

6. SERVICE TRANSFORMATION PROJECT GROUP

Paper was taken as read, KF informed the committee that the STPG meets
on a fortnightly basis. The STPG has currently developed 5 projects which
they are keen to implement as well as developing more projects to meet the
financial targets.

CLINICAL

7. Policies for ratification

There were no policies for ratification this month, however the committee did
note that the ‘Guideline for the Urinary Catheterisation of Male and Female
Patients and the Management of Urinary Catheters in Primary Care’ was
ratified at the Clinical Excellence Group 24th February 2010.

8. Local Safeguarding Adults – Annual Report

Paper was taken as read. It was noted that MG has been acting as the
Safeguarding Adults Lead since August/September 2010 and that he will
assume the substantive role from May 2010. The committee noted the content
of the report.

9. Local Safeguarding Children – Annual Report

Paper was taken as read, it was felt that the report does not provide any
benchmarking information on our performance. The new national guidance
will be placing this service under greater scrutiny along with new quality
measures (CQUINS) relating to supervision. As part of our CQC registration,
we have previously declared compliance in this area. KF will review the new
CQC outcomes (against the judgement framework) to provide assurance to
the committee.

The recommendations in the report should read “update once national
guidance received” rather than defer amendments. The committee noted the
content of the report.

10. Infection Control – Annual Report
Paper was taken as read, AD advised that Infection Control are seeing an
increasing number of patients with bacteria resulting from indwelling catheters
for residents in care home settings. There has been an increase in a particular
strain of MRSA PBLMRSA is a strain that tends to affect younger people. The
Pre-Operative MRSA screening programme for decolonisation has been a
success. As has the TB screening of students at John Leggot College. The
clinical waste collection is also going well. Next year’s SHA bacterium target
for community is 4 which is recognised as being extremely challenging. The
committee noted the content of the report.

FINANCE

11. Finance report for Month 10 and Verbal Update on Month 11

Paper was taken as read. The Month 11 position is reporting at break even
year to date and forecast. Most of the actions required by Commissioners
including HHCT business case have been delayed and will not contribute this
year. The equipment from the panel earlier in the year has been ordered and
has a delivery date for after the 1st April 2010. The current run rate should
enable us to remain within our resources for 2010/11. Community Services
are forecasting to have delivered all their financial targets for this year
including recurrent and non recurrent CRES totalling nearly 10%. The hard
work of staff to deliver this significant achievement was acknowledged.

12. Budget Setting and 5 Year Plan

The previous 5 year plan has been updated to reflect World Class
Commissioning assumptions and reconciled to the PCTs plan. Over the five
year period the scale of savings is broadly in line with what was expected.
Following the update at last month’s meeting when the overall envelope was
discussed, service transfers have not yet been taken out, nor have
management costs (112k badged against CRES subject to negotiation).
When agreed, the baseline will be adjusted..

For 2010/11 Pay budgets were set according to actual salaries, non-pay the
lower of budget or spend in 2009/10.. The PCT have agreed the overall
envelope of 3.5% uplift pay/prices and 3.5% off for CRES = 0% small uplift.
1.5% of the contract relates to CQUINS for which Community Services have
received a 1% net uplift upfront. The CSC agreed to keep the £123k CQUINS
as a reserve/contingency plan leaving a recurrent CRES of £719k to be
delivered. This will be achieved through STPG and remainder through 2.5%
on pay budgets, to be reviewed after rebasing. PIDs will go to the Finance
and Performance Committee early April 2010. The contract still requires
rebasing, which is critical to the commissioning and delivery of sustainable
services. The CSC acknowledged the risks and for this reason the CSC
approved the budgets only on the basis that the contract rebasing would go
ahead.

PERFORMANCE

13. Monthly Performance Report

Verbal update given by Rebecca O’Neil. Currently validating the work of the
Data Warehouse to insure that it is reporting accurately on a monthly basis to
ensure that they match, staff data to ensure that all activity is being picked up.
RO is to hold a meeting with the trainers to ensure that they take account of
the data problems which have been identified.

RO provided the committee with a monthly service report for Physiotherapy as
a working draft - the feedback received by Physiotherapy has been positive.
The committee advised that the report needed to include outcome
performance and more information for non contact work. Report to be further
considered at Finance and Performance Committee.


GOVERNANCE

14. Bi-Monthly Governance Report

AB explained the report was not currently complete and that a full report will
come to the committee in April 2010. Verbal update given, CQC update for
core standards nearly all the information is in for this year, aim for 18th March
to have basic data uploaded. CQC QRP rating expected shortly. NHSLA letter
is due to be sent to PCT’s but has not currently arrived – assessment option,
Pauline Ling is contacting the NHSLA.

HUMAN RESOURCES

15. Quarterly Workforce Information Report

Paper taken as read, retire and return information has been added to the
report. The sickness absence level has increased – to look at statistics, but
the report still relates to joint provider/commissioner.

ACTION POINTS FROM SUB COMMITTEES

16.1 Finance and Performance

The committee noted.
16.2 Governance

The committee noted.

16.3 Executive Management Team

Verbal update, have been focusing on the contract for 2010/11 and CQC.


OTHER ITEMS

17. Risks identified

None identified

Date, time and place of next meeting: Thursday 8th April at 1pm in G71
Horkstow House Brumby
          NHS NORTH LINCOLNSHIRE COMMUNITY SERVICES

     MINUTES OF THE 19TH COMMUNITY SERVICES COMMITTEE
                           MEETING

                                8TH APRIL 2010

            HELD IN ROOM G71 HORKSTOW HOUSE BRUMBY

PRESENT:

Paul Clark           Non-Executive Director (Chair)
Karen Fanthorpe      General Manager Provider Services
Therese Paskell      Deputy Director of Finance
Mark Janvier         Associate Director of Performance
Bryony Simpson       Head of Service – Speech and Language Therapy
James Marr           Independent Committee Member
Peter Flood          Independent Committee Member
Roni Wilson          “Who Cares” Representative
Sue May              Head of Children’s Nursing Service (representing Angie
                     Davies)

APOLOGIES:

Andrée Borrett       Head of Service – Podiatry
Elaine Kemp          Associate Director of Human Resources
Angie Davies         Chief Nurse – Community Services

IN ATTENDENCE:

Heather Ingle        Minutes Secretary

2. DECLARATION OF INTEREST:

Paul Clark – Commissioning
Therese Paskell – Commissioning
Bryony Simpson – Commissioning/NLaG
Roni Wilson – RDaSH member

3. MINUTES OF PREVIOUS MEETING HELD ON 11TH March 2010

Amendment to previous notes. Item 8 Local Safeguarding Adults - Annual Report,
Item 9 Local Safeguarding Children – Annual Report and Item 10 Infection Control –
Annual Report. The minutes of the meeting should formally record that the
committee noted the contents of the reports.




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The minutes of the CSC are sent to the PCT Board as part of the reporting structure.
It was agreed that minutes should only be forwarded once they have been approved in
order to ensure accuracy is confirmed.

4. MATTERS ARISING AND ACTIONS UPDATE

No paper detailing the actions from the previous meeting has been produced.

5. GENERAL MANAGER’S VERBAL UPDATE

5.1 Transforming Community Services –with regard to the proposal for organisational
change, KF confirmed that NLaG with Lindsey Health and RDaSH are the two
bidders. On the basis of potential conflict of interest, Bryony Simpson and Roni
Wilson left the meeting whilst this agenda item was being discussed.

KF advised members that following the presentation of both bids in March, further
questions had been raised and responses were received on 6th April. KF provided a
verbal summary of this additional information and members were provided with a
paper copy of both submissions. After consideration of the information, it was agreed
that the CSC preferred option remained with the NLaG and Lindsey Health bid, as it
was felt this option offered the greatest opportunities for transformational change.
Members agreed the areas for further questioning at the interview to be held on 9th
April. The CSC recommendation will be shared at the meeting of the TCS Steering
Group which is to be held on 12th April. It is expected that the TCS Steering Group
will make the final recommendation for consideration at an Extraordinary PCT Board
meeting to be held on 19th April.

2. Community Contract 2010/11 – the contract with commissioners has not been
signed by the due date of end of March. Although the financial value of the contract
has been agreed, commissioners have not confirmed their agreement to a number of
underpinning actions, including undertaking a service rebasing exercise. KF is due to
meet with the Chief Executive tomorrow and will discuss how we proceed. In
summary:

      The CSC is committed to securing an urgent solution which enables
       community services to deliver a sustainable contract which ensures a safe
       level of care
      Professional concerns were expressed regarding the signing off of an
       unsustainable contract:
           o CQC registered manager required to ensure sustainable services to
               meet the needs of the population being served
           o Deputy Director of Finance professionally unable to advise signing a
               contract which places community services in recurrent deficit
           o Independent Committee Members appointed to ensure community
               services are fit for purpose
      Agreement of a sustainable contract is in the interest of both commissioners
       and providers
      Acknowledgement of the risk that not signing the contract could have a
       negative impact on the current discussions re transfer of CS under TCS



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      The BAF for Community Services should be amended to reflect the current
       position

Members of CSC requested clarity about the appropriate route for resolution:
         o Position of CEO?
         o Requirement to report position to the PCT Board?
         o Mechanism for arbitration if no rapid agreement can be reached?


3. Care Quality Commission – KF advised the Committee that evidence was being
collated against the CQC’s Judgement Framework (the structure used by CQC
inspectors when visiting trusts) and was being entered onto Performance Accelerator.
The CS Governance Committee will receive an update on the outcome of using this
framework in terms of the comprehensive nature of our evidence.

6. STRATEGIC PLAN UPDATE

KF presented a paper advising that the original strategic plan produced in October
2009 included a commitment to update the document once the PCT had produced its
commissioning strategy and there was a decision about the organisational changes
under TCS.

The Committee reviewed our nine strategic objectives – all remained relevant but
there was agreement that the first objective should be clarified in terms of the
different roles for commissioner and provider in respect of addressing health
inequalities.

It was agreed that KF would refresh the current strategic plan by:
     Reflecting on the progress made against the objectives
     Reflect key messages drawn from the Commissioning Strategy for
        Community Services
     Review the Business Plan for 09/10 and update for 2010/11

A further revision of the document would be required once the business case for
transfer of services had been completed

7. STATEMENT OF INTERNAL CONTROL

The SIC has been prepared to allow the Accountable Officer, the PCT Chief
Executive, to be assured that the responsibilities that have been delegated to the
General Manager, Community Services have been complied with.

KF asked that Pauline Ling be thanked for the work she has done in preparing this
report.

 The Committee approved the document for signature, subject to some final
amendments.




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8. POLICIES FOR RATIFICATION

There were no policies for ratification

9. PATIENT & PUBLIC INVOLVEMENT STRATEGY

KF provided a verbal report outlining her view that although individual services are
undertaking some good work, there is no overall approach endorsed by Community
Services and the work is, as a result, somewhat fragmented. It was recognised that
embedding patient involvement is one of our strategic objectives. RW commented
that from her experience, it can be difficult to know how to get people/patients
involved. It was agreed there needs to be a more systematic approach, beginning with
a Community Services strategy setting out best practice and confirming our approach.
KF to prepare an initial version for consideration.


10. FINANCE REPORT FOR MONTH 11

A small year to date surplus is reported for the first time all year –thanks to the staff.
A break even position is still forecast for the year end and achievement of recurrent
CRES target is expected. PC expressed his gratitude to everyone for this.

However this has been due to very stringent controls and actions which are not
sustainable including introducing and extending waiting lists, holding 18 vacancies,
etc and a longer term solution needs to be found for the historic cost pressures in
discussion with Commissioners through a contract rebasing/reprioritisation.

Month 12 final report will be produced at the next meeting of the CSC incorporating
elements of the final accounts that relate to provider services e.g. segmental report,
full cost recovery and management costs.

CRES PIDs/plans were discussed at the last CSF&PC. Further CRES meetings are
being arranged, before the next CSC to ensure ongoing progress. Provider are ahead
of last year in terms of developing, documenting and implementing plans. STPG
meets fortnightly.

The capital plan will come to the June CSC although having received £166k in
2009/10 it is unlikely the amount available in 2010/11 will be significant.

11. MONTHLY PERFORMANCE REPORT

MJ suggested that a year end statement should be produced in a similar way to that
produced for finance.

The Committee supported the proposal to hold a workshop to progress the
Performance Framework. A revised performance framework will be out for the next
meeting although it was recognised that this will be work in progress.

12. BI-MONTHLY GOVERNANCE REPORT



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Peter Flood presented the paper in the absence of AB. The main points for action
were agreed as:

     PCT Integrated Governance Committee – the concern was raised that as no
      community representative is present at this Committee, there was no one available
      to answer any questions/convey the position on specific matters. It was agreed
      that KF would check the Statement of Accountability in terms of reporting
      arrangements (including confirmation about whether SLA minutes and CSC
      minutes should be considered at the IGC). KF will feedback initially to the CS
      Governance Committee later this month.

     Clinical audit – members would appreciate comments to be included in terms of
      how we are progressing against the various audits in order to be able to make a
      judgement about our position.

13. BOARD ASSURANCE FRAMEWORK

This report has been prepared to allow the CSC to review those risks which have the
highest rating on our Assurance Framework. The risks are reviewed on a monthly
basis at the Executive Management Team and subsequently discussed in detail at the
CS Governance Committee.

It was agreed that risk reference PCC25a should be reworded for the sake of clarity
and that the scoring should be reviewed in light of current position with the signing of
the contract.

14.    PALS AND COMPLAINTS

The content of the report was noted.

It was noted that one of the complaints related to deferred provision of a wheelchair –
this complaint has prompted the PCT to take legal advice, the result of which will be
useful for future discussions with commissioners.


ACTION POINTS FROM SUB COMMITTEES

15.1 FINANCE AND PERFORMANCE - MARCH

All ratified. The notes will be out for the next meeting.

15.2 FINANCE AND PERFORMANCE ANNUAL REPORT

Report noted and work of committee recognised. TP to consider the suggestion that
the report should go to the PCT Finance and Performance Committee for information.

15.3 COMMUNITY SERVICE GOVERNANCE

Report noted. In particular, CSC discussed the actions being taken in respect of the
risk relating to incidents involving syringe drivers.


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15.4 AUDIT COMMITTEE

   Nothing from the previous meeting (December 2009) which required action by
    CSC.
   Patient safety risk report presented to the recent Audit Committee by KF
   BAF – copy has been requested by the Chair of the AC

15.5 EXECUTIVE MANAGEMENT TEAM

The GM provided a verbal report of the issues discussed at the weekly EMT including
CRES plans, service rebasing, CQC registration and Staff Survey

15.6 SERVICE TRANSFORMATION PROJECT GROUP

CSC noted the progress being made.

Project Initiation Documents are needed as a matter of urgency to support projects.

BS commented that the performance reports for individual services might show that
non-attendance at appointments were an issue and might be worthy of considering
how we can reduce this problem.

KF advised that she was pursuing the potential for roll out of the Productive
Community Services initiative as this would underpin the STPG approach

OTHER ITEMS

Risks Identified

The risk score regarding the contract should be reviewed.

Date, time and place of next meeting: Thursday 13th May 2010 at 1pm in G71
Horkstow House, Brumby




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