NHS Brighton and Hove Clinical Commissioning Group (CCG) Governing Body Meeting held in Public - NHS Brighton and Hove CCG
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NHS Brighton and Hove Clinical Commissioning
Group (CCG) Governing Body Meeting held in
Public
DRAFT Minutes
Date: Tuesday 6 October 2020
Time: 14:30 – 17:00
Location: Meeting held virtually (MS Teams)
Present:
Chris Adcock (CA) Chief Finance Officer
Karen Breen (KB) Interim Chief Officer
Allison Cannon (AC) Chief Nursing Officer
Jane Chandler (JC) Independent Clinical Member – Registered
Nurse
Adam Doyle (AD) Chief Executive Officer
Samantha Durrant (SD) Lay member – Finance and Performance
Gill Galliano (GG) Lay Vice Chair
Elizabeth Gill (EG) Joint Chief Medical Officer
Nina Graham (NG) Locality Representative
Andy Hodson (AH) Clinical Chair Meeting Chair
Mike Holdgate (MH) Lay Member – Patient and Public
Engagement (PPE)
Jerry Luke (JL) Independent Clinical Member – Secondary
Care Clinician
Andrew Taylor (AT) Lay Member – Governance
Charles Turton (CT) Independent Clinical Member – Secondary
Care Clinician
In attendance:
Lola Banjoko (LB) Executive Managing Director
Ramona Booth (RB) Director of Planning, Performance and
Intelligence
Nicola Bottomley (NB) Company Secretary, East Sussex and
Brighton and Hove
David Cryer (DC) Executive Director of Strategy
Tom Gurney (TG) Executive Director of Communications,
People and Public Involvement
Peter Kottlar (PK) Executive Managing Director – Sussex Wide
Complex Commissioning
Moosa Patel (MP) Corporate Governance Support
Emma Snowdon (ES) Senior Governance Officer Minutes
Terry Willows (TW) Executive Director of Corporate Governance
Two members of the public were in
Members of the public attendanceItem
Item description Action
ref
1. Welcome and apologies
1.1. Apologies and welcome
The Chair welcomed all those attending and noted that the
meeting was being recorded and would be posted on the
organisation’s website. Members of the public were admitted to
observe the meeting virtually.
There were no apologies for absence received from members.
The Governing Body was quorate.
1.2. Declarations of conflicts of interest
The Governing Body noted that there were no new or existing
declarations of interests considered prejudicial to any of the
agenda items.
1.3. Questions previously submitted by the public
The Chair noted that no questions had been received from the
public ahead of the meeting.
1.4. Minutes of the Previous Meeting
The Chair presented the draft minutes of the previous meeting
and invited comments.
The Governing Body resolved to approve the minutes of its
meeting held on 28 July 2020 as an accurate record.
1.5. Action Log
The Governing Body reviewed the action log. There was one
action recommended for closure.
The following matters were highlighted:
Action 10 remained in progress.
The Governing Body resolved to note the Action Log and
approved Action 10 to remain open at this time.
1.6. Report from Clinical Chair
The Chair presented the report.The following matters were highlighted:
Amy Galea was welcomed to the CCG as the new Executive
Director of Primary Care.
Thanks were given to Wendy Carberry the outgoing Executive
Director of Primary Care, who had a long and distinguished
career in the NHS and would be missed. Over the past two to
three years, Wendy had worked tirelessly to help develop the
Primary Care Networks.
The Annual General Meeting had been successful and the
governance and communications team were thanked.
There would be an annual review of the constitution, and
Governing Body members would shortly receive details of
workshops and opportunities to input into the process.
The Governing Body had held an Extraordinary meeting in
private on 29 September 2020 in response to national Phase
3 requirements from NHS England/Improvement around CCG
mergers. The Governing Body had resolved to approve
retaining the current CCG footprint; specifically NHS Brighton
and Hove CCG, rather than merge with NHS West Sussex
CCG and NHS East Sussex CCG.
The Governing Body resolved to note the Clinical Chair’s written
report.
Action 11: Karen Breen to take the Primary Care Transformation KB
plans to Primary Care Commissioning Committee (PCCC) and 08/12/20
the Joint Sussex Committee (JSC) as part of the restoration
programme.
1.7 Interim Chief Officer and Executive Managing Director
Report
Karen Breen (KB) and Lola Banjoko (LB) presented their report,
which provided an overview of the key updates of relevance to
NHS Brighton and Hove CCG since the Governing Body’s July
2020 meeting.
The following matters were highlighted:
Planning was underway for the EU transition period which
was ending 1 January 2021, and in preparation for that each
NHS organisation had been asked to nominate a Senior
Responsible Officer (SRO). Terry Willows (TW) would take
on that SRO role. The Black Asian Minority Ethnic (BAME) disparity programme
of work was highlighted.
CCGs would be working with system partners to deliver a
series of planned events and activities coordinated across
Sussex to recognise Black History Month in October which
aligned to priorities within the BAME Disparity Response
Programme.
Local Update:
The Local Government Association (LGA) had facilitated a
review of the Brighton and Hove Health and Wellbeing Board
(HWB) last year, however this had been paused as a result of
Covid-19. The review was now underway again and the HWB
was looking to widen the involvement and representation of
key NHS provider partners; Brighton and Sussex University
Hospitals NHS Trust, Sussex Community NHS Foundation
Trust, and Sussex Partnership NHS Foundation Trust. As
part of the review process over the next two months the HWB
would be undertaking a period of engagement with system
partners and stakeholders to help inform the review. The
CCG was a statutory member of the HWB and would have the
opportunity to feed into the review.
The CCG had commissioned additional triage capacity from
ARCH Healthcare as part of the national “care and protect”
model in March to ensure that the homeless and rough
sleeper group, who had been housed by the local authority in
hotels since then, had access to health and support services
and were registered with a GP practice. ARCH has produced
a positive film which highlighted the support for this vulnerable
community during the pandemic, and could be found via the
following link, which was picked up by local media:
https://m.youtube.com/watch?v=WzI_DXOp7c4
In terms of the national BAME programme, one of key issues
identified was the recording of ethnicity data. Without the data
it was difficult to target specific groups within the community.
This would be addressed via the Sussex Data Integration set,
and a proof of concept was already in place. Lots of targeted
engagement with the BAME community was taking place.
The following points were raised in discussion:
It was noted that all practices in Brighton Hove with a BAME
community had taken up the specific Locally Commissioned
Service (LCS) and uptake had been high considering it was a
voluntary LCS. It would be important to engage with theBAME community to identify any barriers to accessing GP
services to address any disparity.
Concerns were raised about the European citizen staff within
health and social care following EU transition. It was noted
that a programme of work was in place across the Sussex
Health and Care partnership which looked to address the
potential workforce challenges. It was noted that a workforce
report would be brought back to the Quality Committee in
November, and as part of this, the EU transition workforce
challenges and mitigations would be addressed. It was noted
that an update had also be taken to the recent Audit
Committee in relation to EU exit and preparedness.
It was noted that although the update on Crawley East Surrey
Horsham and Mid Sussex (CRESH) System did not
specifically detail the risk and impact on Brighton and Hove
CCG there was minimal impact on Brighton and Hove patients
from a population perspective.
Reference was made to the safeguarding reviews at 2.6, and
a request made that the link be shared. It was noted that a
comprehensive update had been taken to Quality Committee.
It was noted that the ARCH video was a real demonstration of
value added, and it would be useful to receive more detail into
the next steps. It was noted that the CCG had a statutory duty
to reduce health inequalities and this was a positive example.
Work had been carried out jointly with the Local Authority and
integrated homeless strategy was being overseen by the
Integrated Care Partnership. A comprehensive report had
been taken to the Quality Committee on the Regulation 28
which could be shared.
It was noted that a detailed report on the staff survey results
would be taken to the next Quality Committee and the People
Plan recommendations would be brought to the following
Quality Committee.
The Governing Body resolved to note the report, including key
updates for NHS Brighton and Hove CCG.
Action 12: Tom Gurney to ensure workforce challenges and TG
mitigations related to the EU transition are featured within the 25/11/20
workforce report coming back to Quality Committee in November
2020.
Action 13: Allison Cannon to share the link to the safeguarding AC
reviews, referred to at 2.6 of the report, with Samantha Durrant. 08/12/20Action 14: The Governance team to share the homeless report, Governance
which had been taken to Quality Committee, with Samantha Team
Durrant. 08/12/20
2. Strategic developments and other reports
2.1. Integrated Care System (ICS) development update
David Cryer (DC) presented an update on the developing ICS.
The following matters were highlighted:
ICS were a key component of the NHS Long Term Plan (LTP)
and of the CCGs response to it, the Sussex Strategic delivery
plan.
Sir Simon Stevens, Chief Executive of the National Health
Service in England, had recently been quoted in the Health
Service Journal talking about expected legislation for ICS in
2021.
The intent of an ICS was to help Providers and
Commissioners work more closely together to integrate care
for the benefit of patients. This was a significant policy change
away from competition and towards collaboration in the
delivery of healthcare and decision-making around Health and
Social Care, to make it easier for collective management of
day-to-day performance and longer-term transformation.
The Sussex Health and Care Partnership (SHCP) had
become an ICS in April 2020. Its collaborative structure and
relationships had worked effectively and been strengthened
during the Covid-19 pandemic and supported delivery of the
CCG’s response to it.
The ICS required all partners, including CCGs, to consider
how they worked together and how they discharged their
responsibilities, particularly around assurance, governance
and leadership. There were some key areas that needed to
be explored, the impact on the CCG needed to be understood
to ensure that it could maximise the benefits of the developing
ICS.
A System Reform Steering Group was being established to
engage the Governing Body and others in discussion around
ICS development. The Group would agree a wider
engagement process with Governing Body members and
CCG member practices.The Governing Body discussed the positive developments in the
Sussex ICS. The following points were raised:
The aspiration to gain assurance within a partnership of
equals was noted. The timescale to commence formulating
plans would likely be November/December and would depend
on the governance review being carried out on behalf of the
Chairs Forum.
The mandate of representation of General Practice within the
Partnership Executive Group of the ICS was queried and the
aspiration to strengthen this was noted. The Steering Group
would be formally requested to consider this.
The representation of patient and public within the ICS was
also to be considered.
The governance review was requested to look at
representation and to include feedback from Governing Body
members.
The Governing Body resolved to:
Note the update.
Agree the positive developments in the Sussex ICS.
Endorse the process for engaging the Governing Body and
membership on the implications for Commissioners.
Action 15: Andy Hodson would formally request that AH
representation of primary care, patients and public within the ICS 08/12/20
was discussed at the System Reform Steering Group and the
outcome of this discussion to be brought back to the Governing
Body.
Action 16: David Cryer to request that the Governance review
engages with Governing Body members in relation to the DC
representation of primary care and patients and public within the 08/12/20
ICS.
2.2. Extension of Joint Committee for NHS111/Clinical
Assessment Service (CAS) mobilisation
Peter Kottlar (PK) presented the report, which included the
Agreement and Terms of Reference (ToR) for the Joint
Committee for the Mobilisation and Delivery of NHS111 and the
CAS across Kent, Medway and Sussex.
The following matters were highlighted: Following the agreed deferral of the NHS 111 CAS service by
six months due to the Covid-19 pandemic, the service had
successfully mobilised on 1st October 2020. The benefits of
the CAS function were already being seen at the front end of
the Urgent Care system.
The Agreement and ToR for the Joint Committee for the
Mobilisation and Delivery of NHS111 and the CAS across
Kent, Medway and Sussex had been updated to reflect a
further six months extension sought to the end of March 2021.
It was proposed that a single Governing Body GP or Clinical
member represented all three Sussex CCGs. This was
consistent with the requirement of a single Lay Member
representing all three Sussex CCGs, with the aim of
alleviating pressure on Governing Body Clinicians to attend
the meetings.
The following points were raised in discussion:
In relation to 10.2 which set out how the CCGs would
maintain effective oversight, assurance was requested that
the actions outlined were being carried out. It was noted that
the minutes of the Joint Committee would be provided in Part
2 of the Governing Body meeting.
The Governing Body resolved to:
Note the background and context that had led to a deferral of
the original go-live date of NHS 111 and the CAS to 1 October
2020.
Approve the updated Agreement and Terms of Reference of
the Joint Committee for the Mobilisation and Delivery of
NHS111 and the CAS, effective October 2020, thereby
extending the duration of the Joint Committee by six months.
Approve that delegated authority was given to the three CCG
Clinical Chairs to appoint the CCG Governing Bodies’
representatives on the Joint Committee for the Mobilisation
and Delivery of NHS111 and the CAS across Kent, Medway
and Sussex.
2.3. Covid-19 update
TW presented the report and gave an update on significant
Covid-19 developments.The following matters were highlighted:
The paper set out the infection status at the time of writing,
however the Director of Public Health had more recently
announced on 6 October that the Covid alert status would be
increased in Brighton and Hove up to Amber, in recognition
that the number of cases had increased in the previous seven
days. This recognised that there had been an increase in the
amount of testing available within the city, rather than a
significant upturn. It was noted that there was concern
particularly regarding the 16-25 year old cohort.
Whilst infections were increasing in Brighton and Hove, there
was not a concurrent pattern in the surrounding Sussex
areas. The seven day infection rate had reduced in
surrounding areas and hospital admissions had reduced
across Sussex, with no patients in Intensive Care Units.
Adam Doyle (AD) gave an update on the Resilience Forum.
During the first wave of Covid-19, the Sussex Resilience
Forum (SRF) had converted into the Strategic Command
Group, for leaders across Sussex to collectively consider how
the Public Sector system could work together to respond.
Over the next six months, the system anticipated having to
manage a resurgence in Covid-19, exiting the European
Union (EU) and the winter period. This would have different
impacts for each Public Sector organisation and could cause
significant issues if they did not work well together.
An Executive Steering Recovery Group had also been
established, to be clear what recovery would look like
collectively. The Group had agreed that it would focus on four
main areas:
o Skills
o Culture and Tourism
o Community cohesion
o Resilience of Public Sector organisations
The CCGs’ Executive Managing Directors had been asked to
play a role in place regeneration and recovery, not just on the
recovery of NHS services but also on the recovery of the
wider Public Sector.
The following points were raised in discussion:
It was noted that the report was helpful and it was queriedwhether Governing Body members could receive a more
regular update.
The Governing Body resolved to note and take assurance from
the update provided on Covid-19 developments and the system’s
ongoing response.
Action 17: Terry Willows to review the regularity of the Covid-19 TW
update report to Governing Body members. 08/12/20
3. Assurance and Committee Reports
3.1 Board Assurance Framework (BAF)
TW presented the Board Assurance Framework (BAF).
The following matters were highlighted:
The draft BAF had been approved by the Audit and
Assurance Committee on 16 September 2020.
The BAF articulated the CCGs’ overall achievement of the five
Corporate Goals and gave an assessment of the strategic
risks the executive believed would impact on the delivery of
these.
Corporate Objectives would be finalised and agreed by the
Joint Committee of the Sussex CCGs in November 2020.
Future iterations of the BAF would show by exception where
these were materially adrift and needed to be escalated to
Governing Bodies.
Committees would review the relevant Operational Risk
Registers ahead of Governing Body meetings and determine
whether there were any significant risks that needed to be
escalated to the BAF for Governing Body oversight and
consideration.
An alert status was included in the top right-hand corner of the
BAF which showed if the overall assessment of progress
against the Corporate Goal was stable or had improved or
deteriorated.
If used effectively, the BAF would influence the workplans
developed for each Committee and direct the Governing
Bodies on areas where they would require further assurance
or information.
The following points were raised in discussion: It was noted that comments raised at the Audit and Assurance
Committee had been considered but had not necessarily been
included within the version of the BAF. The comment raised
related to the importance of having a method that provided
assurance that controls in place against the risks had been
tested and were appropriate.
There was consensus that the developments of the BAF had
been useful, and it was now easier to follow and told a clearer
story.
The Governing Body resolved to:
Review and approve the revised Board Assurance
Framework
Take assurance on the CCG’s progress towards, and
controls and assurances around, each of the five Corporate
Goals.
Action 18: Terry Willows to set out how controls in place for risks TW
are tested within the next iteration of the BAF report taken to the 11/11/20
Audit and Assurance Committee.
3.2 Finance and Performance
3.2.1 Report from the Finance and Performance (F&P) Committee
held 30 September 2020
Samantha Durrant (SD) presented a report from the Finance and
Performance Committee meeting of 30 September 2020.
The following matters were highlighted:
The Committee had agreed that they were content to delegate
responsibility for finalising the revised Terms of Reference for
the Joint Finance and Performance Committee to the three
Chairs and the Executive Director of Corporate Governance.
Although it was not reflected in the paper, Chris Adcock would
also be invited to join these discussions.
The ongoing uncertainty with regards to the recent changes to
the financial framework for Months 7-12 was noted, which
would require a further update when resolved.
The need for further clarity in respect of individual CCG
statutory duties in the context of financial flexibility at
Integrated Care System (ICS) level was noted particularly
given the significant sums had already been allocated across
the system. It had been requested that wider performance data could be
presented including national and regional detail.
The Governing Body resolved to take assurance from the
discussion that took place at the Committee meeting on 30
September 2020.
3.2.2 Summary of M5 Finance Report
Chris Adcock (CA) presented the summary Month 5 Finance
report.
The following matters were highlighted:
It was noted that final system planning returns based on the
revised month 7-12 financial envelope were now due 20
October.
Assurance was provided in relation to engagement with ICS
system Chief Financial Officer (CFO) colleagues and CFOs
had collectively agreed to peer review key components of
their financial returns.
The year to date deficit was £1,128k, and the in-month deficit
was £967k. The difference of £160k was for a claim made in
month 4 for Covid-19 funding for which NHS England /
Improvement (NHSE/I) had requested additional supporting
information, prior to releasing the balance of funding.
The CCG had not achieved on one of the Better Payment
Practice Code (BPPC) targets in month 3 because insufficient
cash was available in May 2020 resulting in some NHS
invoice payments being delayed until 1 June 2020, causing a
breach in June 2020. All targets had been met in subsequent
months and the position had now largely been recovered.
The report set out a number of areas of overspending offset
by underspending on prescribing, and the circumstances were
being reviewed.
The risk assessment contained within the report reflected the
achievement of the statutory break even position being
dependent on the successful conclusion processes outside
the direct control of the CCGs.
The following points were raised in discussion:
It was noted that although guidance for month 7-12 guidanceraised many questions, it was important for the CCG to be
substantially complete in the reporting of any issues by 20
October. Issues would be brought back to the Governing
Body.
The scale of outstanding issues being worked through was
noted.
An aged debtor was defined as a payment exceeding 30
days.
The Governing Body resolved to:
Take assurance from the reported position at Month 5.
Note the NHS Brighton and Hove CCG Month 5 position.
3.3 Restoration and Recovery
3.3.1 Report from the Joint Committee of the Sussex CCGs held
16 September 2020
The Chair presented the report from the last Joint Committee of
the Sussex CCGs’ meeting held on 16 September 2020.
The following matters were highlighted:
The Committee had discussed the Operational Risk Register,
and how it would be used and presented within the various
sub committees.
There was an update on the Covid-19 decision log.
The Committee had received an update on restoration, in
particular the CCGs’ response to the Phase 3 letter of 31 July
2020.
There was also discussion regarding the IT procurement
service and the approach was endorsed.
The Governing Body resolved to take assurance from the
discussion that took place at the Committee meeting on 16
September 2020.
3.2.2 Planning and restoration update
Chris Adcock (CA) presented a report that provided the
Governing Body with an overview of the Sussex system’s Phase
3 plan and current performance against the Phase 3
requirements.The following matters were highlighted:
The paper was the first of the more focused briefings which
had been requested by the Governing Body, and built on the
detailed reports received by the Joint Committee and
Executive Management Team.
The paper provided an overview of the Sussex system’s
Phase 3 plan and current performance against the Phase 3
requirements.
The report set out specific plans and trajectories related to the
following key areas:
- Acute Care: 52-week waits, cancer long waiters,
diagnostic capacity
- Mental Health: Improved Access to Psychological
Therapies (IAPT), Dementia Diagnosis
- Primary Care: Annual Health Checks for those with
Learning disabilities, Physical Health Checks for those
with Serious Mental Illness
The report also detailed system risks (testing, patient choice
and behaviour, workforce and hospital discharge)
Ramona Booth (RB) and Lola Banjoko (LB) provided the
following further updates in relation to the system risks which
were specific to Brighton and Hove:
52 week waits and Cancer 62 day Patient Treatment List
(PTL) remained challenged within Brighton and Hove. 52
week waits made up half of the overall system number and
related to cancer and endoscopy. It was forecast that this
would increase until year end. Brighton and Hove had the
highest number of 62 day waits, however it was anticipated
that this position could be fully restored back to pre- Covid-19
levels of activity.
The Brighton and Hove system was currently fully compliant
with outpatient follow-ups, Computed Tomography (CT) and
Magnetic Resonance Imaging (MRI) requirements of the
Phase 3 letter.
Current performance indicated that there needed to be a step
change in performance in October and November to reach
stated objectives for day case, day patient and endoscopy.
There was an additional risk related to IAPT services in
Brighton and Hove.LB set out the challenges in terms of the restoration and
recovery.
In terms of the 52 week waits, it was a clinical prioritisation
process.
The specialities with the greatest challenge were Trauma and
Orthopaedics and Ophthalmology, and work was taking place
to increase capacity.
Endoscopy was the biggest challenge in terms of cancer, and
lots of insourcing was now going on and plans would seek to
further streamline the pathways in place.
Further optimisation work was taking place around the non-
admitted pathways using digital options.
The Clinical Commissioning Reference Group had recently
been reinstated, chaired by the Local Medical Director which
should bring the challenges from Primary Care into the
meeting with the Trust and to ensure there was shared
decision making.
The following points were raised in discussion:
It was noted that the paper needed to be viewed in the
context of the financial arrangements facing the NHS. Risks to
the system needed to be really clearly set out and understood
prior to the submission in October.
The Governing Body resolved to note and take assurance in
relation to the:
Phase 3 requirements and system approach to Phase 3
planning.
Specific plans and trajectories relating to the following key
areas:
o Acute Care: 52 week waits, cancer long waiters,
diagnostic capacity
o Mental Health: IAPT, Dementia Diagnosis
o Primary Care: Annual Health Checks for those with
Learning disabilities, Physical Health Checks for those
with Serious Mental Illness.
System risks (testing, patient choice and behaviour, workforce
and hospital discharge).
3.4 Quality and Safety3.4.1 Report from the Joint Quality Committee held on 8
September 2020
Jane Chandler (JC) presented a report from the Joint Sussex
Quality Committee meeting of 8 September 2020.
The following matters were highlighted:
The British Pregnancy Advisory Service (BPAS) level of risk
had been de-escalated. The provider had provided a
comprehensive thematic review of the incidents that had
occurred nationally, including incidents in Sussex, and this
had been submitted to all the CCGs across the country, as
well as through the Serious Incident (SI) process, which had
been submitted to the Sussex SI scrutiny panel.
There had been a surge within mental health acute services
as predicted, and the six breaches referred to within the report
related to Western Sussex Hospital.
The Committee had received an update in relation to the
National Flu programme.
There had been significant debate related to the Annual
Public Involvement report, and the challenges of acquiring
public opinion in the Covid-19 world was noted. The
Communications, People and Public Involvement Team was
working with Governance Team around how public queries
could be handled differently.
The following points were raised in discussion:
The report noted that the lay members had met and had
dialogue with the Communications, People and Public
Involvement Team and a specific action had been taken for a
summary of these discussions to be provided to Joint Quality
Committee members for further assurance. It was queried
whether the governance review could pick up whether this
action did provide the necessary assurance to the Quality
Committee.
The Governing Body resolved to take assurance from the
discussion that took place at the Committee meeting on 8
September 2020.
Action 19: Terry Willows to ensure that as part of the TW
governance review consideration was given to the mechanisms 08/12/20
in place for providing assurance for all of the CCG’s statutory
functions, including PPI.3.4.2 Winter Plan update
Lola Banjoko (LB) presented an update on the plans that had
been developed across the Sussex Health and Care Partnership
(SHCP) to prepare for winter.
The following matters were highlighted:
The Winter Plan had been discussed earlier in its
development by the Joint Sussex Quality Committee and had
been discussed by the Finance and Performance Committee
on 30 September 2020. The plan had been corrected based
on feedback from the Committee in advance of submission to
the Governing Bodies.
The plan was underpinned by extensive documents at an ICS
level, including the system wide plan, extensive place based
plans and organisational plans. These had been submitted to
NHS England (NHSE) on 1 October 2020 as draft winter
plans. Feedback on the plans was expected in the next
fortnight.
Plans had also been through extensive development and
review by Local Accident and Emergency Delivery Boards,
Local Management Teams, the Executive Management Team
(EMT), Health and Wellbeing Boards and Health Overview
and Scrutiny Committees.
This was a Sussex ICS plan. An ICS Assurance Group had
been setup to consider, take assurance on and request
amendments to this, in advance of the submission to the
Governing Bodies. The plan had been signed off by the ICS
Silver Group and ICS Chief Executive Group in addition to
normal CCG and other statutory structures.
Plans included actions around capacity and discharge,
communications, flu, severe weather, Primary Care and MH.
For 2020/21, escalation and oversight arrangements on
winter, Covid-19 and the end of the EU transition period, had
been combined. There was also an integrated approach to a
set of escalation triggers.
Extensive work on demand and capacity modelling had
informed the Winter Plans and actions contained in them and
the CCGs’ restoration plans. This had informed the system
actions around discharge arrangements and the need to
maintain as low a number as possible of people waiting in
hospital who were fit for discharge. This would be important
for delivery of Elective Phase 3 and Urgent Care. An Executive Oversight Group had been setup to consider the
position on patients that were medically ready for discharge.
Plans around this continued to develop as Covid-19 changed
operation and as national hospital discharge guidance and
Adult Social Care guidance was implemented. This would be
built into draft plans during October 2020.
The Primary Care Winter Planning Group was undertaking
work around Primary Care planning.
The plan was linked to and aligned with work on financial
plans.
The plan would continue being developed in October 2020
with feedback from the Regional team and Local Authorities’
Winter Plans. An update on the plan would be presented to
the Joint Sussex Quality Committee in November 2020 and
Finance and Performance Committee in December 2020.
The following points were raised in discussion:
The significant assurance provided by report was noted. It
would be helpful if the report provided more insight into the
stand out risks.
The challenge of the system carrying such a significant
number of risks was noted particularly if all risks all
crystallised at the same time. It was noted that significant
work had taken place across Sussex on an escalation
framework to mitigate against a domino effect.
The Governing Body resolved to:
Take assurance from the report.
Note the update on the draft Sussex Health and Care
Partnership Winter Plan 2020-21 submitted to NHS England
and NHS Improvement on 1 October 2020.
3.4.3 Influenza Prevention Plan 2020/21
Allison Cannon (AC) presented the Influenza Prevention Plan
2020/21.
The following matters were highlighted:
The paper detailed the complexities and challenge associated
with the delivery of the National Flu plan for the CCG and the
system for 2020/21. The paper built on work presented to the Quality Committee
since July, and the Quality Committee recommended it would
be useful for the Governing Body to have visibility of the risks
and work being undertaken to mitigate against them.
The plan had also been approved by the Executive
Management Team (EMT) who agreed that EMT would
receive weekly updates around the progress made with
vaccinations to the eligible cohort. The data was now being
received.
The workforce in Primary Care and provider organisations
had risen to the challenge of ensuring the population could be
vaccinated.
Given the scale of the complexity this year, a number of task
and finish groups had been established to deliver the key
components of the Flu Plan.
A programme director and clinical lead were now in post to
provide additional resource.
The risks around vaccine supply and the delivery of the
vaccine to the system were noted. The CCG was working
closely with NHSE in relation to the phased delivery of the
vaccine.
Healthwatch had provided positive feedback that patients had
felt safe accessing flu vaccination.
The following points were raised in discussion:
It was noted that although the RAG rating for stock related to
preparedness, it may provide false assurance, given it was
out of the CCG’s control. NHSE had provided assurance in
relation to the supply of vaccination to meet demand. Data
currently demonstrated that demand was greater than this
time last year. Modelling had been carried out to determine
the demand and potential gaps and this had been sent to
NHSE and detail would be fed back via The South East
Regional Flu Board. Risks were being escalated.
Assurance was requested in relation to the additional cost of
the delivery plan due to Covid-19 and additional trained
workforce showing for completion by end September and the
process for communication out to providers. In relation to
funding, final confirmation was awaited from NHSE, and
would be communicated out to practices as soon as possible.
Online training had been provided across the system andwould feature in the next iteration of the plan along with the
arrangements of community providers.
The Governing Body resolved to:
Endorse the Sussex Influenza Implementation Plan.
Take assurance on the effective management of risk to the
successful delivery of the national influenza Programme
Objectives by the Sussex System Influenza Programme
Board.
Action 20: KB to support AC with escalation of concerns and KB
risks to the Regional Flu Board, in order that clear 08/12/20
communications can be provided around the issues faced.
3.5 Audit and Risk
3.5.1 Report from Audit and Assurance Committee held 30 July
2020 and 16 September 2020
Andrew Taylor (AT) presented reports from the Audit and
Assurance Committee meetings of 30 July and 16 September
2020.
The following matters were highlighted:
The NHS Sussex CCGs Audit and Assurance Committees
held their first meeting in Common on 30 July 2020.
The Committee received the following reports:
1) The development of the risk management framework.
2) The internal audit plan and associated risk. The
Committee did not take full assurance on the Progress
Report and Recommendation Tracker as it was felt
there was insufficient detail presented to support full
confidence in the programme. The committee
requested a more granular plan to demonstrate the
resources in place to deliver on the plan and would be
presented to the extra-ordinary Audit and Assurance
Committee next week.
3) The paper set out the appointment of external auditors
BDO for the audit of the Mental Health Investment
Standard.
The following points were raised in discussion: Discussion had taken place at the EMT in relation to the
deliverability of the internal audit plan and the resource to be
put in place to support this.
The Governing Body resolved to take assurance from the
discussions which took place at the Committee meetings on 30
July and 16 September 2020.
3.6 Primary Care
3.6.1 Report from Primary Care Commissioning Committee held
15 September 2020
Gill Galliano (GG) presented a report from the Primary Care
Commissioning Committee meeting of 15 September 2020.
The following matters were highlighted:
NHS Brighton and Hove CCG’s Committee was not quorate
due to the absence of voting clinical representation.
Decisions of the NHS Brighton and Hove CCG PCCC were
virtually agreed by the Independent Clinical Member -
Secondary Care Clinician on 20 September 2020. All
decisions had now been approved. A process had been put in
place to ensure the quoracy of future meetings. No decisions
on Brighton and Hove local matters CCG were taken at the
meeting.
The following points were raised in discussion:
The paper did not fully capture the excellent patient and public
engagement taking place around primary care service
provision within Brighton and Hove. It had also been promised
at the meeting that the future model for public engagement
would be confirmed at the PCCC meeting in November. It was
to be determined how this would this work within a Sussex
wide engagement session.
It was noted that the interim governance arrangements had
been agreed in April 2020 and had been reviewed more
recently and would be reviewed again in February 2021,
which should provide some stability.
The efficiencies of working at scale was noted, however
PCCC was a more place based committee and the population
of B&H was approximately 1/5 of Sussex so it would be
important to ensure scrutiny for place issues remained
possible.
The Governing Body resolved to take assurance from thediscussion that took place at the Committee meeting on 15
September 2020.
Action 21: Tom Gurney to discuss with Lay members on PPE TG
the most effective methods for the organisation to engage with 03/11/20
the population in the context of a pandemic, and a proposal to be
brought back to PCCC and the Governing Body.
3.7.1 Minutes of the Annual General Meeting
The Chair presented the draft minutes of the previous meeting
and invited comments.
The following matters were highlighted:
NHS Brighton and Hove CCG’s Constitution had been
updated, and the Annual General Meeting (AGM) was no
longer a decision making meeting. As a result the minutes of
the NHS Brighton and Hove CCG AGM held on Wednesday
15 September 2020 were presented for approval.
It was noted that the minutes of the previous AGM held in
2019 had been received at the meeting and had been
published on the CCG’s website.
The Governing Body resolved to approve the minutes of its
Annual General Meeting as an accurate record.
4. Closing
4.1. Governing Body Forward Planner
TW presented a draft agenda for the next meeting.
The Governing Body resolved to note the draft agenda for their
next meeting.
4.2. Any Other Business (to be notified to the Chair at least two
days before the meeting)
There were no further matters of business.
4.3. Evaluation of the meeting
There were no reflections raised.
4.4. Matters for Delegation to the Governing Body Committees
The following matters were for delegation to the Governing Body
Committees: Representation of PPE and primary care within the ICS to be
formally requested to be discussed at the System Reform
Steering Group and the outcome of this discussion to be
brought back to the Governing Body for wider discussion.
5. Date of Next Meeting
8 December 2020
14:30-17:00
Meeting to be held virtually
Resolution of items to be heard in private:
The motion was carried that “In accordance with the provisions of
Section 1(2) of the Public Bodies (Admission to Meetings) Act
1960, it is resolved that the representatives of the press and
other members of the public are excluded from the second part of
the Governing Body meeting on the grounds that it is prejudicial
to the public interest due to the confidential nature of the
business about to be transacted. This section of the meeting will
be held in private.”
Freedom of Information Act: Those present at the meeting
should be aware that their names and designation will be listed in
the minutes of this Meeting, which may be released to members
of the public on request.You can also read
