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 Minutes of the meeting held Tuesday 26 July 2011 in the Boardroom, Kings House, Kings
                                Street, Dudley DY2 8PP.


Chairs of Black Country PCTs
Mrs G Cooper        Interim Chair, NHS Dudley (chair)
Mr R Nugent         Chair, Sandwell PCT
Mr J Oatridge       Chair, Wolverhampton City PCT
Dr G Archenhold     Chair, Walsall PCT

Non-Executive Directors of Black Country PCTs
Ms J Deakin        Non-Executive Director, NHS Dudley
Mr B Jones         Non-Executive Director, Wolverhampton City PCT
Ms N Devi          Non-Executive Director, Sandwell PCT
Dr R Gutteridge    Non-Executive Director, Walsall PCT

Executive Directors
Mr R Bacon           Chief Executive Black Country Cluster
Ms S Ali             Director of Nursing and Quality / MD Walsall
Mr A Williams Director of Commissioning Development / MD Sandwell
Mr J Green           Acting Director of Finance

Non-voting members
Mr J Crockett     Managing Director, Wolverhampton City PCT
Mr R Haynes       Assistant Chief Executive Communications for the Cluster
Ms P Jones       Patient and Public Representative
Mr D Orme        Patient and Public Representative

In attendance - part meeting
Ms M Lawrence        Consultant Nurse in Health Protection, Sandwell PCT
Mrs A Hodgson        Assistant Director of Corporate Governance

Members of the public
Mr C Bayliss       British Telecom
Mr M Ladek         GSK
Mr N Zaddin        GMIS

Mrs Cooper welcomed those present to the public board meeting for the Black Country

Black Country Cluster                                                       Board meeting
Minutes of meeting held on Tuesday 26   Page 1                             30 August 2011
July 2011
Apologies for absence were received from Mrs Kimara Sharpe, Assistant Chief Executive
Board Secretary, Dr Stephen Cartwright, Medical Director, Mrs J Jasper, Non-Executive
Director, Dudley PCT, Mrs Mal Madders, Assistant Chief Executive, Human-Resources, Mrs
Grainne Siggins, Non-Executive Director, NHS Walsall, Mr Mohammed Nazir, SHA Non-
Executive Director, Ms Valerie Little, Director of Public Health, NHS Dudley.

There were no declarations of interest.

There were no questions from the public

These were accepted with the following amendments;

      Ms N Devi to be included in attendees present at the meeting on 28 June 2011.
      Mr M Nazir to be removed from attendees present at the meeting on 28 June 2011.
      49/11 Mr Bacon went on to report on the review meeting with the Strategic Health
       Authority. The feedback received from the Strategic Health Authority was that the
       Black Country was complimented for its strong financial performance and for a sound
       general performance for service delivery. It was recognised however, that there were
       significant pressures on emergency departments over the winter period and that
       further planning and preparation was necessary before winter 2011/12.
      54/11 Resolution to be changed to; ‘The board approved the first draft of the Legacy
       Document, and the changes for the membership for the subcommittees of the cluster
       and noted the proposed approach and timescale for the development of a high risk

10/11 Ms Michelle Lawrence gave a verbal update on the joint formalisation of tasks being
      undertaken by the emergency planners across the cluster to ensure resilience and
      consistency across the Cluster. Mr Bacon stated that he was pleased to see an
      integrated way of working developing during the transition and suggested a
      structured written report is circulated and discussed at management team meetings
      to track and monitor the timescales of completed tasks. Further engagement with
      Public Health and the Local Authority is required to reflect other plans that may have
      an impact as the team develops across the geographical areas. Priorities for the
      immediate future will include establishing a robust cluster-wide senior management
      on-call rota and reviewing major incident plans, training and preparedness. The
      board asked for assurance in relation to local plans being currently fit for purpose,
      which could be implemented in the interim period as we move towards a cluster plan.

45/11 Stakeholder events report at the September meeting
51/11 Mr Green to provide a detailed analysis for the August meeting.

Ms Ali stated that the first meeting of the Clinical Executive took place on 7 July 2011. The
terms of reference were discussed and the committee concluded that the Clinical Executive
will primarily take forward strategic commissioning issues around quality and provide
assurance to the Cluster Board, to ensure the quality of services and patient safety was not
compromised through the transition. This will be done in partnership with the Black Country

Black Country Cluster                                                         Board meeting
Minutes of meeting held on Tuesday 26     Page 2                             30 August 2011
July 2011
Clinical Senate, chaired by Dr David Hegarty, which remains the driving force in the Cluster
for strategic commissioning decisions that affect care delivered across the Black Country.

Southern Cross
Ms Ali presented the report highlighting the key issues surrounding the current fragile
situation within Southern Cross homes and the impact that it could have on part of or the
entire cluster. Ms Ali stated that actions were being taken to mitigate against the risk this
situation may provide. The Black Country has 19 registered Southern Cross homes across
the geographical area, 5 in Dudley, 7 in Sandwell, 5 in Walsall and 2 in Wolverhampton.
Good communication links with Southern Cross are in place. Regional care home managers
have confirmed that there are no plans for any of these homes to close and there will be an
orderly transfer of the homes to other providers during September, October and November
2011, although actual providers and transfers have not yet been confirmed.

Ms Ali reported on the recent scenario joint health and local authority contingency exercise
which took place in Walsall. The exercise identified a number of issues one being the need
for the Cluster to develop a commissioning strategy for care homes and to take into account
the wider issues facing this sector including increased financial pressure in the future.

In response to a question from Mr Jones in relation to how the 4 PCTs were undertaking
elements of the quality and risk assurance to show the advantages of working at a Cluster
level, Ms Ali stated that the joint commissioning group has met to discuss the scope of these
issues and shared between each of the 4 PCTs.

In response to a question from Ms P Jones in relation to how residents and staff are being
monitored, Ms Ali stated that a forum where monitoring takes place and intelligence shared
is already in place, the 4 PCTs have a set of parameters in place around quality and are
cited on these issues.

Dr Archenhold asked of the 19 registered homes identified across the Cluster, could
assurance be given that the homes will revert back to the landlords that have a provider arm
or, will there be homes where the landlord and care provider are separate organisations. Ms
Ali stated that her understanding is that 80% is looking very resilient, further work is needed
to be done to identify if the remaining 20% turns into a risk, and until a clear provider is
identified and transition plans are in place we will remain vigilant. Ms Ali was unable to give
assurance at the moment but planned on discussing it at the next table top exercise.

Mr Orme reported on the work from the local involvement network.

Resolution: The board noted the progress of the work being done and the scenario
             planning that will be replicated across the other PCT’s, and the need to
             work closely with Local Authority colleagues, whilst recognising the
             need to maintain quality through this transition period.

Stroke and Cancer Update
Ms Ali was unable to give an update this item was deferred until the next meeting.

Mr Bacon gave a verbal report on the progress of the Cluster. He stated that SHA’s will be
clustered by 3rd October 2011. NHS Management Boards will be reconstituted during
October to include the four SHA Cluster Chief Executives and Senior Responsible Officers
for the new national bodies and relevant Department of Health leads. Mr Bacon recognised
that this will have implications for the Cluster.

Black Country Cluster                                                          Board meeting
Minutes of meeting held on Tuesday 26      Page 3                             30 August 2011
July 2011
Mr Bacon reported that another away day for NEDs is being organised to consider and
discuss the implications of the guidance received for governance. He also informed the
board that the Clinical Senate has appointed Dr David Hegarty as Chair. Finally Mr Bacon
talked about the recent publication of Healthy Lives Healthy People, and he went on to state
that the Director of Public Health is expected to be directly accountable to the Chief Officer
of the Local Authority when Public Health moves to the Local Authority.

Resolution: The Board noted the report.

Mr Green reported a £5.4 million under spend so far in 2011/12, slightly ahead of trajectory;
with the full year forecast remaining £17.7 million under spend. Mr Green stated the Cluster
has a QUIPP target of £100m for the 2011/12 financial year with the majority of schemes
having been built into contractual arrangements. The majority of the year to end surplus has
arisen against the Planned Surplus line, and he recognised there are other lines which are
reporting substantial variances. He went on to state that there are a number of risks
emerging to the delivery of the QUIPP programme in 2011/12 and 2012/13 the most
challenging of which is over performance on commissioning healthcare. However early
signs suggest that the over performance previously reported at Walsall, Sandwell and
Wolverhampton PCTs is likely to continue. Dudley PCT has not identified any significant
variances from planned activity during May; forecast over performance has arisen across
Royal Wolverhampton Hospitals (£3.5m) and Walsall Healthcare (£1.8m). Significant over
performance is identified for Royal Wolverhampton Hospital Trust with a forecast outturn
estimated at £3.3m, without remedial action elective budgets are forecast to overspend by
3%. Outpatient budgets are also experiencing pressure and if this trend continues will over
perform by 5% at year end. The largest variance appears at Walsall Healthcare Trust and
has arisen against Maternity activity. Early investigations suggest changes to maternity
services at Sandwell and West Birmingham Hospitals which was incorporated into plans for
2011/12 has resulted in activity which is greater than initially anticipated.

Mr Green reported on the variances identified in non NHS activity across the four PCTs in
the Black Country with the most significant issue relating to forensic ‘step-down’
requirements for a number of continuing care placements at Wolverhampton. This has been
offset by utilising some of the PCT contingency.

Mr Green went on to state that the year to end under spend of £270k against Primary Care
has been forecast to continue, with the largest forecast under spend (£950k) relating to two
of the three equitable access contract at Walsall PCT.

Mr Green reported on the early signs of over performance against secondary care contracts,
which is a concern for this year but potentially a more serious issue for the next year. He
also confirmed that all contracts with NHS Acute Trusts have now been agreed and
contracts signed. Variances have been identified across most of the PCTs in the Black
Country during the first two months of the financial year. A rectification plan is being
constructed to address this situation.

He reported on outpatient budgets experiencing pressure and if the trend continues there will
be an over performance of 5% at year end. Pressure appears in both Sandwell & Walsall
with regard to the Pharmacy contract. Both PCTs are forecasting a deficit which collectively
amounts to £800k and relates to dispensing fees.

Mr Green stated that confirmation has now been received from the Strategic Health Authority
that all of the schemes have been approved and the non recurrent released back to the
PCTs. Finally Mr Green reported that Capital Expenditure plans have been agreed by the
Strategic Health Authority.

Black Country Cluster                                                         Board meeting
Minutes of meeting held on Tuesday 26      Page 4                            30 August 2011
July 2011
A detailed discussion took place around over performance of the acute trusts and the board
agreed to bring this item back to the meeting in August for further review.

In response to a question from Mr Nugent in relation to how the delivery of QIPP will be
monitored, Mr Bacon stated reports are received through a central QIPP office each month
of each individual QIPP scheme across the Black Country, risks and issues from which the
board will be kept fully briefed.

In response to a question from Mr Oatridge in relation to what proportion of the £100m is
contractual dependent, Mr Green agreed to update the board at the next meeting.

In response to a question from Mr Oatridge in relation to Public Sector Payment Policy, Mr
Green recognised the need to improve performance in this area and agreed to update the
board at the next meeting.

A number of appendices supported the paper.

Resolution: The Board received the report for assurance and noted the over activity
            within the Cluster where more analysis is to be reported.

Mr Green stated that this was an overview of the latest performance of the four constituent
PCTs in the cluster. A number of detailed appendices supported the summary table within
the report produced by Mr A Wilson. Mr Green stated that action plans are in place to
address breaches around mixed sex accommodation.

In response to a question by Ms Devi as to why there were gaps in data, Mr Green stated
that the gaps related to specific performance and was an area where issues were being

In response to a question by Mrs Cooper in relation to Choose and Book, Mr Williams
recognised that this was an area for concern, and could be raised at the Primary Care sub-
committees of the PCT board to receive views from GPs.

Mr Orme stated that at the beginning of June he was informed that the meeting of Patient
and Public Steering Group had been wound up. Mr Orme is to raise this item at the Dudley
Group of Hospitals Board meeting in due course and asked for the Cluster Board not to lose
sight of this item.

Resolution: The Board is asked to note the report for assurance, and noted the areas
              of concern.

Mr Williams provided a verbal update on the emerging key areas of work, with the highest
profile issue being related to the configuration of the Clinical Commissioning Groups (CCG).
Mr Williams stated, following a meeting with Clinical Leads the Cluster set out its view, that
out of eight groups Dudley was the only formed group likely to be authorised given the
revised guidance that is emerging from the government. He went on to explain three tests
that the CCGs would need to pass for authorisation, stating that the SHA are now RAG
rating CCGs using these tests.

Mr Williams stated that colleagues in the emerging group have been engaged and invited to
communicate how to achieve configuration without disengaging with colleagues in general

Black Country Cluster                                                         Board meeting
Minutes of meeting held on Tuesday 26      Page 5                            30 August 2011
July 2011
practice. Mr Williams recognised the tight timescale of 6-8 weeks to move forward and
conclude on configuration, a more definitive report is expected within the next few days.

Dr Archenhold requested an update at the next meeting on the authorisation of the other 7
consortiums and this was agreed.

Finally Mr Williams was pleased to announce that leadership arrangements for the four work
streams have been identified through the skills exchange programme. Lynne Allen has been
appointed to lead on the Development of Primary Care, Kimara Sharpe, Project Manager for
the Commissioning Support Service Development, John Dicken, to coordinate and authorise
Clinical Commissioning Groups, and Les Williams, Lead for Strategy and System Planning.

Resolution: The Board received the detailed verbal update, welcome the
            identification of three tests, and note the board requires an update on
            the discussions between the consortiums that are not going to meet the
            size criteria.

Ms Hodgson presented the report which was written by Mrs Kimara Sharpe. Ms Hodgson
asked the board to defer the approval of the Assurance Framework until the next meeting to
ensure gaps are completed.

Resolution:   The Board accepted and noted the report.

Mr Bacon reported on the key points of the Job Description and highlighted the purpose of
the post.    In response to a question by Ms P Jones, Mr Bacon stated the post will help
establish the networks that will assist Healthwatch to operate effectively and facilitate the
transition. He went on to explain in relation to the Health and Well Being Boards, the post
will supervise from a health perspective the best way to coordinate the work in directorates,
during the transition arrangements.

Resolution: The Board approved the establishment of the post of Black Country
              Cluster Assistant Chief Executive for Partnerships subject to changes

Tuesday 30 August 2011 at 14.00hrs, the Boardroom, Sandwell PCT, Kingston House, West
Bromwich, B70 9LD.

The meeting closed at 16.50hrs.

Black Country Cluster                                                         Board meeting
Minutes of meeting held on Tuesday 26     Page 6                             30 August 2011
July 2011

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