Joint Committee - 6th December 2018 (Thu, 6th Dec 2018 - 3:00 pm) 

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can I welcome everybody and welcome the members of the public who joined us as well and I just want to say something about to me I'm Alan Wells I'm the new Independent Chair of the joint committee my background is about The Thirty years running a government agency in education and then in the last 10 years I've been a non-exec director of a PCT of primary care trust and a lay member and deputy chair of a clinical commissioning group in north-east London and a member of the joint Committee in north-east London my term of office comes to an end there in March a and I believe in that's my maximum term of office
as the most important thing I can say is that turn I'm a patient
two years ago I had a kidney transplant so I used every service there is basically in the NHS because her after a kidney transplant my wife gave me one of her kidneys not the best one show I say
that term we still talk about that
but after that I had a couple of nasty infections are used pretty well every service that was in the NHS I saw both the really good things about the NHS
where at its best it is probably the best service in the world and I also saw some of the challenges faced by the NHS and some areas where perhaps we're not of the wrestling the world far from it and where we need to improve
I have already met a number of people around the table from north-west London and can I say thanks to everybody has been so welcoming and put themselves out to meet me
have before this meeting I hope to have met everyone well certainly stay and I hope to have been to a CCG governing body meeting in every one of the eight CCG's certainly by the end of January
I think the essential thing about being an independent chair is to be independent it sounds obvious but it's important to be independent I intend to remain independent independent of officers independent of individual CCG's because the only benefit in my view of having somebody independent is if they maintain their independence
as you know this is the joint committee
and I think the joint committee and CCG's the CC G's need to be the drivers in improvement in the NHS over the next few years and it's important that this Committee is not just a receiver of information
if only receives information will soon questioned whether it's worth meeting at all
so we need to make sure that it institute's action that it's assures itself when it's OK to assure itself and that it takes decisions are say something about that are not interesting minute it's also important that our decisions are informed by the individual CCG's in north-west London
not that we just communicate decisions we've taken to them but they they inform our decisions of the decisions that we take because they are the people on the ground
I don't want to say something about it
the way I tend to chair of committees
I take the view always everyone's read the papers so I don't encourage people presenting to read the papers
I encourage brief presentations of the major points of the paper that's being presented and illustrating any changes that have taken place since the paper was written I believe it's important to give more time for questions and discussion than just a have long presentations which limit the time for questions and discussion I also think it's important it's always difficult with microphones but to have free discussions and to be able to ask questions and to challenge it's quite important that we do challenge if we're asked be assured of something we need to eat just to be clear that we are assured and if we're not assured we need to be able to say why we're not what would make us a short because it's quite important where its minuted that were assured that we are that we have just ticked a box that we aren't just nodded its rope but we've asked the girl questions are important
can I also encourage the use of plain language now it's not unusual in all organisations it was true when I was in education and it's certainly true in the NHS that language grows up in organisations acronyms grow up I understand that we're not the organisation with the most acronyms in fact the Ministry of defence has the most acronyms I won't ask you how many think it has but it does have rather a lot so we're not top of the league table for accurate acronyms but it is important that we try to speak in language that particularly language that people members of the public can understand
and can contribute basically on the all the rest of us can understand I'm a lay member I'm not a collision
what I always say to people presenting is presented so you're presenting to your next door neighbour
it depends if you've got on with our course but to try and present in that way because if you can explain somebody your next-door neighbour then generally most people will understand what you're talking about the final thing I say this just in this point is this is a meeting held in public not a public meeting and there is a difference
at the end of the meeting we allowed 30 minutes for questions from the public and comments from the public
at the end of the meeting which is scheduled to be five or nine o'clock can I say they should be questioned the star in the remit of the joint committee not questions are
intended for just an individual clinical Commissioning Group wish you could ask those questions
usually at the meeting of the individual CCG I'm going to be quite liberal and tolerant about the questions you ask because I think it's important you are the members of the public you are the taxpayers who fund
the NHS so it's quite important that you have the freedom to ask those questions can I urge you unless you really need to do to make sure your mobile phones are on silent so they do ring I do understand that sometimes collisions need to have their phones so that they can actually hear them
about possible could you put them on to silent okay I first of all Kai Tate apologies we had Jules Martin Nichola Burbidge Melanie Smith and Martin Lees who are the apologies for today
I was I wanted to welcome some new people to us at least Paul Brown who sitting just down the end there though his hand our CFO chief finance officer who's taken over from Neil Ferrelly who retired at the last meeting and Jo Ohlson in attendance who is an
interim director of acute commission and Jo just put our hand and she's over there and Lynn Hill who's taken over from Graham Hawkes as CEO of Healthwatch Hillingdon you're very welcome
your chair
Chair of Hillingdon my apologies
okay one more thing to say This is are we as you know webcast and streamed this meeting so it's important to use the microphones there usually fairly self-explanatory although I know that sometimes they do get in the way of contributions but if you possibly can at the very end of the tables are the slot for people presenting and if you can give those up when you've actually presented so that somebody else can take over that would be very helpful understand there's going to be no fire drill at day off our chest of the alarm the usually is every meeting I chair usually have a fire alarm test but not today the Pyrex it's a marked so it should be an OK the final thing to say is we are no longer a shadow Committee the constitutions have been or the harmonised constitutions have been approved by NHS England are for all of the eight CCG's so we're no longer shadow committee this is our first meeting as a formal Committee
thanks very much for him but he did all the hard work to try and get to all of that through and I'll just ask Ben to say what this means in terms of procedures
thank you Chair so yes yes so NHS England have
put the constitution through the legal and compliance checks and have to affirm they are and they pass and they are now live and we are operating under that new arrangement so what this means is we are no longer a shadow committee and we are now able to act within the the full remit of the terms of reference that the governing bodies of all eight CCG's have agreed so this means we're able to take decisions in four key areas
firstly strategic matters in line with the health and care partnership plan was the STP and we were also able to agree Multipower commissioning plans and set the direction for across borough boundaries services and providers and and agree seven agreed the joint financial strategy
and later on in this meeting would be looking at the financial recovery plans part of that I'm just a word on how we make decisions and they can only be made with the unanimous agreement of all the voting members so what this means in practice firstly we must be Corot and that includes at least one representative from each of the eight CCG's
and secondly if he does come to a decision everyone has a vote and his present must vote in favour for that decision to be passed so if anyone votes against or abstains that that decision is not taken
and thirdly just to point out that in practice we very rarely have decision making by a show of hands and but if it does come to that we just need to be clear on the people who do have a vote and I will just quickly
described that for you
so the people round the table no votes its first of all it is the Chair ceased the Chair of each CCG and or They Deputy separate today that is the GP chair in a case of Hounslow has been delegated to marry Clegg
and other voting members of the accountable officer the chief finance officer and I it's advocate clinician and the Director of Quality in nursing
and the finale the three lay members will happen too
that's pretty much how it once we have a decision on the agenda later on the financial recovery plan and we will see that in action
OK thanks very much bent or can I just quickly go round the table and again introduce themselves I know you've got nameplates but I'm sure everybody in the audience can see the name plate so if we can just quickly go down no life histories but just a brief introduction of who you are stocking with Mark online
and Mark Easton and the chief officer of the north-west London CCJs
Diane Jones chief nurse and director of quality for north-west London CCG's M C Patel Chair of Brent CCG Jonathan Turner deputy managing director Brent CCG standing in for Sheikh Auladin
Andrew Steeden acting Chair West London CCG
Louise Proctor managing director for West London CCG
Philip young lay member
Lindsay Wishart lay member
Christine Vigars has watched representative
Lynn Hill Chair Healthwatch Hillingdon
Neville Purssell Chair of Central London CCG
and Nick Young Brent lay member patient representation
what Lizzie Bovill Director of performance in North West London CCG's here for the Winter planning item
Mary Clegg managing director Hounslow CCG
Janet Cree managing director Hammersmith and Fulham CCG
James Cavanaugh vice chair for Hammersmith and Fulham here for Tim Spicer our Chair
Tessa Sandall managing director Ealing CCG
Mohini Parmar Chair Ealing CCG
Javina Seghal and managing director Harrow CCG
Genevieve Small Chair how CCG
Caroline Morison managing Hillingdon CCG
Ian Goodman Chair Hillingdon CCG
Alex Harris taking the minutes
Paul Brown chief financial officer for north-west London CCG's
Juliet Brown the health and care partnership director
and Ben Westmancott Director of compliance
okay I am item to register of interests members were reminded that there is a register of interests they need to keep up to date if you bear new interest you should put them into the registry men dress if you have any interest today in India gender item you should declare them now
if you later decided that you have I don't think it's likely that you have
a conflict of interest and you need to be clear at that time I think there is a declaration that turf
what's to be made I think lie you Paul yes just pick a side and he just started Chair so they're not to in the declaration yesterday will be for next time to three declarations and have added to the register the first is that I was previously an equity partner of Rs them are some are internal auditors I was also previously a shareholder there was off this post before took a post I've sold out Sheldon
second thing is I was a non equity partner of Carl Ferrer who do provide consultancy services to the NHS and have provided consulting services to north-west London in the past and the third thing I was until September to scan the non-paying voluntary chairman of the social enterprise called Grange primary care collaborative see icy
patches his I ceased in September
thanks very much
and Kay a Minister of the previous Meeting I'll go through for accuracy first page by page A as signal if you want greatly accuracy Page 1
phase 2
can be signed as a correct record agreed
thank you
she's wrong
I think only actions are in fact
been progress or closed on late
the actions Juliet I've got next to the actions I think they are
charting the actions that were picked up in the health and care partnership report there appears left on the island of fine
OK report the council officer Marc
Chair I will take your stare and assume people over from read my report so alone I already had a few bits which there are additional I think the first thing to say is probably rather less on quality on this agenda than people would see normally we have the meeting this morning of the north-west London quality and performance committee and am I think Diane will take the opportunity to give her a quick debrief on that meeting when we got on to the item about when to preparedness but I'm sure nobody needs reminding them promotion of quality is an important part of our work and we will regularly feature on agendas of this meeting and the second thing I wanted to pick up is on page 2 and ready just highlighting that when we talk about the work of the North West London Partnership
people often have in mind very strategic long-term programmes
I just wanted to flag that some
earlier this month the joint health and care partnership board agreed three short term very specific
projects that they wanted to pick up
this is an IV antibiotics in a community cast to care and nursing homes and eligibility for community services across different boroughs so I think that's a really good example of where the partnership you know can and should demonstrate that is doing things to improve services for patients both in the short term as well as the strategic issues that we are grappling with the final thing I wanted to mention is the NHS 10 year plan rich sham we still believe is going to be published before Christmas although
it does appear to be somewhat delay I think what I particularly wanted to highlight as a paragraph in here about how the expectation is that there will be a process of public engagement and in the new year on the plan and I think that that is my reminder to say that some vigour the next meeting where both have a report on the 10 year plan and on our ideas about how we might engage with us with our public on it so happy to take any comments or questions
be questions for marking his report
it's to note that's not their decisions
OK thank you very much let's move on to a
preparation for winter which I think will be interesting to all of us you need to be aware that this is for assurance you need to be assured that these preparations are good enough
for the winter so it's not just that noting and Zionist Union
AQI especially suggests the matter in the paper and then for further discussion questions Lizzie is in in in attendance to discuss property to pick that out we did speak air and have a discussion at the G8 quality performers Committee this morning
there were also a few other themed items I think be helpful if we just gave a flavour of what we discussed this morning so that you are aware but a further paper will come to joint committees in future
so just to say that we had our thing areas we had one around a fractured hip so fractured neck of femur and we had a discussion about what we can do differently to improve the outcomes for patients where they have fractured hips and a paper will be going to our clinical and quality board to discuss that as a wider health and care partnership in in due course we also talked about the stretched the national strategy for reducing the equal eco lie which is a gram-negative bloodstream infection if any spur national reduction by 50 percent and so we are relaunching a strategy looking at how we can do our part in north-west London to see a reduction also and then finally we talked about was we had a deep dive into cancer and are commissioned services of 60 two days so those are three areas are themes that we talked about how how quality performers Committee this morning as well as looking at the Winter prepared this paper
so if I was going to introduce that paper and am introducing it as the Chair of poetic quality performance committee is that a paper which we had to submit for our north-west London looks at the floor or any deliverable the systems that we have across north-west London which we had to submit to NHS England to demonstrate our preparedness for managing and supporting patients for this winter period which effectively is between December but extended into April early parts of maize
what we've done is we've looked at Valencia from last year in terms of how we dealt with winter last year and how we can improve on that and that is what the plan which I have in front of you demonstrates what we feel we can put in place to support
going through winter in a very safe way for mainly of vulnerable patients
as we said the paper is therefore assurance so happy that Lizzie's also leave us to take any detailed questions or discussions at people to have around this paper thank you
so it's a subject close to my heart and Lizzie knows I'm going to ask about his integrated urgent care and what I found having had some involvement is in this is that we're making some changes now in the integrated urgent care system and we're joining things up and when patients know what they are and understand what they are and how they can access them patients seem to like them but there is
not enough knowledge and understanding of how you can access and how you can get a you can bring one one one and be booked into an extended access Harbaugh be booked to see your own GP and all this kind of thing because these are very very new things so patients think are with my GP is closed and I need to see someone quickly I have to go to A&E so is
making that bit really work is really dependent on how clearly and simply we explain to our patients how they can use the system or what's available
take the questions first and then if you really want to come back on Yasir Dion
it's really picking up
barely a point in terms of signposting and the sort of strategic approach to it his summing-up I think we're all the same sort of adverts on television telling her to get a flu jab and earlier this winter and be prepared and where you can go but what we really need to know really how effective it doesn't actually change behaviour in other words was the market was the communications spend effect
we think it is intuitively but do we actually know
how effective these met key strategic messages are from the centre
I think we do need a sort of strategic push from the centre and rather than just necessarily relying on newspapers picking up particular strands of it for whatever editorials on requirements they have
and really it's really taking a strategic approach to marketing and communication generally grisly unquestionable and
two points the first just to pick up on that
in the three central boroughs we have been doing work Healthwatch spin and work on the use of urgent care and it's very clear that people simply don't know what's available so there's a nice big need for Communications push on that
secondly it would be good to have an evaluation which I'm sure you will at the end of the year and can we be assured that that will include measures of patient experience of all these new initiatives
thank you Allah questions Genevieve
I'm just you and ask what the plans are to review these plans over the course of the wind had to ensure that their wherever responding to emerging themes
Greg McHugh
i'm player Yedlin hell and what's in the sector for many years and what I didn't get a sense from from this paper is how you're going to encourage the providers to work together collaboratively over the winter so that when there are precious in one area they are shared out rather than organisations working in isolation trying to get corporation collaboration from partner organisations
anyway getting people to the right place will serve might feel about the first one then there was a evaluation and whether that would include patient public feedback including reviewing the plans during the course of the winter I think was the suggestion there and making changes or so and those one again get him providers together I'm going to add one
as the property of the Chair which is are we tend that there are the right number of beds
for the winter because there seems to be a national concern already about there being too few Bates so dying if you can try and answer all of those not in work
it's Thin Lizzy and I am so I can particularly take the Number 3 and measures of patient experience that that was the question the science and then this is actually leading on the work in terms of the planning to respond
to the other queries and certainly we want to be able to we will be built an inpatient experience in patient stories what we're doing more more of is making sure that we bring those patient stories to our key committees and we want to introduce them to our joint Committee hair into all of our other governing bodies as well and attempts at the actual plan itself we will be gathering patient stories and experiences that will be part of how we evaluate how well the plan has
materialised throughout the winter
among others
alright alright
so far a couple of questions then it tells of a car mechanic communications campaign which was then see a necklace of question so we have a national communications campaign which is now ramping up as we go towards the Christmas period and the year which will be predominantly around
encouraging people to self care where possible using one by one to obtain advice around self-care using local services local pharmacies
were expecting the same as last year which was a wrap-around of the evening Standard on the metro making sure everybody's aware about GPs being available 8 8 The how you access those 3 1 1 1 which is the new part of the new system for this year
they are evaluated it is obviously very difficult for a local north-west London nor national perspective to really understand the impacts of the messaging and whether or not you chatted significantly changes behavior but we are we do have a communications strategy and campaign planned for this winter and North West London level around using our north-west London services and flew as well as complemented by the national campaign
in terms of evaluation we plan to evaluate the plans that we have in place after the new year so we will do that basically the first month after they've been put into use so that we can understand how things go in particular for the pressure points which will be Christmas the bank holidays and those key working days just between Christmas and new year when the pressure is really on the system
and to ensure that patients who were ready to go home have left over that period of time
and I would say just in terms of patient experience yes we will include patient experience of that time and journey over the winter however I'd also say that a number of the pieces of work that have been described inhaler co-produced with patients from the beginning so it isn't just about their expectant yet meeting their expectations at the end we have lay members than we have patients actually sitting on most of these groups that are developing these new services so they are involved from the start
in terms of collaborative working we've got for any delivery boards across north-west London where all of the providers from those local areas are sitting around the table together and yes one of my key messages throughout the last few months how we escalating to each other how we talking to each other and how we combining our efforts at times of pressure to make sure that we're working as a system and then we've also been talking about what happens when more than one system in north-west London starts to come under pressure and what's the role of of of north-west London at that point in trying to respond from a regional perspective
i'm final question so where was your cheque was actually say It's so it isn't just about beds I would say it's about demand in the totality so as outlined in the plan we have a number of new initiatives for this winter around in trying to ensure that all of those who attend A&E need to be in A&E but do not need to be admitted are seen treated and discharged so that includes all of our faculty services which are new for this year and enable people to go home
and be cared for at home and the services that we have in place we're also measuring readmission for those that are about to ask me that question to make sure that actually we have lower readmission rates from our new services this year than we had last year prevented people from coming back into hospital then for those that do have to be admitted we have opened additional beds across all of our key sites this winter to create the capacity that we expect from our calculations to meet the demands for the patients coming in
and one of our additional measures is around
the efficient use of those beds than ensuring that we are protecting those beds for the patients who are being admitted to the emergency care pathway so there is space in the hospital for them and that we've got Community services in place to enable those patients to go home when medically fit to do so and that they're not staying in hospital unnecessary periods of time
comprehensive answer to my biggest question otherwise very good thank you very much and any other questions or comments yet Caroline
so on that last point that paper mentions the 240 million of funding that's gone to local authorities and the questions ready just how across north-west London are we sort of communicating what initiatives are going in as part of that funding because obviously we've got quite a lot of cross-border flows would be helpful to the process
can so from a north-west London perspective we've got just over 8 million pounds coming in to the local authorities in terms of winter moneys that have been allocated discussions have been ongoing at all four of our A&E delivery board about the best use of those funds we've had some borrowers very clearly articulating how their funding is going to be used and some there are currently more grey
around where that funding is going to be allocated this winter we have had direction from the London regional office to both the local boroughs as well as the
in each of these any delivery boards around how this money should be used to support winter used to support patients to be discharged on time and agreed with the local NHS
and we presented at the joint Overview and Scrutiny Committee on Tuesday evening with a number of councillors from the bars of north-west London
on this exact paper
and also work gained agreement from them a view that
there should be transparency about how that funding is used so it is an ongoing discussion
the first bullet point of your plan is to
reduce the number of
beds occupied by long-stay patients by 25 percent and I was wondering how you're going to measure that and how frequently against a measure that and what measures we can do if that target is being missed
so that is a national targets not just the north-west London target is based on the daily reporting that our trusts produce and submit to NHS England regarding bed occupancy
and put them in this case for patients who have been in there spade in those beds for more than 21 days and
we've been working on a plan over the last six months to reduce our bed occupancy for those patients who were ready to be at home obviously we do have cohorts of patients who are clinically appropriately in hospital for longer than 21 days and when not discussing those in terms of this targets these are purely for patients who are ready to leave we are making progress towards our 25 percent it's not complete yet
across north-west London but as I said we have invested both from a CCG perspective
and from predominantly from CCG perspective also from VCS funds in some cases into their traditional community services to support patients to leave hospital in order to meet that target
Imodium do we know what our baseline figure is what we're starting off with them therefore we want to get to
we do by the four different endings Liverpool's I'm happy to share it with the each chair outside of the meeting
so the offline having
any other questions or comments are Hughes assured
so if you're not assured
I think we are assured because I don't see any dissent from that thank you very much that's very helpful thanks to the presentations and can we move to Item seven Elton Care Partnership progress update her as you Juliet years
thank you Chair and Just Fair clarification this report in previous times bringing here has been the STP update and you will still hear nationally
areas being referred to as St peas or state sustainability and transformation plans and partnerships we have taken the decision within North West London are coming together as a partnership we want to refer to it and call it what it is which is a health and care partnership for those wondering what the difference the title report from last meeting to vest that's that's what it is but this is not date on how we are working together as a system to transform and improve care and patient experience for our residents
just to highlight a few things from the report before we go to questions at the last couple of times I've reported has been about the refresh that we are working on as a partnership both in terms of governance and how we make it more straightforward and more line to snatch two governance but also looking out their priorities that we want to focus on as a partnership
that's not the focus of this report thank you for everybody was inputted into that and helped to develop that to the place that it is that has gone through our leadership governance to our joint Health can transformation group last week and will go to the Partnership Board next week for approval and my proposal is we then bring that back to the next joint Committee about how we're setting up and then implement that governments and what those new programmes
we are also continuing and talked about here previously about what Britain has an integrated care system and last month I reported about how nationally the
desire is for all STP areas to move to becoming an integrated care system at that time we reported that the bins Wave 1 and wave to and we were hoping to put in an application for Wave 3 which we anticipated would be from March next year
mobs already alluded to the fact that they were waiting for the 10 year apparent plan to be published and whilst we know the drive to become an integrated care systems will be within that 10 year plan the mechanism by which we go from A to B is not clear at the moment so again as we get more information I will bring that but we are working very closely with the national integrated care team who want to support us to get that the work is ongoing
so the focus of this report is what we've been looking to the future we have also been continued to work as a partnership to improve and develop our services to the priorities that we had already identified and I guess this two ways we work as a system the first is individual boroughs taking forward initiatives and ideas and then us coming together to learn from that practice and see how we can expand it and the second is what is it worth as doing once at a larger scale
so we make sure that we are working to the common framework across cross all of ours so this report hopefully gives examples of good work is an update of where we are and all our priority areas and give some examples of those different types of transformation the ASC will also was to move a waif not away from a narrative reports they ask this Committee was we like the stories we need to see how it's making a difference but we like with like that to be supported by more hard outcomes data that demonstrates difference we're making so you will see through this report there are graphs there are out there how comes information in there as we move forward with our new areas of focus that articulation of outcomes is being
at work through right from the start so when we start reporting on their we will track those outcomes through from the beginning of the programmes through to the end
I would just like to put a little bit of colour too to the words and not go through all of these examples you've all read those stray but I think it's important to highlight some of the stories and behind all the numbers are what is the difference where making for our residents and wannabe examples the transformation happening on a system wide basis between taken four in an individual error to start with some primary care and online access to GPs and
in Brent in the harness Network Ten practices there went live with an online digital system in the middle of November
in this land since that time we had over 400 patients access
to their care in the way of those patients most people are aged between 17 and 40 and of those over 75 percent have been able to have their issues resolved digitally online without needing to visit their GP so there is clearly a demand for this service it is early days is three days and weeks of the service being going and I'm sure MC can talk a little bit more about it but what we're also doing is looking at how do we learn and roll that out across because we know the demand is that its central London is the next CCG that will start to implement that
I pick out a in there about supporting care homes and I think building on Lizzy's report is really important that we are helping people to manage the half their care managed narrowed and care needs managed in the community and in their home and for many of our residents that's in a care home so we've done joint work with our local authorities developing a a booklet that helps people to spot the signs of deterioration and rolled out training around that to care homes 80 six care homes have now taken part in that training and the feedback has been overwhelmingly positive because we do have relatively unskilled workers at times particularly out of hours caring for residents and this is giving them the skills they need
really important picking up an early point that we evaluate this going forward has it made a difference has enabled more people to be cared for in their care homes and we will continue to pick up on that
also to pick up on Lizzy's report about discharged to assess and we picked up on patients who are in hospital for a long period of time and one of the ways we do that is a programme called discharge to assess
where people who are ready to go home from hospital but waiting assessment of their ongoing care needs are discharged home with support so that their needs can be assessed within their own home environment what we find that means is they are this will be able to get going forward is more tailored to their needs because it's easier to assess what you actually need when you're in their own home
but it also means they stay in hospital is reduced and to date over 3 thousand people this year have been discharged on that and we've just started working with the more complex pathways so those patients who have been in hospital over 21 days
we've had our first patients go home that way which is a big step forward and takes a lot of inter agency working to do that
one patient story linked to that is a gentleman who has been a discharged home
and his Welsh was the it wasn't long term care needs but his wish was to die at home and we know that that is the wish of a lot of people rather than in hospital and sadly too many people are dying hospital
this gentleman did die a couple of weeks after being discharged home but for him and his family that was a really important change to how we provide care that he was able to go home from hospital
very finally I had a number of actions to pick up that this report so let me just highlight how the actions from the previous meetings been picked up
I was asked to provide a more focused on children and young people you will know that our health and care partnership going forward one of our areas of focus is children and young people so that will come to the next meeting where we look at the priorities for children and young people serious and long-term mental health illness want more of a focus on mental health I wanted it more of a focus on that there are some elements about what we're doing within primary care and initiatives are about helping people to get back to work in this report
there was an Outer action about putting outcomes information into the report and hope we can see a start towards that and there is a specific question around commissioning obesity you will see that referenced in here as being one of our priorities it doesn't go into much detail but again when we bring back on new priorities the detail will be contained within their
so thank you
for your question going I'm sorry did you want to say something about Joan
Judith mentioned of narrative Juliet's encapsulated right after the insurance ideas of starting working to work in a different way the GPs of study found Dick charm a very useful way of
engaging with their patients and
it is early days as any three weeks or so
there being very positive about it if it mainly young people who use that protected the younger Ansel Juliet's Anders between subdued Forte in the main
it as a set his early days yet but that's a very positive sounds can be happily practices
and painful
that's good news and the EU
thank you for being my chair I had deserted craters that
ran on page 6 feet tall spat the patient activation measure and the number of assessments that have been completed in court to which is quite a significant is that some sort of understanding of what has been the outcomes for patients it's the sort of so water from those assesses how is that it may have improved their care
the near the question was to ask about the perinatal mental health that we can see that it says that we've had some funding from an exercise would bid to extend the community service for up to one year and just wanted expect ongoing or is there a plan that we can continue to manage and have that service ongoing once an HSC funding is no longer available
yet wonderfully answer
a case on the panel's assessment I think there are two points to that what does it mean the first use of Pam's assessment assesses a person's ability to understand their condition and self manage their condition are undertaking an assessment scores somebody from one to four what that means is a GP and other caregivers can say I can understand how able what person is to manage their care and therefore
tailor their care package or their care offering to that that person
really important as we start looking at social prescribing and bring that in so there is national evidence that
in tailoring and getting someone's Pam's assessment and Taylor and care to their need there is then a reduction in their accessing urgent care wherever because well because they can because we can tell that care so that's where we are at the moment we've put a huge effort in over the last couple of years to increase the panel's assessment and start to use those there is a GP in Hounslow who is doing an assessment of what has been the impact of that and it's imminently waiting to be published every week I ask have we got that yet are we there with it but we are assessing that the second part is
we've now got the first people having a second Pam's assessment from when they were first assessed a year ago or 18 months ago to a new assessment and the desire would be to move people to be more able to self manage because we know those ones with the the better Pam scored do use less urgent care less the 10 day any less frequently now that evidence and so we're working with them or caregivers are working with people to increase their scores so that access can so that's that's where we are with it
the second point about parental mental health I think is a really important so we get we often get seed funding to try and get something going two important points one is we need to evaluate and make sure is is it delivering intended outcomes and the second is as if it is what are we doing to take that on is I haven't got a business cases proven itself or do we need more seed funding we need to work with that we go through the postnatal mental health
overcomes I'm sorry
yes Trojan Horse question
and do we know how many officials refused to do
apart from school and also do we have figures for how many Pam falls were given out in other languages and powerful English
so I don't have the numbers here I can take that off line and get back to you as far as refusing I I don't know if that's an indication in itself isn't it with that at the Pam's score is being done in a number of ways with with people I know that him Houndslow have
then it through sending out a questionnaire and people retain returning it and that was a way to get a lot of people
engaged others it's a site's sitting down and helping people to interpret and even though it's only a few simple questions it can bat can take a while so it's I think it's
matching it to the person's needs the other area that we are working with Ealing and others areas on these are carers Pam because quite often is not just that person is their principal carer how are they able to manage so I don't have a specific numbers but I know it's something people are cognisant of as we rolled out
when you do get them as you do if you could perhaps just circulate them by now rather than Robin has come back to another meeting for Benzema
and I'm may be one of the people who was asking about the outcome so on the grateful to see that a lot of that detail is in there and I am the keen to see some women
outcome and impact measures a low one thing in particular and I may be a bit premature in the question because I know we have in our got the money yet and I know we're waiting around the STP way for the capital submission remembering what was in there and that some such a long time since we don't have those business cases
so a lot of that money is badged for the outer possible Hobbs and I wondered how well and I know some of the hubs are sort of up and running how much have we tested
exactly what we're going to do if and when we get some of that money and making sure that we spend it well and we care about the outcomes that we want and how we can measure and likewise looking at London North West
which I remember a lot of that money is to do with
helping that trust to become more financially sustainable and filling up the empty space in Central Middlesex hospital which is obviously on the borders of Brent so I was kind of them
just wanting to know how ready we are to work on a spring into action and make sure we spend the money well
at very good questions that you very much in your right and actually we had a discussion this morning with the Chair's Mendy's as if we get this money we need to be on the front foot to make make sure we are well governed are in order to make sure we're spending this money wisely and the NHS or any planning scales for capital money of this this ilk means actually when we first heard those plans and conceived of the hops was a while ago now and we need to make sure that the models of care that were proposed are still relevant that we've taken account of the digital agenda and that's changed how care is provided and also I think we've got now much stronger primary care plans and strategies where primary care at scale in in local boroughs don't do these does the hub building support that approach
so way over the next few months we'll
ask those questions with each borough
and look at each hub that we have proposed and look at Isis are
is it meeting the new requirements is the right outcomes models of care and just really look at La ask those questions as we go forward and that's planned between now and March when the wider things with them
London North West and indeed all the acute trusts so the plan going forward is that they the next step is when we have a agreement that we have the capital they need to go from a strategic outline case to an outline business case and that will be the responsibility of the individual trusts we have been very distressing outline case was very clear about what it was that needed to be produced but the through governance process we bring all of those together as he is it meeting the aims and what do they all work together certainly with London north-west yes there is money for Central Middlesex on their be Cadden A Cat and making those work more effectively but there is also money for critical care development because if we are too
reorganise acute care we need increase critical CAC Pacitti and we need increased physical bad capacity at at our other acute Trust said that the lot of the money is going for a unique capacity bed capacity in critical care capacity
and regards are only one or two other grocers and we need to move on after that Sir undertook with all shows a question or a common
will either then or till the end because we are not protecting the questions while comments from officers to officers are very helpful but not the purpose of Christiania
thank you it's useful having some of these graphs and what this show very often this great disparity between the different city juries now when we run
explaining to the public why we were holding the strong committee the rationale was that we were going to aim for consistency across so I think that when we get these graphs which flourish a disparity which may be very good reasons it would be good to have some explanation about why that is and also that might then throw up areas of good practice that could be taken across from one strategy to another
will take that as I said yesterday that she was having a suggestion rather than a question that I think are helpful suggested that if you can't just take the unborn Philip I think you had your hand over at the end
one just one question it's about signalling and signposting are we looking at developing any combined health and social care
voice operated How do I navigate the NHS
he said Yes I think a couple of ways of answering that first we have the Health Act Now which has rolled out a run not a across north-west London and does provide sir I'm information on how we know and increasingly that's going to these developed with the social prescribing offers of bringing in health and social care and I think that is really important that we have that digital platform
one of the main things and a mock alluded to bringing an engagement plan around our 10 year plan and our health and care partnership plan next time on one of the main things we want to engage with our public about is how do we sign post this most effectively what is it that is needed for that so I think we probably got a little bit more listening to do and then we need to
pull Latin but yes travel the best service in the world of people who have made their what their views were no use
programme let you make your comic knows I think of the two reasons really one and only one to get on the wrong side of the chief finance officer and secondly as your first meeting I feel a bit cruel about putting you so I would throw your first meeting based in your fifth may be would be sensible cloak it may have come and gone and I think thank you Chair you don't want it to two to add them to think the question that Lindsay asked about
the relationship really between the hubs and the hospitals South Quay is it really really crucial and
we we we do need to ensure that as a result of this investment we are able to make the changes in the in acute side as well as in the is an electronic airside so is really reassurance that that we are on to that and that that issue in its very point very well made
OK we've noted I'm report thank you very much and yet we now move on to the board assurance framework which is a major way that we look at how we manage our wrists and vans going to briefly that overthrew that
thank you Chair so maybe we've had the assurance and and being assured already this meeting and what this document aims to do if we get it right is to remind us of the key things that we should be seeking assurances on and how we do this when we start without objectives across north-west London CCG's and there are set out on the first page of the main paper there are three areas one to deliver good quality services and outcomes and secondees around delivering our strategy and a third is around financial sustainability
underneath that there are nine areas of focus key things we want to do to help us deliver these objectives for each one of those we've said ask ourselves the question what's the the biggest risk they can stop us being successful
and for each one you then set out what it is we are doing to mitigate and manage those risks so during the first one which is around primary care and you'll see the graph at the top left-hand corner and it starts off quite hide a score 20 Issa is a five by five matrix and asked the school when we doing nothing about it at all and if you look at the column below that Graf your seats on where things start with the word control that's things that we've done to try and reduce the likelihood of this happening or to reduce the impact should it happen an A the controls here around enhancing and strengthening primary care so putting in place it reduced the risk down to a school of 16 on this one and you'll see a dotted blue line of 12 that's the score that we simply want to get it down to a number for comfortable we've done enough so the theory is on that bottom left-hand column whereas court action as is a further action were going to take to reduce the scroll down to a comfortable level
I just point out at this stage when the senior management team reviewed this document on the 26th November the challenge that came out there was are we confident that the actions are strong enough to get the rest down not just for this one but for all of them and that's what we'll be doing with the risk owners between now and the next version of this document
on the bottom right hand side he talks about assurances and those are the things that are false the papers that come to this Committee or governing body or somewhere else that tell us whether or not we're having the right impact whether we really managing these risks
i'm quickly drew attention to the risk of a five which is on page 6 of the document is around financial sustainability and Nihar you'll see that the risk was gone up EU moneys particular challenging in the NHS we will hurt your stories about that we have the financial and recovery plan on the agenda today the theory is that though we deliver that plan and that risk school goes down
and the other one I want to draw attention to his number seven on a date around our collaboration development programme how we are putting together the CCG's to two to leave ridge of commissioning and powers and to help address the variation unwarranted variation across the system you'll see that screw has got down to the blue dotted line and that is where you've heard earlier on about the constitution's being agreed when our Afshar reform we now feel we done sufficiently enough work to an closed at risk often get against the risk appetite
the others you'll see the risk is going up and down well going down Andrew you see the rationale for that sum Brian is document to the Committee today
too if I can get the cover shoot up
I am asking the Committee to consider the extent to which the board assurance framework is an accurate reflection of our principal risks to achieving our objectives and to comment on the strength of the controls and assurances
but can I just say I think that in terms of up this kind of bored assurance framework the real questions are
are you convinced that it's being managed that the risks are being managed adequately because I don't think this Committee itself can manage those risks and are you convinced that somebody is doing the detailed scrutiny my experience of maps of Borderlands bang works is if you're not careful nobody's doing the actual detailed scrutiny that we try to do it in a Committee of this kind and more strategic committee you would need the whole meeting placid now the couple of days basically to do it so I think it's worth concentrating on that we're sure that the risks are being managed rather than going through individual myths of Orissa working and trying to work out whether the school should be 12 or should be 16 because we'll be able night and and secondly is somebody doing the scrutiny and that's my first question ashes are lever that question
are we sure these are being scrutinised in detail elsewhere in Russia can tell us been whether elsewhere is
suddenly or so each one of these risks the top right-hand corner has been assigned to a senior person across the CCG's to tick to mansion and his risk and these scrutiny into the top-right corner as the lead committee that's looking at these entries and that's where the detailed scrutiny and should happen and whether a person should be held to account for whether they are then managing the risk adequately as an additional safeguard to that and me my team we wrote with the risk leads to make sure these entries are accurate and up to date
and then before it comes here and governing bodies this whole document is looked at by the senior management team as of another filter and earn a check or challenge before we them before we say Yes we comfortable visit or not OK questions
and just a couple on the areas where this committee is down as the lead committee so an first one I've got is area focused 3 which is the outpatient transformation programme
this is the CCG's and more familiar with have done quite a lot of work around managing referrals from GPs but I think where a number of CCG's have really struggled is getting some traction around referrals or happened between consultants in hospitals and I think we need to make some specific reference to that's one kind of looking towards Luis for response on that and then just do just a brief point on to others the mental health one which is also down for this committee and also the of the workforce were in both of those I was looking around the assurances something about outcomes
because seeing an improvement in outcomes would give me assurance and what I'm seeing more in that column is actions that we've done but nothing much yet about outcome so it's a work in progress and it's certainly I'm happier with this document since the last time it came to this Committee
you've asked me about our already but looking for more on outcomes in those two areas but the specific question around consultant to consult or referrals
thank you so the apparitions programme which has a a joint provider and CCG programme board
is absolutely about treating or referrals the same so that everybody gets the right access the right support and and the point about consult consult referrals and actually with us and turns growth is higher through that route into about patients than through primary care was actually raised at the last meeting
and we have agreed to have a particular focus on that in January and I would be very content actually to reflect that within this
Bath going forward for this area
another gap between India comments really will begin to take on board can I earn a beyond the other one so Paul and your now the risk of similar for risk number the financial is number five on Unit says Neil Bibby he's my all-time great MC question yes yes I've just watched wants to risk around town the every three and that's in relation to the readiness of the acute trusts to run the soft triage
Second January
are we ensured that all our partner trusts are ready and all that clinical teams are regular consultant Louise
so they were all charged with being a day they have all committed to being ready and I will find out if and sense that has been achieved at the meeting next week where we have an expert panel
they are not descended I mean there is real challenge from the joint lead of this from Lesley Watts who is chief executive for Chow western and with her role across the system and absolutely this is this item is being taken to the provider programme board on a monthly basis as well so that there is a
quality of of challenge
in terms of ensuring that we come together across commissioners and providers to try to deliver the ambitions of this piece of work
you can just if you lose when you got that assurance both videos report back if an e-mail do frankly I know that the lead come to the next Committee by an e-mail pressed your empty were copied into our people so that they actually get that ensured Mark I wanted to say something
as we just had to remind people this is now a weekly standing item on the Chair's meeting so when we come to the next chairs meeting after that the Programme Board meeting we can have a discussion there about our level of assurance
in other questions or comments on this
cannot say been I am though not to get complement very often are in fact almost oeuvre I just like to say I had she thought this was very good the bulge was vehement quiet and I've seen quite a lot of them I can't understand it all but this one actually I've got at least 50 percent understand what's down that seems to me to be a victory but genuinely can I say I think it's a very very good piece of work and I say in general let me say that I've been very impressed by the papers we should pat yourself on the back and don't expect that every meeting OK let me make my past those compliments onto the GOP has to go in by all means collaboration Development Programme Board the report to their mark
yes so I think I can be relatively brief on this so as we've been reporting through the meeting we've we've largely put in place the new structures or there are still some fine tuning to do and we had a conversation this morning because he had performance about some of the fine tuning those required there
we've also reported that we've now largely appointed to the new structures
M and A in terms of its impact upon staff the staff consultations have either been completed or are currently underway I suppose what I'm getting round to saying as I'm hoping by the time we get into the beginning of 20 19 will be in the enclosed down phase of this particular and stage of the collaboration project as ever we are set a new challenge though and the new challenge that we've been set is the 20 percent reduction in administrative costs by
Twenty Twenty Twenty Twenty One
so when we come back in the new year will begin applying to our minds as to how that is achieved and I guess in particular whether we need some form of continuation of some kind of programme to do that or whether there's some other arrangements would be more appropriate but it but in terms of the work the tasks we set ourselves at the beginning of this programme they are now heading towards relatively safe completion I think
Every much Mark questions or comments
at Christie
can we have at some point and more information and the wider discussion on the role of quality in all this and I'm quite unclear what the terms of reference are of the quality committee and I don't know about the membership because there was a suggestion at one stage there should be a Healthwatch member and that doesn't seem to have been actions that one point the wider point is that looking back at the Board of assurance framework is one of the headlines is to ensure that all the trusts across the
and North West London improve their CQC rating now and don't know where that sits I think there's still a lot of confusion between what rests with individual CCG's and what rests with North West London and this was a question that has been raised with us those by members of the public are concerned about whether they take their concerns and also by other local authority colleagues in Scrutiny colleagues who want to know where the responsibility sits so there are lots of things here that I am unclear about I may be alone that
just to assure you you are not alone and have access to unpack my comments about the meeting this morning at the quality committee
when I was talking about
fine-tuning I think we came to the conclusion this morning that would be very helpful if Diane and her team essentially wrote a paper on on what we might call the north-west London quality system which would tackle exactly the questions that you've raised so how do we work as a system to produce the quality outcomes that we want to read his responsibility sit in north-west London where does this sit with individual CCG's were the roles or particular groups in particular individuals
I think until we've got clarity on that we won't have assurance that we've got the right mechanisms in place to get the kind of quality outcomes that we want so am I'm hoping that can be done as a piece of work relatively swiftly and I'm
certainly discussed at the next meeting of the policy committee
other questions comments
no fine thank you very much I think it's to note any way we now move away from joint for this joint strategy into joint commissioning and come on to finance a pool you probably got to deal with these two separately I think because they one needs to be ratified for approval and one is purely for assurance so if I could just take the month seven financial position headline position I take it that everybody's read the paper
the headline position on a month's seven kick yes are thought to stop I give my early reflections of being three weeks in post now
and I spent most of those first two weeks of going around talking to
chairs and managed directors within the CCG's as well as up to working with my finance team and I've been very pleased like to put on record the degree to which people take their financial responsibilities extremely seriously and
and the finance is a well scrutinised by by Committees I think we start with we stopped in a good place in that respect
the second observation though is that I have found a number of areas where we do things differently differently between areas
the most opportunity I think pretty things more consistently or it will help in many ways will help us clearly be more efficient bills help us be more effective in our dealings with other Asians is something that's something we need to be working on the next experience and then the final thing is it is without doubt the case that the financial situation is is hotting up and getting harder
both in terms of the current year but also looking ahead
to next year so
we have a lot of hard work to do and therefore we need to we need to address that joined up working really quickly so that we can we can use our collective abilities worked together to Topley manages to punish the system better
in terms of the headlines hopefully you've read the papers the chairman said
a collaboration we have a deficit
targeted control to the targets of night with four million in this year not as made up of a deficit target in Harrow 20 million all other CCG's contributing surpluses
as of months seven and the reporter position is that we are adrift from that by focusing on the Wetherby drift by that by the end of year by seven points seven million
not at the moment is all shone against Harrow's are Harrower's has position is tolerated to a predicted 20 A million we're doing a lot of work in the next generation as the chairman referred to on the recovery plans or come back to two dozen sacked but just give you a few more headlines before do so the first is in terms of quip overrule all CCG's are contributing or achieving at least 75 percent which is good however 25 percent or numbers of this is a big number in itself that's 20 three and a half million there were short and obviously explains a large two logically the the problem
CYP Now point to note is that within the greatest area of problem is without a contract with providers particularly acute providers
actually half of that problem is outside of the patch so we put a lot of effort into managing close within are are punch but those outside we have less less leverage over services a key lesson that we need to take forward into the new year is how to be how to manage the whole solar system
if you look at the available to go into the detail but hopefully you've had chance to look at some of the decent ended the provider activity some quite interesting
messages there in terms of where the pressure points are particularly annoyed elective care which is over in
most most boroughs but actually not at all so we need to again apply the learning how is it that in some boroughs with Minister ready keep activity fairly fairly flat and on this one we should be aligned with providers who don't want patients of clearly without beds or without some ability to see them within four hours so we need to work with providers to trust non-elective care of him as a key area for us again going forward
paper also sets out an instant it's in quite a bit of detail is probably quite hard to
talk to to read when they can possibly be clear in the future but on page 9 and we set out what we've called the most likely scenario so we are still saying reporting seven million
adrift from the the targets
but makes a number of assumption one key assumption is that we are supported nationally and more regionally
40 p at hand which is costing us money within the atmosphere than borough
Hammersmith and Fulham borough so that's a cut us a Kosovar assuming is going to be covered
the most likely position shows that number of these CCG's and this is about the Forth road out of those you've got the paper in front of them
are changing that position and and moving out the position but West of Manchester's suggests that they can improve their position to 15 million
the net effect of all those would be a deterioration from the seven billion death adrift from control total to 17 million
however there is a possibility that we will receive additional was called incentive funding from the centre which is applied to CCG's to improve their position so it is possible that we will receive a further 15 million as result of the improved performance in West
what means that it still quite uncertain afraid that we are saying that we stayed with a position of saying seven million there were some ups and downs there those are two of the biggest ones I've mentioned so it is still conceivable that we will be able to achieve the control total but it is looking less and less likely
over the next few days with completing work with providers to agree the position in terms of contracts
we're still doing that in some cases it's a complex series of discussions around what to counter Inn in connection with a contract and we are adrift in terms of what we think we owe the plot as to what they think we owe them again that's good could swing the position
either way in our favour or out of our favor
the process for completing a piece of work is is a deadline of the 20th December
that means or by month aides I think it's likely I'll be s sticking with this position I set up a million deficit unless obsessively material happens on contracts until the contract negotiation points I mentioned is is complete and we get clarification on the GP at hand and the potential incentive payment so assist headline in terms of what's coming coming next
I think at that point charities stop and take any questions I was actually find other specific questions and and talking about this report on the financial position as it stands because we'll come on to the
the financial recovery plan second item
in questions
i'm going to ask question anyway I can opt out of area or acute providers hospitals do will know if that is a or because we have less control in the sense of that do we know if if actually they're over
the overspend vegetable they demand do we know if that is the same for other areas of London boasts over instance north-east Xavi's where they would use those providers more predominantly or are we effectively suffering more than would be the case of
their home providers the one for that awkward
yeah I think of it this is a national trend of She patient choice means of patients come decide where they want to go and be treated clearly within London the ability for people to travel is much greater so all the London CCG see quite a bit of movement between the boundaries and yet it is it is true that it is a pattern across most that is more difficult to manage this type of care than it is those where the contracts held and you got more More leavers
I haven't got the latest information had been inched thing to ask I will ask my CFO colleagues actually chose a good question just to see whether we are currently an outlier or not
our questions comments
I move straight on to the financial recovery plan then can you call
so the financial recovery plan is quite lengthy document songs could tip chez queue and give you some of the headlines again
it deals with two time periods it sets out a series of actions to help us ensure that we achieve targets native 19 and it also talks about what would it do to have a good 19 20
the talked a bit about the most likely situation that we'd been calculating and that we would miss on control Total by 17 million
his broken down between the eight CCG's that's
that we ever see of 3 CCG's showing a movement away from their control total of as in Harrow Hammersmith and Fulham and Ealing whether it will be a deficit against the plan one as I mentioned earlier West where this could be a surplus with remaining fall
achieving plan
so I've taught ready about a scenario where GP at hand it's not funded and that that would make it worse after all and I've also talked about a good scenario which is that we received his centre money for four West
the paper also sets out a number of other best case scenario so it is still possible that we could
achieve the the numbers so
the conclusions of the paper are quite rightly that there is a wide range and a safer that does make me feel massively comfortable but I've Hopley explained why that is
at the moment we're in the process of closing down
quarter on quarter to contract figures with this East with with our providers that will
triangulation process will give as much greater clarity
the paper also talks about variability again I mention that at the start I do think there's a lot of variability in the way we do things and that needs to be tightened and we will set an early in this meeting talked about winter and that in itself is it is a key pressure it could result in additional activity flows
so particular to talk about some of the areas where we're focusing attention and
how is clearly an area where there have been quite long-standing financial problems
Mark himself attended the governing body this week and it was it was great to see actually because we've got a new chair and Genevieve and new
and you sit a team of clinical directors and I do think it's a chance to have a
clean slate and a new start
also in Paris until he gets lost in the figures that delivery of quick numbers is quite significant actually the highs proportionately
so we do have an opportunity there
the detainee issue is only week three but it seems very difficult to me to conceive of a situation where we could achieve a financial turnaround at Harrow with him within one year is going to take at least two and possibly three
but obviously if we were to take that approach that would have implications on the whole collaboration and that's something that the
joint committee needs to consider
Second CCG to mention its Hammersmith and Fulham the GB at hand issue is called causes a lot of management time but on top of that the financial problems are a really heating up and for Hammersmith and Fulham is relatively new territory to be in a position of financial pressure so I think that's another CCG where we need to focus our time and helped the management team to to deliver
so the financial recovery plan sets out action at to a two time periods
2 thousand 18 19
kind of obvious thing to say but we need to look for every single penny the wheat Cam
we need to ensure that we
get as tighter controls we can on contracts it's difficult when with his foreign to the year to make material different but every penny counts as a
and if every CCG can deliver the most likely scenario or better with the other
tutors that I mentioned it is possible that we could end the year with with with achieving control total still and that would then give us a much better and stronger place to move forward for next year
the movie into 19 20 this is a huge amount to do
we need to use scale it seems to me we already do but in some preliminary work on the financial
challenge that we face
and it is large it again depends a lot number of things the Stormont mentioned the delay in the 10 year plan there's also been a delay in the notification of elephant allocations so it's making it harder to predict what next year looks like but under all scenarios can be challenging to be honest and it seems again impossible to see how we can get through that without significant transformation
in the way that we were right
to do that and this
this will be a point will pick up again in the next paper
can it seems to me that we need to work very closely with with our trusts
transformation cannot happen both alone clearly and we did find solutions that help address better these save money where we save money
and hopefully the opportunities are there
to do that to find new models of care and when she asked about the substitute an opportunity for us to put in place solutions that they will have their will provide new models of care for patients that are better but save save acute trust money from having lots of agency staff care for patients who
don't want to be hosted in the first place and as happened to pay the bills on the back of them
so really Tim's 19 20 in summary I approve as to be an externally facing financial strategy to develop the words with arm
was collaboratively collaboratively with other providers
and separate bays for any to deliver at this joint committee needs to be stronger United worked together to tell delivers up a plan
Irwin the Chair has point if I could ask Vinci to comment because the flats recovery plan has been scrutinised by the Finance Committee how means young Lindsay
thank you Paul and so there is a another meeting of the Finance Committee though it's a weekly Committee and with represented Haitian across all eight of the CCG's
the last Meeting did among other things scrutinises recovery plan it was a very
constructive and positive meeting in fact I think there's a recognition that's an awful lot of work to be done and there were some suggestions and comments and sort of further kind of challenge and testing of a new order to get this we need to do these things and look at these areas I won't go into a lot of detail because that would probably take up too much time for this Committee one thing I did want to ask and I'm going to take the opportunity is looking at the action plans which are from slide
and the next four pages a lot of the dates for those actions are kind of the end of November and I'm wondering too fat or are we on track have we done arose actions and have we developed a further set of things that we need to do and I wonder if Paul could
update the tall around how many of the actions we really have completed and how much have just given us a further set of actions to do
you did you mean we created you mean my plea monthly I thought it sounded like a lock at the meeting weekly
somebody's meeting your move to Davey soon I guess
yes because actually I was the sum the somebody's who were meeting weekly as the business recovery group
yes we are on track with all of the all all all of the tasks
some some issues as I say that I have mentioned the role I am allocations things like that are outside of our control when those delayed then we can't do things any quicker but fundamentally we are using that adapts at those those tables you refer to Renzi and we will look at them every week and make sure that we're on track and yet broadly we are on track with all those tasks
a yet
my question is much links to the mixed paper but given what you were saying I thought a brief up here and the papers next paper says the localist system and organisations are expected to adopt a shared open book approach to the whole of the planning I suppose my observation to date is where a long way from that
how given that we've actually Scott start all this in the next few weeks as part of the planning for next year
how we go to achieve that major culture change across the system
he wants to answer that question for that or do we just leave it in the area
marked you answering
well I'll certainly have a go is not be others who wished to contribute and I guess the first thing I say is my observation is the FT directors group is relatively functional and there are some very honest and engaged conversations there
I think the second thing I would say is that the papers that we're going to consider next as does indicate a change of direction but not one which is completely unfamiliar to people
and it doesn't raise issues that we've not been talking about for a while so I didn't and I do think it's a great leap to the new system I think the third issue is the extent to which
the system incentives change around us and I would suggest that a lot of the behaviours that weave
experienced in the past are really driven by the fact that the system is designed in a particular way and the way it's designed essentially puts you into something of a competitive position so the most the system encourages us to work together as a whole integrated system rather than a series of competing entities the better we've been told that in 19 20 there will be some small steps in that direction through things like
and a terrace
the possibility of them whole-system control totals rather than individual organisation or control totals so I wouldn't want to overemphasise I'm
those issues I think you're right in your implication that it's going to be a big cultural change for people that I've been I guess my observation is that we have at least started the journey
just coming back to the financial recovery plan am so obvious London historically has been very fortunate in all of us having a considerable month of surplus in the system we then went to a stage where we had CCG's in surplus providers in deficits we have now got CCG's running into deficit and providers in deficits so and a lot of CCG's were under capital for a period of time before they are now just getting the allocations to spend in line with the allocation is the population and where into a recovery phase so unless we can
absolutely get the system to work together there is a real risk to patient care in the wrong end off in ignorance of artwork historically the has been under capitation
and therefore services by definition
would would be sponsor or would be would be different
so unless we know we get a full system transformation in the way we go forward
I think the issue of quality needs to be highly gender as we move forward into this
comment it was any other comments or questions
what am I understand as you may know this poll is that also that trusts are going to have a reduced allocation next year because money is moving and therefore effectively
the review every Dutch in CCG allocations because effectively the move of money out of London basically because of the feeling that Truss out London have not benefited in the same way as London has and I think it was two or three per cent basically a reduction in the funding for the trusts which is effectively a Well it's not a reduction in funding because we don't have to fund them obviously but it actually has an impact clearly on the trust's ability next year
yes stars corrected such is still quite unknown exactly what impact it will have a zip there's a thick think or market forces factor which
essentially as a national tariff on Trayvon was aware of the market forces factor essentially just that to take account of different price Bamezon different parts of the country and the chance is right that has been adjusted and with a view that
relatively London is is overrule providers Rover rewarded as result of that formula
I love the London providers of lobbying very hard and and will be significantly affected in theory we wouldn't because our allocation is not based on market forces factor but I'm concerned that we would get embroiled in as many said they are as bright as going into deficit the whole system becomes harder to to navigate so it is that it is one of quite a few risks aware trying to work out the implication of
OK I'm not just this week we ask our unusually to ratify this we had a quiet discussion with Mark Anbang about whether it was to approve or ratified of Mark took the view that he hadn't ratified for a long while in their 40 was quite tempted by the word ratify I think it's fair to say so we agreed just to satisfy his vanity that we should ratify because the decision I think especially is taken by the joint finance committee but we do need to formally ratify is that agreed
thank you very much then we come on to the
principles and operating models for the next year basically contract you man Gerry is that you can speak to that
OK thank you very much I think a number of papers say far have trailed and that is an uncertain environment were operating in more than usual and I'll say very challenging are bats in the holy grail is that we work in a more collaborative way and perhaps we have done and so the purpose of this paper is to set out a more collaborative approach to the contracting round that's the way that we pave trusts for the work that they do for our patients after April 2 thousand 19 is based on some initial planning guidance issued by NHS England and NHS improvement which is encouraging us to do that as people have already signalled that some changes to the payment mechanisms for next year but again not all of these are known
as for example the market forces factor is essentially saying there will be some Gareth Moore guaranteed income for providers than they have had this year so I think in return for some more certainty we would hope for some more joint working around some objectives the kind that Juliet has signalled so what this paper does is proposed the principles and objectives for the coming year for discussion by this group it also proposes some governance which recognises individuals or organisations autonomy but also suggests the partnership
governance that we could use
and it sets out the timeline which some of you who I know are very keen eyed would have spotted some of them have passed and some may be questioning whether guidance is going to arrive in the time that was signalled I think I can tell you it won't but we will have some interim guidance are before Christmas and that's basically all I was going to say by way of introduction
the front sheet says what the paper has come here for so basically to ask you to support this approach see how far we get some discussion around the principles and objectives since writing this paper I think people have commented within the senior management team that we've got some landmark priorities are that we've agreed as a partnership that we could add to it and that we will come back to you working through the CFO chief finance officer Forum and others to work this up thank you
so do you support the proposed governance arrangements
I do use a hold the vote system approach in line with ICS development and likely National planning guidance we don't have the national planning guidance calls
with EU support
consider the principles and key objectives
and note the next steps
yes if
agreed thank you very much
to any other business Mahaney are using
quality in our planning ran from nineteen twenty somewhere in there be quite helpful if they could just do that
it include more on quality I think it
is in fact comment Diane mate I thought we did a little bit more but clearly not enough
always include something on quality the NHS is always worth mentioning patients have reared occasionally
always goes down well I was fine because quite often you talking we forget
if I had the patience if I could share may be one of our principles needs to embody quality more explicitly
yes I made the point already and quality should be at the top of the agenda I know finance is really important I think we should always start off with quality I think that's
what we're about is provided quality service for people that we serve OK Any other comments on that paper
greedy Any other business other than that
yes of course
thank you Chair
it was really to say either a suggestion either to have commute comes and engagement as a standing item
showing the sort of outward nature of what we are actually doing and how it impacts the patient
on us regular basis as part of the agenda
people find that helpful communicate baseline last I handle you thing and devise a regular item
so I'm not sure you need it absolutely every meeting by certainly guiltily I would have thought
what do you think
meaning so I think there is something around them
the narrative the years which is probably useful to have because it to touch point of A&E and and GPs is not not locking now viable imminently uplift producing various other ways of people accessing health services and I don't think to put the narrative on that right so something around
the lack of this quite quite useful as
well as for you to suggest your the members of this committee and is for you to suggest any agenda items that you wish to be discussed my or my view is always the same that is not where the discussion takes place it's important is where the decisions are made you need to be clear we need to be clear with decisions made some decisions made clear here some decisions were made at CCG governing bodies but actually discussion seems to me to be a good thing I'm personally think I'd be interested in not neon reactions or we may look in future to have some seminar type meetings because I think actually in those more informal forums it's easier frankly to say things that you might later recanted on basically because you actually can come up with creative ideas and creative thoughts outside of in the sense of forum like this which is is is a different vehicle basically so I think I'd be interested in what people think about that but I do think there have been some what have you call them development sessions or seminars and not I'm not advocating having even more meetings let me say but I do think that sometimes they achieve a purpose that can't be achieved in a formal Committee that be interesting what people's views are on that okay no art no Any other business I'm sorry can I just comment on this proposal we ventured that we will bring to the next meeting
all sorts on occasion of the 10 year plan and may be once we have that we can agree perhaps period as you suggest a periodic update on comes engagement
we were very helpful Dion said in Game Over sorted my pointless ran the same thing as Nicholas intensive engagement it'd be helpful that we backed that also around our equalities and protected characteristics because as CCG's we do have an obligation in a duty in that area and I see that going hand in hand with where we are at race quality of this agenda that that would be part and parcel of doing battle so that we make sure that that's quality and Equalities and something that we do here
OK thank you can I say this as a formal closed the meeting the Council thank you very much for giving Ms Archer an easy time relatively
I upset a lot of things in my life I'm a say as my wife said to me You're you seem unduly nervous I dunno well sir that's a Chair things all over the world but I seemed to be more nervous in north-west London obviously in Wales there whether your reputation goes ahead of you
but can I say thank you thank you very much it's been both an enjoyable and I think very helpful and helpful for me so thanks for your help to these meetings we now move to questions from the public I'd made the appoints beat before about the questions some questions asked had been submitted in advance James grievous yanked greedy here against you want me to read your question or do you want to read it
for years and then very very peaceful mostly yup
tripe chore York looking at the question from James's what is the north-west London collaborative estate strategy do you plan to sell off any excess land and do each of the eight CCG's have their own estate strategies if so where can the public access these strategies
I think there is a microphone is their own yes if you could bring it forward is just that because its podcast of people won't be over here you otherwise
just as
well I have to say there was a microphone
there is another Microsoft
thank you for having several microphones were well stocked up and not worth more to Iceland and the question really is about transparency and engagement are we know from the public media that there's less on the state's Board which is looking at the valuation and sale of
samplers alleges land that's Nando's obviously owned and paid for by the public
my question really is and we don't know in north-west London what's been considered for sale if anything we don't know where to access information as to what might be under consideration for sale and we do not know whom practice makes the decision to sell to value to sell or not to sell and we do not know whether this body or local CCG's identify and put up
surplus land from the NHS for sale so it's quite easy to get hold of information
he wants to answer if he lets Murray lets me so I would distinguish between an estates strategy and a land disposal strategy because CCG's actually a mushroom CCG's actually in any land
although they certainly make you so the furnace of estates sit could hear me
I was just saying that CCG's don't own land they do occupy buildings that the buildings they occupy and release so when Ewen CCG's changed their estates arrangements there is generally a paper which goes to a governing body meeting for example yesterday I was in Brent and Brent Arab paper in the public part of the meeting which explained how they were going to save money
by moving out of their current headquarters are moving in with the council and that would be a very typical very good move because it saves money and because it aids integration with them with local authorities is a slightly different position for trusts and particularly foundation trusts because of course they do own land and buildings and ever since the NHS was established in nineteen forty eight
we've obviously have to take a view on what land we need
and Germany and were wetland become surplus to requirement is disposed of and the reason for that is relatively straight evidence self-evident if we didn't do that then we would own how ring of tuberculosis hospitals around the outskirts of London that we used to own her tuberculosis ship that was more than the Thames and so clearly as healthcare needs me wrong of need for estates moves on and there are actually some quite well known disposal schemes in North West London probably the one that's most familiar will be the one that the Brompton are proposing in Fulham Road so they're proposing as part of a move to south of the river to dispose of their Chelsea estate and rebuild south of the river
and and yet the answer to your question where decisions taken on that well insofar as it's about the sale of assets if it is a foundation trust the Foundation Trust Board is allowed to do it if it's an NHS trust and that it's a bit more complicated and and actually the approval of the Secretary of State is normally required you mentioned the London estates abroad and that is part of the London devolution agreement and we're mad devolution agreement is fully in force rather than going to the Secretary of State is the London estates board that will authorise that transaction
it proposed growth also worth mentioning there's a whole series of rules regulations about what you have to do what you dispose of surplus NHS land so the first people you have to offer it to our other NHS and public sector providers and then only when it's established that it's not required
could you offer into the into the open market and once he goes the open market the NHS rule is you have to maximise
value am
just just for completeness I should mention not the partnership so it not another another collaboration but the partnership does have a draft estates strategy and you really embodies the capital's nasty elements of our partnership STP plans that's currently in draft form we would anticipate publishing it when it's approved which will probably be early in the new year
it's OK
among other things on that let me say as well which I know from my acknowledges that Turkey was important as if land sold that that the profits from the land should come back into the NHS by doing things a national government agreement on that as such although I think locally almost everybody sees it coming back to the NHS because at that in a room key not that some landed surplus but basically that the profits of the sale of the land comes back into the ages NHS basically who originally the taxpayer who under originally but thanks very much for that question
I'm not a question from Meryl do you want me to reject mayor or do you want to read it
what I'm reading it
I should have said I'd Thirty years like these ideally with literacy and numeracy and the net effect of it my literacy became a lot worse
it's one where you should have come to me 30 years ago actually and I probably could have helped you at that point
we both would have been a lot younger
yes we worked with work would have been a lot younger I'm not sure it necessarily Up My Thirty years I actually solve the problem
OK I read it for its reported that remodelling of the effects of reorganisations of acute care services are to be undertaken shortly is beyond the control we don't worry about it is important that the scope of the MoD remodelling and the parameters include all of the necessary factors including population growth identified patient need travel and transport factors equality issues and you said to mention a few what opportunities will there be for local authorities in the m for the public to be involved at the formative stage in commenting on and make an input into drop proposals for them for the remodelling you will of course except that in the interests of transparency the modelling exercise should not be carried out behind closed doors
Mark increases
yes recently answered a similar question from Councillor Coleman of Hammersmith and Fulham surfer if I just cover
what I said to him
the remodelling exercise will be initiated and if and when we get to the fifth of the capital that were expecting 4 am for Sock won and then
we don't we don't yet know when announcement on that will be made although we've been led to believe the bid announcement before Christmas so this is a piece of work we will initiate when we have the news on the allocation of capital the aim of the red modelling exercise is essentially to predict acute bed requirements after North West London hospitals
and the peak the principal stakeholders
he will cut open the model if you like are the acute hospital providers and the North West London CCJ's we have said that piece of work will be done under the supervision of what's called the joint Health and Care transformation broken
and the rock of our eight local authorities six are represented on there were two local authorities aren't represented on their we we've said that we will consult with them as well we've also said will involve the eight directors of public health
in north-west London am you mention a couple of other things which are normally dealt with separately so you would normally do a separate travel impact assessment of any reconfiguration proposal we have them one previously so there will be a question of whether that needs to be refreshed and we would also normally do an Equality Impact assessment and again would have to revisit that and see the extent to which that would need to be
refreshed and I think we've always said that we will do this as transparently as we possibly can so the the specification that we set out in the understandable assumptions that underpin it we have no problem with making a
making available publicly
I just I just can't follow up on your behalf it does that include the public coming the point you're making his or
will the public and those bodies being involved at the formative stage not necessarily young stage my experience sometimes is that the public were involved when actually all the plans have been drawn up which is a bit too late actually to involve public impatience or will they be involved at that early stage of deciding on the on the shape of their configuration or is it likely to be lower your proposals being comment
I would just do a bit of a distinction between a at year a technical modelling and planning exercise which is required to satisfy
outline business case requirements so it does have to meet certain technical parameters
and a more generalised discussion you might have one to have about service models and capacity
so I don't say that because I want to dodge the issue clearly there will be a lot of dialogue with the public about whether we are planning sufficient capacity in north-west London but I think you're
clearly we wouldn't say Well he's very technical specification that we want the public to comment on work before we before we take it out to the specialists who model this kind of stuff but we certainly want to debate with the with the public about what we are trying to achieve or what the implications are
very hopeful Mark yes you can come out now
you nigga Mike Farrar afraid because although we can hear you is the podcast
we are so glad to come back on that first of all you mentioned six local authorities will be involved which the 2C you
are saying we're not
just to be absolutely clear I said six were all these this committee I was talking about and to or not and I then said that we would also involve the two that weren't on the on the Committee the two that aren't on the Committee can probably guess are Ealing and Hammersmith and Fulham I
find that interesting and disturbing because those are the two local or Sarah cities who at least as things stand at the moment are those who are going to be most affected if the original plans for downgrading of A&E services are
implemented it is in Ealing that Ealing hospital is in its in Hammersmith and Fulham the Charing Cross hospital is in not to have those local authorities involved in the planning of in the planning and looking at the modelling strikes me as as being a way of
of not looking at what local authorities know about local populations
to justice just to check that you heard me I did he you so so you heard me say that we would involve those two councils in the development of the modelling but those councils have decided not to sit on that particular committee so that's the distinction that we draw
right can I ask how you intend to involve this
local authorities because I know that my own local authority Hammersmith and Fulham is is very concerned at what it sees as
a lack of willingness to to involve it in the remodelling and to be transparent in the remodelling
yes I mentioned that I've been in conversation with a Councillor Coleman a so what I've said to him is that we will involve Hammersmith and Fulham council with the remodelling and
we are completely open to a discussion about the best way of doing that we intend to come up with a draft specification which I imagine will form the basis of discussions with all of the Council's in in north-west London
I dunno the colleagues who are from Hammersmith and Fulham want to add anything
James you are threatened with Headingley when I too am added the further of other than that of the new Chair that commitment intended in showing that we did have appropriate communication
I get to come back to school on the question of public investment and it does sink
let me
this before you were there Mac but
we were told that modelling was done before to Amy's were closed when those terrain is were closed there was an immediate and very negative knock-on effect on the remaining a Lyonnais in north-west London we have figures that show that quite clearly particularly for type 1 A&E cases I think it would be I have asked and been refused the modelling figures for that earlier I'm modeling I wanted to look at the parameters that we used then to see why that sort of era in modeling actually happened and that's why I sink to get some local look
from local people who know the area to look at some of those parameters might actually be a helpful step instead of using parameters that maybe just maybe were somewhat wrong in the initial modelling
just to reiterate
Bolton Abbey to share our proposals of modelling was happy to take public comments on them more than happy to be completely transparent about the underlying assumptions
OK other other questions have not been notified by other questions from members in public that Ikea even if they've not been floated on Aim in Nevada caucus will ask
can I say thank you very much thank you for your questions that
concludes the
session for patient questions and concludes the meeting thank you are much of your attention