Bevan Commission Meeting
Date of meeting:Tuesday 24 May 2016
Time of meeting: 08:30-16:00
Venue for meeting: Boardroom, School of Management, Swansea University
Version: V4
Present: / Name: / Identification:
Professor Sir Mansel Aylward (Chair) / MA
Sir Anthony Newman Taylor (Vice Chair) / ANT
Chris Martin (Deputy Chair) / CM
Dr Helen Paterson / HP
Fran Targett / FT
Professor Elizabeth Robb / ER
Professor Ewan MacDonald / EM
Professor Bim Bhowmick / BB
Professor John Wyn Owen / JWO
Professor Trevor Jones / TJ
Professor Phillip Routledge / PR
Juliet Luporini / JL
Helen Howson (Secretariat) / HH
Sion Charles (Secretariat) / SC
Dr Tom Powell (Secretariat) / TP
Beth Williams (Public Health Wales) / BW
Apologies: / Name:
Nygaire Bevan
Lieutenant General (Retired) Louis Lillywhite
Ann Lloyd
Professor Michael Marmot
Sir Ian Carruthers
Mary Cowen
Professor Dame Carol Black
Professor Andrew Morris
Sir Paul Williams
Dr Anthony Calland
Ruth Dineen
1. / Welcomes and apologies
MA welcomed all to the meeting and noted apologies received from Nygaire Bevan, Lieutenant General (Retired) Louis Lillywhite, Ann Lloyd, Professor Michael Marmot, Sir Ian Carruthers, Mary Cowern, Professor Dame Carol Black, Professor Andrew Morris, Sir Paul Williams, Dr Anthony Calland and Ruth Dineen.
MA Thanked Chris Martin for ably chairing in his recent absence overseas.
MA also welcomed Beth Williams as a temporary member of staff from PHW and also reported that Sania Munir had left the Commission at the end of March.
MA stated that external and internal changes has happened in MA’s absence, in brief those being:-
  • New government
  • New Minister
  • New agenda
  • New future for the Commission with - new ways of working with more time to discuss and debate
MA explained that there was a clear designated purpose and focus for today with an agenda designed to allow greater debate and discussion.
2. / Chairs Update/Brief on Transition Arrangements
MA explained that the hosting of the Bevan Commission had not been as had been anticipated following his meeting with the Minister before his departure and had resulted in delayed progress.
There was discussion around whether hosting within another NHS organisation or university could be an option, MA reported that he had spoken to all viable Universities but none had expressed an interest or were able to proceed at the time.
MA had met with Marc Clement (Professor and Head of the Business School) and stated that there were no transfer/hosting issues with Swansea University in view of secondments and TUPE (Transfer of Undertakings (Protection of Employment) Regulations 2006). This matter was also discussed with Professor Richard Davies (RD) the VC during his meeting with him. RD was at the time unaware of many of the issues relating to the Bevan Commission and its role and independent status.
Most recently, Cardiff University had expressed an interest in hosting the Commissionwhich had changed the situation. MA had sought legal advice on this matter.
Cardiff and Swansea Universities are now both interested in hosting the Commission from 1st October 2016. In light of this and to ensure openness and transparency, Commissioners advised that a transparent tendering processand sub group should be established to manage this process. This needs to exclude any members of the Commission with links or a vested interest with either Swansea or Cardiff Universities. Declarations of interest were noted at the meeting and included ;
Cardiff University; MA, PR,BB, ER
Swansea University; JWO, JL, TJ, HH
CM was asked to chair and lead this small subgroup of three Commissioners to undertake this process.
(Note – subsequently confirmed as ANT and FT)
Action A9: CM to chair and lead hosting process subgroup and provide advice to the Commission for their formal ratification.
JWO queried why the Bevan Commission and Bevan Foundation could not become closer as they both shared the Bevan ‘Brand’. MA explained that the Foundation unlike the Commission is affiliated to the Labour party and therefore due to the Commissions independence prevented closer ties. MA and HH had met with them to ensure clarity on agenda’s and roles etc
3. / Meet with Richard Davies Vice Chancellor Swansea University and Marc Clement
MA thanked Professor Richard Davies (RD) for the warm reception for the Commission from the University and formally introduced him to the members of the Commission outlining his CV and widespread knowledge and experience.
RD explained that since becoming Vice Chancellor of Swansea University in 2003 a radical change agenda had been pursuedwith external investment sought. He reported the day before (Tuesday 23 May), a large science and innovation facility had been planned and approved as part of the University’s development. Under his leadership, the University has adopted a radical and ambitious and exciting agenda for change, building on its strengths and attracting substantial external investment to accelerate the pace of development.
RD also shared his wider vision of the University with the Commissioners and the ongoing plans for the future.
MA thanked RD and MC on behalf of the Commissioners
4. / Minutes of the Last Meeting
As Chair of the February meeting CM took Commissioners through the previous minutes and action points.
Update to Actions:
CM & HH to discuss Bevan’s role and visibility around prudent healthcare with Andrew Goodall and report back.
Bevan Commission and Andrew Goodall to link more closely updating him on papers, plans and their thinking to ensure the opportunities to inform policy and delivery were maximised.
MA had an appointment in the diary to meet with Andrew Goodall in the next week and would ensure these meetings were regularised.
Matters Arising from the February 2016 Meeting Minutes:
Deputy Chairs Update and Minutes
Under the Previous (December2015 ) Meeting Notesregarding the presentation made by Dr Layla Jader, amendments were proposed for greater clarity on the following point‘Some Commissioners also expressed concerns around the technical soundness of some of the evidence.’ Commissioners felt that further elaboration was needed and explicit reference related to the soundness of the statistical inferences made during the epigenetic presentation.
Action 10: Dec 2015 minutes in reference to Dr Layla Jaders presentation to be amended.
Discussions with ABPI members
Further dialogue had been held withsome companies including Astra Zeneca, Johnson & Johnson and Bayer. CM and HH discussed with Commissioners the need to ensure that any joint work must align with the Commission’s agenda and priorities and not their own. CM summarised the conversation.
Advice for Minister
A number of papers had been finalised in February including ; Early Intervention; End of Life Care and Redrawing the relationship – MA agreed to follow up on these and also the Barriers paper and the future priorities paper, with the new Secretary for Health, Well being and Sport, Vaughan Gething, when he meets him shortly .
Action11: MA to meet with and update Vaughan Gething and report back at next Commission meeting.
Future Generations Commissioner
HH discussed the recent meeting with the Well Being and Future Generations act Commissioner, Sophie Howe who attended the February pre meeting. Sophie was keen to collaborate with the Commission and further meetings were planned to expand upon this. Discussion ensued regarding the Auditor General for Wales and Future for Generations with a potential overlap of responsibilities
Health Board & Trust Visit update
CM thanked all assisting with the visits to health boards and Trusts. Wales Ambulance Service NHS Trust visit was only organisation outstanding but a date had been set for June 2nd in Cwmbran. Commissioners who were able to attend this should link with Helen
Auditor General – Wales Audit Office discussion: Huw Vaughan Thomas and Chris Bolton
CM summarised the points covered at the meeting. Commissionerswere updated on the Behaviour change festival recently undertaken in North Walesand on further work on managing risks being planned with the Wales Audit Office.
Format of Meeting Minutes and Actions
ACTION A12 A Status column to be added to the outstanding actions before the next meeting to provide explanation of why they have not been completed.
All were thanked for their contribution to the last meeting and a summary of the actions would be added to the minutes of this meeting.
5. / Barriers and Enablers Paper – Discussion and Preparation for Sign Off
It was noted that some very powerful stories were collected from Bevan Exemplars.
EM stated that this was a good paper and would make more progress if we stop trying to change the NHS as a whole. EM felt that there was a need for government legislation on decision making and deliverables being assessed or quality assured with standards set by an external agency.
JL agreeing with EMthat what was needed was a common goal, common ground, with everyone on-side including the Minister and WG. BB stated that this was a good paper, and if our job was to scrutinise, have we got lessons to learn?
Some commissioners felt that there were too many recommendations and that a single message was needed, specifically around WG producing a clear vision for how the health service should look in the future.This was agreed. The remaining recommendations might be better suited as indicators for future improvement and should not be lost. In addition it was suggested that greater positive focus should be place on the enablers and the order in which they were presented.
MA summarised the key points and confirmed that the amendments would be noted and made in redrafting the document.
Action A13:Update and amend Barriers and Enablers Draft for future final sign off.
6. / Future Directions And Key Priorities in Health And Well Being for the Incoming Government in Wales
HH presented a paper to help set the scene and provide focus for the following discussions of the day. This included points raised at the discussion on this in December along with other organisations’ priorities for the NHS, including the NHS Confederation and the Kings Fund .
7. / Session 1 ;The purpose of This Session was to Discuss and Debate of Key Issues and Questions for Future Health and Care in Wales
A facilitated session was undertaken and it was suggested that all were asked to give a brief statement or simple quote on the key matters for the future that people would easily understand and could be simply expanded upon. The following comments were made:-
  • We must maximise the health and wellbeing of people on Wales
  • Use the best evidence
  • Fewer lives lost because quality of care is not improving fast enough
  • Wellbeing at the heart of our lives now and forever
  • Today in Wales we want everyone to be well
  • The main purpose of Welsh Government is to improve health and wellbeing
  • Improve the health of the future generation
  • A single simple system integrating patients and carers
  • A Wales where people are enabled to fully function
  • My government will put a higher priority on health and wellbeing over commercial interests
  • Narrow the gap to enable health and wellbeing by all
  • Create an environment for people of Wales improve health and wellbeing
  • Well informed citizens
  • Sustainability - educate/engage with the young
  • Working together to enable people of Wales to enjoy their lives
  • Create an environment where we have healthy citizens from cradle to grave
  • Living lives in best way possible
  • Together we will add years to life and life to years
  • Now we must universalise the best - Bevan
  • Public service = common purpose to enable people at every stage of their lives to do as much as possible
  • Enable people to live full lives
  • Remove all barriers to enable people to access integrated services
  • 'Health gain for Welsh gain'' or Health gain, avoiding premature death and improved quality of life
  • We will transform the health and wellbeing of Wales
  • We will close the gap between the rich and less rich
  • Make living a healthy life easy
  • Provide patients with information they need to manage their own condition
  • Create a future for our children
  • Improve integration
  • Simple system for integration
  • Using the best evidence (how?)
  • Compassionate care for all
  • Today in Wales we want all our citizens to be well
  • Reduce health inequalities
  • Data driven learning from international examples
  • Putting trust back - engaging
  • Right environment for your children
  • Sustainability taking into account wider determinants of health
  • Living the life we choose for as long as we can
  • To provide patients with information needed to manage their care
  • Remove barriers to integration for the benefit of the people of Wales
  • Measurable indicators
  • Well informed citizens choosing wisely
  • Caring for those who need it, investing in those who can't
  • Work with the people of Wales to create an environment where we live well and healthily to add to your life and life to years
It was agreed that these would be collated into a short number of key themes for further consideration
8. / Session 2 Agree and Formulate the Key Issues to be Included in Forthcoming Future Priorities Paper for the Commission to focus upon
The group had further discussion on future priorities and agreed that there should be some visualisation around what success looks like.
MA stated that the Commission must continue to promote the implementation of prudent healthcare as this is still not fully understood or applied by the whole of the health service. In order to demonstrate prudent healthcare, we must be able to see it, feel it and touch it.
A discussion also took place around possible ‘pathfinder’ themes and the following points were made:-
Bevan Pathfinder for Health and Wellbeing with people of Wales.
  1. A vision for the future for health and wellbeing in Wales – to include; a social model for health / population health etc.
  2. Creating aPrudent Wellbeing and Health Culture – to include; future generation / clear indicators accountability and prudent public services etc.
  3. Integrated thinking in practice – to include; health, well being and care from the public and patients perspective.
  4. Smart Governance -a whole society approach to include health Public service Boards, Regulatory bodies, appraisal and validation.
  5. Quality (systems) standard – to include /ISO (predictive analytics) regulation etc.
  6. Transformational change:
  • Innovation
  • Improvement
  • Implementation
The Secretariat will take information collected today and formulate into a draft paper summarising the discussions for wider comment and feedback. MA will use this information in discussions with Vaughan Gething in upcoming meeting. MA will also talk about what the meeting was about today and invite him to the next meeting to consider and discuss in further detail.
Action A14: Secretariat to compile meeting discussions and produce a paper of Commission Priorities for the next 3 years for wider comment and feedback
Action A15: MA to invite VG to the next meeting
9. / Conclusions and Next Steps
In summary the information collected today will be collated and complied, distributed and agreed. MA will then speak to the Minister regarding these initial thoughts which will need to be formally compiled and submitted before summer recess. All were thanked for their valuable contributions.
10. / Any other business
New meeting/event dates were noted.
Action 16: BW to distribute future meeting dates to all.
Bevan Exemplar meeting: 13thJuly
Pre-commission evening meeting : Evening 13thJuly
Bevan Commission Plenary meeting : All Day 14th July
Bevan CommissionAnnual Conference: 27thSeptember
Pre-commission evening meeting : 27thSeptember
Bevan Commission Plenary meeting : 28thSeptember
Exemplar: conference: Dec TBC
Bevan Commission Pre-evening 7th December
Bevan Commission Plenary meeting : 8thDecember
Expenses and Travel Reimbursement
Action 17: BW to review outstanding expenses claims. All new expense claims should be sent to BW as soon as possible.
Biographies and Declarations of Interest
Action 18: BW will be in touch distribute forms and collect information in the near future.
11. / Date and Time of Next Meeting
The next meeting will take place on the 14th of July at Swansea University with a pre-meeting on the evening of the 13thJuly.

Actions:

Reoccurring Actions
Action / Who By / Completion date
A1 / Once signed off upload previous meeting minutes to web site / Bevan Secretariat / Following each plenary meeting
A2 / Produce meeting minutes / Bevan Secretariat / Following each plenary meeting
A3 / Produce ‘quarterly’ report based and upload to web / Bevan Secretariat / Following each plenary meeting
Completed Actions
Who By / Completion date
Commissioners to provide any outstanding expense claims asap. / Bevan Commissioners / May 2016
Amend draft Decembers minutes accordingly before publication on Commission Website. / Bevan Secretariat / March 2016
Existing terms of reference and Commission constitution to be circulated to Commissioners. / Bevan Secretariat / March 2016
Trevor Jones (TJ) to arrange a meeting regards the Ethical Medicine Industry Group (EMIG) / TJ / May 2016
Produce/develop a summary of key relevant points from political party manifestos / Bevan Secretariat / May 2016
CM & HH to discuss Bevan’s role and visibility around prudent healthcare with Andrew Goodall and report back. / CM & HH / April 2016
Amend ‘Redrawing the Relationship’ paper as necessary and send with ‘Early Intervention’ paper to the Minister. / Bevan Secretariat / March 2016
Circulate Bevan Commission and Academy presentation. / Bevan Secretariat HH / March 2016
Distribute times and locations for outstanding visits. / Bevan Secretariat TP / March 2016
Send early draft of health definition to EM for comment and follow up with Mansel on his return / Bevan Secretariat / Feb 2016