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					                    YORKSHIRE AND THE HUMBER
                 SPECIALISED COMMISSIONING GROUP
                            Meeting held on Friday, 15 April 2011
                          at Sandal Rugby Club, Sandal, Wakefield

                              Decision Summary for PCT Boards

1          STRATEGY AND DIRECTION

SCG        SCG Contracts 2011-12
08/11
           In view of the DH guidance (14 March 2011) which stated that SCGs must be direct
           commissioners of all contracts in 2011-12, it would be necessary to disaggregate
           contracts in the current financial year.

           There was a position of growing financial risk and it was very important that PCTs
           understood the implications of how they would be affected by the changes. Similarly, it
           was vital that PCT/Trust staff who were dealing with contracts fully understand the
           changes that would be required in relation to SCG contracts.

           It was agreed that Steve Hackett, Director of Finance for South Yorkshire & Bassetlaw
           Cluster would hold urgent meetings with the lead PCT and Trusts where contracts for
           2011-12 were still to be concluded and where contracts had been concluded an urgent
           risk assessment and stock-take would be undertaken to identify the associated risks for
           the contract transition.

2          POLICY

SCG        Cancer Medicines Commissioning Policies
11/11
           It was agreed that the following commissioning policies be approved:-

           (a)    Bevacizumab for metastatic colorectal               To be not routinely funded in
                  cancer (in combination with oxaliplatin             accordance with NICE TA 212
                  and either fluorouracil plus folinic acid
                  or capecitabine)
                  Bevacizumab in combination with a                   To be not routinely funded in
                  taxane for the first-line treatment of              accordance with NICE TA 214
                  metastatic breast cancer
                  Bendamustine       for    the     first-line        To be routinely funded in accordance
                  treatment of chronic lymphocytic                    with NICE TA 216
                  leukaemia
                  Pazopanib for the first-line treatment of           To be routinely funded in accordance
                  advanced renal cell carcinoma                       with NICE TA 215
                  Azacitidine for the treatment of                    To be routinely funded in accordance
                  myelodysplastic syndromes, chronic                  with NICE TA 218
                  myelomonocytic leukaemia and acute
                  myeloid leukaemia


           (b) that the key points for commissioners be noted;

           (c)   that the appropriate implementation and maintaining of these policies be
                 undertaken by PCTs; and


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           (d) that these policies are available to the public in accordance with the directions of
               the Secretary of State.

SCG        Regional Policy Sub Group Recommendations for Policy Development
255/10
           The following amendment was made to the minute of the SCG meeting held on the
           25 March 2011.

           (a) that the decisions of the Regional Policy Sub Group report in respect of policy
               developments be noted; and

           (b) that PCTs adopt a policy of ‘not routinely funding’

                    ranibizumab for diabetic macular oedema/retinal vein occlusion; and
                    intravitreal dexamethasome for macular oedema.

3          GOVERNANCE

SCG        It was agreed that a Transition Executive Group be established and terms of reference
06/11      of the group were agreed.

SCG        Any Other Business
18/11
           Annette Laban agreed to be nominated for the Chair of the Major Trauma Network and
           this appointment was agreed by the meeting.




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                        YORKSHIRE AND THE HUMBER
                     SPECIALISED COMMISSIONING GROUP
                                   Minutes of the meeting held on
                                        Friday, 15 April 2011
                              at Sandal Rugby Club, Sandal, Wakefield
 Present:

Ailsa Claire                    Director of Commissioning Development       NHS Y&H - (Chair)
Steve Wainwright                Chief Operating Officer                     NHS Barnsley
Steve Hackett                   Director of Finance                         NHS Barnsley
Graham Wardman                  Executive Director of Public Health         NHS Calderdale
Sue Metcalfe                    Deputy Chief Executive                      NHS North Yorkshire & York
Matt Neligan                    Director of Strategy                        NHS Bradford & Airedale
Julia Mizon                     Assistant Director – Contracting and        NHS East Hull
                                Performance
Jane Hawkard                    Director    of    Strategy    &    Market   NHS East Riding
                                Development
Julie Warren                    Director of Strategy Partnerships and North East Lincolnshire CTP
                                Performance                           and also representing NHS
                                                                      North Lincolnshire
Andy Buck                       Chief Executive                       South Yorkshire & Bassetlaw
                                                                      Cluster
Ian Atkinson                    Chief Operating Officer               NHS Sheffield
Annette Laban                   Director of Commissioning Development South Yorkshire & Bassetlaw
                                & Deputy Chief Executive              Cluster
Andy Leary                      Director of Finance                   NHS Wakefield and
                                                                      representing NHS Kirklees
Nigel Gray                      Director of Development &             NHS Leeds
                                Commissioning (Adult Services)

In Attendance

Cathy Edwards                     Director                                  Y&H SCG
Kevin Smith                       Medical Advisor                           Y&H SCG
Paul McManus                      Lead Pharmacy Advisor                     Y&H SCG
Laura Sherburn                    Deputy Director of Commissioning          Y&H SCG
Paul Crompton                     Business Manager                          Y&H SCG
Frances Carey                     Deputy Director of Finance                Y&H SCG

SCG      Apologies
01/10
         Mike Potts               Chief Executive                           NHS Kirklees
         John Lawlor              Chief Executive                           NHS Leeds
         Ann Ballarini            Director of Strategy                      NHS Wakefield
         Caroline Briggs          Director of Strategic Commissioning       NHS North Lincolnshire
                                  and Development
         Jayne Brown              Chief Executive                           NHS North Yorkshire & York
         Lisa Marriott            Assistant Director of Commissioning       Y&H SCG
         Simon Morritt            Chief Executive                           NHS Bradford & Airedale

                                                                                                  Action
SCG      Declarations of Interest
02/11
         There were no declarations of interest.

SCG      Minutes of the meeting held on Friday 25 March 2011
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03/11
         It was requested and agreed that the Decision Summary for PCT Boards be                     Paul
         positioned at the front of the minutes.                                                 Crompton

         It was agreed:

         that subject to the following amendment the minutes of the meeting held on
         the 25 March 2011 were agreed as a true and accurate record.

         SCG         Regional Policy         Sub     Group      Recommendations   for   Policy
         255/10      Developments

                     To be amended as follows:

                     (a)    that the decisions of the Regional Policy Sub Group in
                            respect of policy developments be noted; and

                     (b)    that PCTs adopt a policy of ‘not routinely funding’

                               ranibizumab for diabetic macular oedema/retinal vein
                                occlusion; and
                               intravitreal dexamethasone for macular oedema.

SCG      Matters Arising
04/11
         (a)      Review of Children’s Congenital Cardiac Services in England

                  A verbal update report on the review of Children’s Congenital Cardiac
                  Services in England was made to the meeting, and a number of key
                  points were highlighted.

                  There was still a degree of confusion as to the role of PCTs in the
                  consultation process. National guidance had been issued to the
                  effect that PCTs should not respond formally to the consultation. This
                  guidance would be circulated to PCTs and it was essential that PCTs
                  briefed everyone accordingly. The SCT would also prepare a                        Cathy
                  template for use by PCTs when responding to letters and enquiries,              Edwards
                  including those from MPs.

                  Andy Buck agreed to liaise with Leeds Teaching Hospitals on behalf             Andy Buck
                  of the South Yorkshire & Bassetlaw PCT cluster to re-iterate that
                  PCTs could not become involved in the consultation as they are the
                  consultors.

                  It was felt that there was a need for clarity of roles, if PCTs/SCG were
                  present at ‘local consultation events’.

                  Issues had been raised with the national team on how PCTs, the
                  JCPCT and the Overview and Scrutiny Commissions would have a
                  role in the consideration of the responses to the consultation, and
                  these matters were being considered.




                  More national work was also being undertaken to ascertain from
                  provider Trusts, their maximum capacity, which some had felt was not
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          accurately reflected in the existing data. National CCAD data was
          also being updated. Further work was also being undertaken
          reviewing patient flows on a more locally sensitive basis.

          The national consultation event in the Yorkshire & Humber area
          would be taking place on the 10 May, with both afternoon and
          evening sessions fully booked.

          On the 14 May there would be a consultation event being held in York
          as part of a national focus group exercise. This event was for parents
          and young people only and would look at congenital heart services
          generally.

          There had been a useful discussion at the most recent Yorkshire &
          Humber Congenital Cardiac Network (CCN) Board meeting.

          The SCT were making arrangements with the Trust for staff
          consultation events at Leeds Teaching Hospitals.

          The Yorkshire & Humber Joint Health OSC had received a
          presentation from Leeds THT on the 29 March. This was followed be
          a tour of the Leeds General Infirmary by members of the JHOSC.
          There had been significant local press coverage. Future JHOSC
          meetings would take evidence from the Yorkshire & Humber
          Congenital Cardiac Network Board.

          The Yorkshire & Humber OSC have written to the JCPCT with an
          interim recommendation formally requesting that the consultation
          period be extended by a period of three months.

          A local information group had been established by the SCT with
          representatives from the Leeds THT, CCN and JHOSC to lead on
          data consistency and the collation of data in respect of the SCG
          impact assessment. Meetings had now taken place with YHPHO,
          EMBRACE and YAS to clarify data availability and requirements.

          A breakdown of surgical procedures carried out at Leeds THT by PCT
          would be circulated to PCTs during the next week.

          The purpose of the Y&H impact assessment was to enable the region
          specific contextual information to be presented to the PCTs and SCG
          for their assurance that all the relevant issues had been considered in
          the review and consultation. Any issues arising from this exercise
          would then be fed to the chair of the Y&H SCG who is the
          representative on the JCPCT. It was anticipated that the assessment
          would be completed by the end of May.

          It was agreed:

              that the update on the Review of Children’s Congenital Cardiac
               Services in England be noted.



 (b)      Yorkshire & Humber Regional Home Oxygen Service

          A report was presented by NHS Leeds to the meeting in relation to
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                  the Yorkshire & Humber Regional Home Oxygen Service
                  Procurement and the governance arrangements for the contract.

                  The existing contract had been extended to enable a procurement
                  exercise to be completed by the third quarter of 2011 with a
                  commencement date for a new contract from May 2012.

                  The proposals set out in the report sought the SCG to act as a
                  ‘collaborative’ for the Y&H PCTs and to undertake the governance of
                  the arrangements.

                  A discussion took place and a number of issues were raised for
                  clarification:

                       the balance between price and quantity needed to be reviewed
                       the date on which the current contract ends
                       the authorised signatures need to be changed in view of the dates
                        and changes to the NHS
                       the split between liability and costs needed checking

                  It was agreed:

                  (a) that changes to the documentation be made and submitted to
                      the SCT and that these be then circulated to PCTs for comment;

                  (b) that work on the procurement exercise continue; and

                  (c)    that a further report be made to the SCG Board                            John
                                                                                                Lawlor/
                                                                                             Nigel Gray
         (c)      Vascular Review

                  A verbal update report was made in relation to the regional Vascular
                  Review.

                  Both the Yorkshire & Humber Chief Executive’s Forum and the
                  Yorkshire & Humber SHA had considered, from an assurance
                  perspective, the results of the consultation exercise and the proposed
                  implementation plan.

                  The Chief Executive’s Forum had raised the concerns expressed by
                  Doncaster and Sheffield and Mid Yorkshire and the Leeds THT.

                  The SHA was requiring, by the 30 June 2011, the submissions via the
                  Yorkshire & Humber SCG of implementation plans by each of the
                  proposed ‘partnerships’.

                  It was agreed:

                       that the update report in respect of the Vascular Review be noted.



SCG      National Transition
05/11
         A verbal update report was made to the meeting in respect of the national
         transition. A letter had been received from the Chief Executive of the NHS in
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         relation to the ‘Pause – Listen – Engage’ exercise.

         Contracts in relation to specialised services would need to be disaggregated
         in 2011-12.

         A discussion followed which confirmed that contracts for 2011-12 were being
         concluded on the basis of existing arrangements, with the undertaking that
         these would need to be disaggregated ‘in year’.

         It was felt that the risks associated with this requirement were considerable.

         It was agreed:

            that the update report in respect of the national transition be noted.

SCG      Terms of Reference of the Yorkshire & the Humber SCG Transition
06/11    Executive Group

         The draft terms of reference of the Yorkshire & the Humber SCG Transition
         Executive Group were presented to the meeting. It was noted that Steve
         Hackett had been appointed as the Finance Director of the South Yorkshire &
         Bassetlaw Cluster.       Any wider membership of the group would be
         incorporated at a later date as necessary.

         It was agreed:                                                                     Cathy
                                                                                          Edwards
            that the proposed Terms of Reference of the Yorkshire & Humber
             Transition Executive Group be approved.

SCG      SCG Financial Plan
07/11
         A report asking the Board to note the revised Financial Plan for 2011-12,
         which was a result of the removal of three QIPP schemes from the QIPP
         programme, was presented to the meeting.

         It was agreed:                                                                   Frances
                                                                                            Carey
            that the revised Financial Plan 2011-12 be noted.

SCG      SCG Contracts 2011-12 – Update
08/11
         A report was presented to the meeting in respect of SCG contracts for 2011-
         12. The report set out the status of contract negotiations with the major
         providers and the national contracts. The report set out that three main
         tertiary providers had still outstanding information to provide.

         The DH guidance (14 March) states that SCGs must be direct commissioners
         for all contracts in 2011-12. This would require the implementation of urgent
         transition plans in year.



         A discussion followed and it was felt that the changes in contracts raised a
         whole host of questions around risk and where liability rested. There was a
         position of growing financial risk. QIPP, PbR would all be affected. It was
         very important that PCTs understood the implications and how they would be
         affected.
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         Similarly, it was noted that PCT/Trust staff who were dealing with contracts
         fully understand the changes that would be required in relation to SCG
         contracts.

         It was felt that Steve Hackett should hold urgent meetings where contracts
         were still to be signed. Where contracts had been signed, Steve Hackett                  Steve
         should carry out an urgent risk assessment and stock-take, to expose current            Hackett
         risks.

         It was agreed:

         (a)      that the update report on SCG contracts 2011-12 be noted; and

         (b)      that the Director of Finance (South Yorkshire & Bassetlaw) hold                 Steve
                  urgent meetings with the lead PCT and Trust where contracts were               Hackett
                  yet to be concluded for 2011-12; and where contracts had been
                  concluded that an urgent risk assessment and stock-take be
                  undertaken to identify the risks associated with the required contract
                  transitions.

SCG      Paediatric Cardiac Outpatients – Designation
09/11
         A report was presented to the meeting seeking agreement to the
         recommendations for the designation of paediatric cardiac outpatient services
         in NEYHCOM, WYCOM and NORCOM. The report set out a summary of the
         progress with the designation process and the recommendations and
         timescales proposed.

         It was agreed:

         (a)      that the following recommendations in respect of the designation of               Lisa
                  paediatric outpatient services be approved.                                    Marriott

                  NEYHCOM

                      Scarborough and North East Yorkshire Hospitals Trust and
                       Northern Lincolnshire and Goole NHS Foundation Trust, both
                       recommended for full designation (subject to standards being
                       maintained)

                      Hull & East Yorkshire Trust were recommended for interim
                       designation, with full designation awarded on the confirmation that
                       the remaining standard was met. (review September 2011)

                      York Hospital Foundation Trust were recommended                 for
                       preliminary designation. (review September 2011)




                  WYCOM
                   Airedale Hospital Foundation Trust were recommended for
                    preliminary designation. (review September 2011)

                      Bradford Hospital Foundation Trust were recommended for interim
                       designation with full designation on confirmation that standards
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                       are met. (review September 2011)

                      Calderdale  and   Huddersfield    Foundation    Trust  were
                       recommended for full designation (subject to standards being
                       maintained)

                      Leeds Teaching Hospitals Trust were recommended for interim
                       designation with full designation on confirmation that all standards
                       are met. (review September 2011)

                      Mid Yorkshire Hospital Trust were recommended for full
                       designation (subject to the standards being maintained)

                  NORCOM
                   Rotherham Hospital Foundation Trust were recommended for full
                    designation (subject to standards being maintained)

         (b)      the position in relation to the process for the designation of the
                  remaining Trusts in the NORCOM area be noted.

SCG      Cancer Drug Fund
10/11
         A report was presented to the meeting which provided a summary end of year
         position for the Interim Cancer Drug Fund and an update on the Cancer Drug
         Fund 2011-12.

         Of a total fund of £5,247,000 received by the SHA, £5,461,000 had been
         allocated to fund approved treatments for up to 12 months or for the duration
         of a fixed course, as appropriate. Funds allocated under ICDF to be spent in
         2011-12 would be retained by the SHA to meet such commitments. Funds
         allocated for the Cancer Drug Fund (£20M for Yorkshire and the Humber)
         would be used to pay for approved medicines initiated from 1 April 2011.

         The Cancer Drug Fund was operational from April 2011 and the DH has
         published guidance which supported current arrangements of the ICDF in the
         Yorkshire & Humber area. However, these arrangements would be subject to
         discussions with the shadow NHS Commissioning Board. The report also
         sets out a number of other issues that needed to be considered with regard to
         policies and the operation of the fund.

         Where a drug had been removed from a priority list following its
         recommendation by NICE or the agreement of a local PCT funding policy,
         treatment should be available on the NHS, subject to any clinical criteria set
         out by NICE. In these cases, PCTs would normally be expected to assume
         responsibility for patients whose treatment had previously been supported by
         the fund. Where the drug has been removed from a priority list as a result of
         new developments or new evidence, any patients currently receiving the
         treatment under the fund should normally have the option to continue
         treatment until they and their clinician consider it appropriate to stop.

         The Priorities Medicine List of medicines and indications would be reviewed             Paul
         and updated on a quarterly basis.                                                    McManus

         A list of NICE Technology Appraisals in development for cancer medicines
         was highlighted and it was hoped to give SCG members the maximum notice
         of any changes in the pipeline.

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         It was agreed:

         (a)      that the information in respect of the ICDF and the Cancer Drug Fund
                  be received; and

         (b)      that the information in respect of the NICE Technology Appraisals for           Paul
                  cancer medicines 2011-12 be noted.                                           McManus

SCG      Cancer Medicines Commissioning Policy
11/11
         A report was presented to the meeting seeking approval to five general
         commissioning policies for treatments. Details of each proposed policy were
         explained, including the estimated cost of implementation.

         It was agreed:

         (a)      that the following commissioning policies be approved:

                    Bevacizumab for metastatic                 To be not routinely funded in
                    colorectal cancer (in combination          accordance with NICE TA 212
                    with oxaliplatin and either
                    fluorouracil plus folinic acid or
                    capecitabine)

                    Bevacizumab in combination with To be not routinely funded in
                    a taxane for the first-line accordance with NICE TA 214
                    treatment of metastatic breast
                    cancer

                    Bendamustine for the first-line To be routinely funded in
                    treatment of chronic lymphocytic accordance with NICE TA 216
                    leukaemia

                    Pazopanib for the first-line To be routinely funded in
                    treatment of advanced renal cell accordance with NICE TA 215
                    carcinoma

                    Azacitidine for the treatment of To be routinely funded in
                    myelodysplastic       syndromes, accordance with NICE TA 218
                    chronic          myelomonocytic
                    leukaemia and acute myeloid
                    leukaemia

         (b)      that the key points for commissioners be noted;

         (c)      that the appropriate implementation and monitoring of these policies
                  be undertaken by PCTs; and


         (d)      that these policies be made available to the public in accordance with
                  the directions of the Secretary of State.                                     All PCTs

SCG      Exception Performance Report up to 31 January 2011
12/11
         The Exception Performance Report for the period up to 31 January 2011 was
         presented to the meeting.

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         The position at month ten showed an anticipated year end overspend of
         £2.1M. The June SCG Board meeting would have the 2010-11 year end
         position.

         It was agreed:                                                                Laura
                                                                                       Sherburn/
         that the contents of the Exception Performance Report for the period up to 31 Frances
         January 2011 be noted.                                                        Carey

SCG      SCG QIPP Programme Report
13/11
         A report was presented to the meeting setting out the QIPP programme
         summary, financial summary and the 19 project highlight reports. The report
         contained details of the impact of the changes to the QIPP projects agreed at
         the March SCG Board meeting.

         A discussion followed and it was noted that the national requirement to
         implement the renal best practice tariff had been changed to 50% to
         compliance so real savings would be less than predicted.

         It was felt that the frequency of reports to the SCG Board in relation to QIPP
         could be implemented on the basis of quarterly reporting, with monthly returns
         being made to the SHA.

         It was agreed:

         (a)      that the contents of the QIPP programme summary, financial
                  summary and 19 project highlight reports be noted;

         (b)      that the submission of the reports to the SHA be approved;

         (c)      that further reports be made to the SCG Board meeting in May in
                  respect of the impact of changes to anticipated savings and the
                  secure mental health rehabilitation project; and

         (d)      that the frequency of QIPP reports to the SCG be reduced to quarterly Laura
                  except by exception if required.                                      Sherburn

SCG      Minutes of the Performance Monitoring Sub Group
14/11
         It was agreed:
         that the draft minutes of the Performance Monitoring Sub Group meeting held
         on the 14 March 2011 be received.




SCG      Minutes of the Clinical Standards Sub Group
15/11
         It was agreed:
         that the draft minutes of the Clinical Standards Sub Group meeting held on
         the 9 March 2011 be received.

SCG      Minutes of the Regional Policy Sub Group
16/11
         It was agreed:
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         that the draft minutes of the Regional Policy Sub Group meeting held on the 8
         March 2011 be received.


SCG      Minutes of the North Trent Neonatology Network Steering Group
17/11
         It was agreed:
         that the draft minutes of the North Trent Neonatology Network Steering Group
         meeting held on the 7 February 2011 be received.

SCG      Any Other Business
18/11
         (a)       SCG Sub Groups

                   Consideration was being given to the meetings of the SCG Sub
                   Groups.      This included synchronising the meetings of the
                   Performance Monitoring Sub Group and the Finance Network Group;
                   the Clinical Standards Sub Group may go to a quarterly cycle; the
                   Regional Policy Sub Group is looking at more virtual meetings and
                   the Designation Sub Group would probably be disbanded.

                   A report would be made to the SCG Board meeting in May, setting          Cathy
                   out the proposals.                                                     Edwards

         (b)       Chair of the Major Trauma Network

                   There was a need to appoint a chair for the Major Trauma Network.
                   Annette Laban indicated that she would be willing to undertake the
                   role. It was agreed that Annette Laban be appointed as the chair of
                   the Major Trauma Network.

SCG      Date and Time of Next Meeting
19/11
         9.00am, Friday 27 May 2011 in the Chevet Suite, Sandal Rugby Club,
         Wakefield.




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