Draft – Minutes for Meeting of the Governing Body held in public
Thursday 5 November 2015, 13.30
Meeting Room 3, Beccles House, Beccles
Present
Name / Position / Organisation
Dr John Stammers (JS) / Chair / NHS GYW CCG
Andrew Evans (AE) / Chief Executive / NHS GYW CCG
Cath Gorman (CG) / Director of Commissioning and Quality and Chief Nurse / NHS GYW CCG
Tessa Litherland (TL) / Director of Contracting / NHS GYW CCG
Rebecca Driver (RD) / Director of Commissioning and Engagement / NHS GYW CCG
Kate Gill (KG) / Director of Operations / NHS GYW CCG
Zoe Pietrzak (ZP) / Chief Financial Officer / NHS GYW CCG
Alan Streets (AS) / Director of QIPP / NHS GYW CCG
Dr Andy McCall (AMc) / GP / Millwood surgery
Dr Hitesh Kumar (HK) / GP / Andaman
Dr Liam Stevens (LS) / GP / East Norfolk Medical Practice
David Stock (DS) / Practice Manager / Millwood
Clive Sillitoe (CS) / Practice Manager / Bridge Road
Cedric Burton (CB) / Lay member / NHS GYW CCG
Louise Jordan-Hall (LJH) / Lay member / NHS GYW CCG
John Plaskett (JP) / Lay member / NHS GYW CCG
Robert Temple (RT) / Lay member / NHS GYW CCG
David Scott (DSt) / Secondary Care Representative / NHS GYW CCG
Graham Dunhill (GD) / PPG Representative / NHS GYW CCG
Jonathan Williams (JW) / Chief Executive / ECCH
In attendance
Name / Position / Organisation
Amanda Sear (ASE) / Business Support Officer / NHS GYW CCG
Arthur Charvonia (AC) / Strategic Director / Waveney District Council
Nicole Rickard (NR) / Head of Communities / NHS GYW CCG/WDC
Alan Kent (AK) / - / Litmus Health Limited
Action
Owner
1. / Apologies for absence
Apologies were received from Ian Gibson, Abhijit Bagade, Mariella Elissen and Andrew Wall.
2. / Chairman’s introduction and report on any Chairman’s action
JS welcomed everyone to the meeting, including the many members of the public, to engage with and oversee the public meeting.
JS reported he had attended the Norfolk health and wellbeing board meeting the day before and outlined the role of their role in terms of health and wellbeing oversight and their scrutiny of how the CCG discharges its duties, particularly in respect of the joint strategic needs assessment. He confirmed they remained satisfied with the CCG in all respects.
He noted that the meeting had discussed the Better Care Fund, the joint health and social care fund, aimed at improving coherent care between the two sectors with the specific aim of reducing emergency care of the elderly in hospitals. It had been highlighted that the work in Gt Yarmouth & Waveney had contributed to a 6% reduction in unplanned emergency admissions to the James Paget University Hospital (JPUH). A stark contrast to national trends.
JS linked that discussion with the discussion on the CCG’s plans today which are a further initiative to commission quite demonstrable improvements in care for its population. He went on to confirm his determination that the CCG will continue to strive for excellence in care for its population.
3. / Declarations of interest
There were no new declarations of interest other than those already on the register.
For the purposes of this meeting, JS reminded those present that he was a member of Sole Bay Health Centre which hold a contract to provide medical cover for Southwold Hospital. He also highlighted that Dr Stevens was a partner of East Norfolk Medical Practice who hold a contract to provide medical cover for Northgate Hospital. He confirmed that neither would be involved in any decisions relating to these respective hospital sites.
The Governing Body noted the register of interests is freely available through the HealthEast website to anyone wishing to view it. / DECLARATIONS OF INTERESTS
4. / Approval of the minutes of the meeting held on 22 October 2015
The minutes were agreed to be a true and accurate record.
5. / Matters arising from the minutes and action log
The action log was updated and will be circulated with the minutes.
QUALITY AND ENGAGEMENT
6. / Communities Delivery Plan
RD introduced this item.
NR gave an overview of the proposed work plan with communities designed to support the delivery of the CCG’s ambitions for high quality integrated care for its population.
She highlighted an action to run a series of workshops with relevant voluntary and community organisations and commissioners to help communities understand and explore specific issues.
Having considered the draft Communities Delivery Plan, the Governing Body supported the direction of travel through the delivery of early intervention and prevention support in line with the priorities set out in the plan.
It was agreed that an update on progress will come to the Governing Body in April 2016. / Governing Body Agenda Item
7. / Public Consultations – GP Practices premises in Gorleston and Bradwell. Presentation on the Options Appraisal workshop
JS introduced this item.
AE described the work which has taken place over the previous twelve months in respect of the issues around premises for Gorleston and Bradwell practices (which have been known for much longer) and which underpin the process by which the CCG had arrived at the point of making a recommendation to NHS England.
AE confirmed that three premises, stressing premises and not GP practices, are currently either not fit for purpose or for the future provision of care for an increased population based on best practice provided by multi-disciplinary teams.
The consultation had proposed three potential options for the provision of a new primary care centre and the clear public majority was for Shrublands.
Alan Kent, from Litmus Health Limited, explained the options appraisal process, which had supported the considerations of the Governing Body to make carefully considered and objective decisions. A full explanation of this process could be found in the paper supporting this item. The Governing Body noted a typographical error on page 13, where Beacon Park should read number 2 in ranking and not number 1 but this did not affect the clarity of the conclusion of the outcome of the paper.
AE stressed that any decision would still require support from NHS England to provide capital to build a new facility. The result of the decision will be communicated to NHS England for joint consideration.
8. / Consultation questions from the Public
The Governing Body answered questions from the public. Full details of these can be found in Appendix 1 at the end of these minutes.
9. / Public Consultations – GP Practices premises in Gorleston and Bradwell – Final Decision and Recommendation to NHS England
After discussion of the recommendation and careful consideration, taking account of all the facts and views expressed through the public consultation and outside it, the Governing Body voted unanimously in favour of approving the endorsement of the Shrublands site as the CCG’s preferred location for a new Primary Care Centre for Gorleston and Bradwell.
The Governing Body also unanimously supported the implementation approach and governance structure as detailed in the paper.
Work will now proceed with NHS England, who hold the primary care capital budget, to access necessary capital funding.
10. / Public Consultations – Shape of the System Presentation on the Options Appraisal Workshop
JS introduced this item.
The Governing Body noted the typographical error on page 8 of 26: item 7.3 should read 7.7.
AE again outlined the lengthy planning and execution which sits behind this complex consultation exercise, including thorough and comprehensive processes involving a Gateway Review, review by the Clinical Senate and NHS England. The background to the proposals had been rigorously researched and were compliant with current best practice and ambition.
The CCG had run a series of public meetings as part of the public consultation which were very well attended with high levels of formal responses. There had also been numerous other meetings with local bodies.
In coming to a recommendation the CCG executive had pulled together the public responses, what is international and national best practice, NHS England guidelines and local experience of services and needs and concluded the development of a general model of care based on more integrated multi-disciplinary community-based services providing care closer to people’s homes and where possible, in their own home, represents the best model of care for patients for now and the future.
AE emphasised the following points:
·  Current services would not stop until replacement services are in place.
·  There is recognition, largely as a result of the public consultation, that services need to be designed and commissioned on a local basis, taking account of and matching the different populations and geographical areas with services.
Alan Kent, from Litmus Health Limited, explained the decision support workshop at which the existing and proposed models of care had been assessed. Using a quantitative options appraisal process the models had been compared using criteria agreed by a multi stakeholder audience. A full explanation of this process can be found in the paper supporting the item. AK confirmed that the new model of care proposed had been a very clear first choice
LJH noted the implementation phase will be key and recorded her expectation that the public will be given a real opportunity to be involved in shaping the new services.
LJH sought assurance around managerial capacity and long term resource to achieve equal access to services across GY&W.
RT was reassured that services will not be withdrawn until replacement services are in place and hoped the public will also take comfort in this point. He confirmed his expectation that the Governing Body will continue to keep a very close eye on this particular point.
JP noted the success of the Lowestoft Out of Hospital team in terms of both patient satisfaction and reducing demand on A&E at JPUH. He echoed his support for services to continue, and be available through community hospitals until beds with care become available. He noted his full support for the proposals but asked AE to reiterate the principles (outlined on page 8 of the report) and the benefits for the case for change (outlined on page 4 of the report), which he went on to do.
GD advised that the Patient Participant Group have always supported care closer to home, subject to the community-based services being in place and local implementation, believing this to the best place for care to be delivered to ensure best practice and ensuring equitable access for the whole population.
LS confirmed that whilst he is comfortable with the proposed model to meet current needs he went on to seek some assurance around the availability and affordability of beds in care homes in the future. AE recognises the pressures to which LS referred and went on to outline the proposed plans for new care homes locally and highlighted the benefits to care homes of providing beds with care, which he believes will mitigate these pressures.
CS shared the experience of Lowestoft practices and GPs, who have found the Lowestoft Out of Hospital team responsive with positive feedback from both patients and carers.
DSt highlighted the support of out of hospital teams in both reducing emergency admissions and facilitating discharge in terms of the acute section of the local health and social care system. This sentiment was recently echoed by the Unplanned Care Board during a recent period of very high demand and pressure across the local system.
11. / Consultation questions from the Public
The Governing Body answered questions from the public. Full details of these can be found in Appendix 2 at the end of these minutes.
12. / Public Consultations – Shape of the System – Final Decision
AE reiterated that the reference to All Hallows, a charitable trust, in Recommendation one refers specifically to the five beds currently commissioned there, not the hospital itself. The CCG recognises All Hallows as an important part of the plans for GY&W and other CCGs and will continue to work with them as a provider for other services. AE expressed the hope that All Hallows would play an important part in implementing the new model of care and bring their unique approach and skills to bear.
After careful consideration, taking account of all the facts and views expressed, the Governing Body voted unanimously to support the development of a general model of care based on more integrated multidisciplinary community services, delivered from community hubs throughout the CCG, providing care closer to people’s homes and where possible, in their own home.
The Governing Body went on to unanimously vote in favour of:
·  Recommendation one: All Hallows Hospital
·  Recommendation two: Beccles Hospital
·  Recommendation three: Northgate Hospital
·  Recommendation four: Patrick Stead Hospital
As set out at the start of the meeting Dr Stevens abstained from voting in Recommendation three.
The Chair passed to LJH for Recommendation five. The Governing Body voted unanimously in favour of:
·  Recommendation five: Southwold Hospital
The Governing Body went on to endorse the implementation phase under section 7.7 of the report – noting the issues which will need addressing at this stage set out on page 16 and 17 of the report.