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Final Meeting of the West Suffolk CCG Governing Body to be held 'in common'with Ipswich and East Suffolk CCG Governing Body andNorth East Essex CCG Governing Bodyfrom 1230 to 1330 hrs on Tuesday 28 June 2022The meeting will be ‘live streamed’ for members of the public (a link for the live streaming will beavailable on the CCG website).Members of the public are invited to submit questions relating to agenda items either, prior to themeeting, via email to jo.mael@suffolk.nhs.uk, or during the live streaming when they will be collatedand asked at the appropriate time on the agenda. The minutes of the meeting which will includeanswers to any questions submitted by the public will be published on the CCG website after themeeting.AGENDAGENERAL BUSINESS1Apologies for AbsenceDr ChristopherBrowning2Declarations of Interest and any Hospitality or GiftsDeclarations of Interest made by members of the Governing Body andlisted in the CCGs Register of Interests which, along with the CCGsHospitality and Gifts Register is available on the CCG website3Minutes of the previous West Suffolk CCG Governing BodyTo approve as a correct record the Minutes of the West Suffolk CCGGoverning Body meeting held on 25 May 2022Dr ChristopherBrowning4Matters Arising and Review of Outstanding ActionsTo note and endorse how we have responded to the outstandingissues which arose at the last meeting and those to be passed to theSuffolk and North East Essex ICB from 1 July 2022Dr ChristopherBrowning5General UpdateWhat has been happening in the CCG since the last meeting?To receive a final verbal reportAllEd GarrattTRANSITION AND CLOSEDOWN6Purpose of the final West Suffolk CCG Governing Body MeetingTo receive a verbal report from the Chief ExecutiveEd Garratt
7Quality and Continuing Healthcare (CHC)To note the ongoing quality and CHC issues being passed to theSuffolk and North East Essex ICB from 1 July 2022Lisa NobesReport No:a) Quality ReportWSCCG 22-29ab) Continuing Healthcare ReportWSCCG 22-29b8CCG Closure and ICB Transition Internal Due Diligence,Assurance and National Transfer OrderTo note the content of the Transfer Order and in particular issuesrelated to the transfer of people, contracts and property to the Suffolkand North East Essex ICB from 1 July 2022Amanda LyesReport No:WSCCG 22-309Governing Body Assurance Framework and Directorate RisksTo note and approve the ongoing risk management issues beingpassed to the Suffolk and North East Essex ICB from 1 July 2022Amanda LyesReport No:WSCCG 22-3110Emergency Preparedness, Resilience and Response (EPRR)To note the statutory responsibilities for EPRR being passed to theSuffolk and North East Essex ICB from 1 July 2022Paul GibaraReport No:WSCCG 22-3211Annual Report and AccountsTo note the agreed process for approval and publication of the 202122 CCG Annual Report by the Suffolk and North East Essex ICB after1 July 2022Jane PaylingReport No:WSCCG 22-3312Chair’s Closing AddressDr ChristopherBrowning13Any Other Business14Questions from the public – Maximum 10 minutesPlease note questions should relate to the items under discussion andmust be a question rather than statement. Where individuals deviatefrom this requirement they will be asked to stop and will not be invitedto take any further part in the meeting.
West Suffolk CCG Governing Body and Sub Committee MembersTitleFirst NameLast NameDeclared InterestType of InterestFinancialInterestsGoverning Body GP MemberCCG ChairLay Lay Member for Governance and Vice Chair CCGChief OfficerGeoffEdDobsonGarrattDirector of Performance ImprovementEnhanced Associate GPPaulAndrewGibaraHassanDirector of Corporate Services and System Infrastructure AmandaLyesDirector of NursingLisaNobesDirector of FinanceJanePaylingGoverning Body GP MemberInterim Chief Operating OfficerGoverning Body GP Governing Body GP MemberFirasWatfehDirector of Strategy and TransformationRichardWatsonGoverning Body GP MemberGoverning Body GP MemberVictoriaAndrewWilsonYagarNon FinancialProfessionalInterestsNon FinancialPersonalInterestsDirect orIndirectDate of InterestFromDate of ReceiptAction Taken to 04/04/202204/04/202204/04/2022Consentto esYesYesYesYesYesYesGP Bury St EdmundsDirector of company providing urological services to Swan Surgery, BSESNEE training hub quality GP leadPMS Provider, Practice Partner Long MelfordOut of Hours doctor for Care UK and Suffolk GP FederationWife is Consultant at West Suffolk HospitalClinical Director for WGGL PNN"Part-time medical adviser for the NHSE EoE Professional Standards unitLay Member for Ipswich and East Suffolk CCGWife is Director of East of England Co-opWife is Director of Eastern Savings and Loans Credit UnionWife is Director of Rainbow Saving Credit UnionFormer Director of Resource Management with Suffolk County CouncilChief Executive Ipswich and East Suffolk CCGChief Executive North East Essex CCGChief Executive (Designate) – Suffolk & North East Essex ICSVisiting Professor of Integrated Care – University of SuffolkDirector of Performance Improvement for SNEE CCGsWife has GDS contract with NHS EnglandVaccinator for EPUTVolunteer at WSFTInterim Director of Workforce, Suffolk and North East Essex Integrated Care System &Director of Corporate Services and System Infrastructure SNEE CCGs DirectOngoing19/04/2022 No further action requiredYesInterim Director of Workforce for SNEE ICSNil DirectMar-21Ongoing19/04/2022 No further action required26/04/2022YesYesDirector of Finance for Ipswich and East Suffolk CCG and North East Essex CCGTrustee of Cambridge Theatre TrustMember of Cambridge Regional College Finance CommitteeSuffolk LMC representative at Future Systems Programme Board meetingsNilClinical Director of Sudbury Primary Care NetworkGP Partner in a dispensing practiceClinical Director Haverhill PCNGP Federation Out of HoursGP Partner at Haverhill Family PracticeDirector of Strategy and Transformation for Ipswich and East Suffolk, North East Essex CCGs and West Suffolk CCGsHusband is employee of Hadleigh Group PracticeDeputy Chief Executive SNEE CCGsShares in company for ophthalmology related workMaternity work for maternity voluntary partnership West Suffolk Hospital.GP perinatal mental health spotlight champion (reimbursed for teaching sessions).Co-chair of West Suffolk First 5 22OngoingOngoingOngoingOngoingGP Co-production lead for Future Systems ProgramNil 2022Leave to Apr 23No further action requiredTo be declared when appropriateTo be declared when appropriateTo be declared at relevant meetingsTo be declared at relevant meetingsTo be declared at relevant meetingsTo be declared at relevant meetingsTo be declared when appropriateTo be declared when appropriateTo be declared when appropriateTo be declared when appropriateTo be declared when appropriateNo further action requiredTo be declared when appropriateTo be declared when appropriateTo be declared when appropriateTo be declared when appropriateNo further action requiredTo be delcared when apprpriateNo further action requiredNo further action requiredTo declare when appropriateTo declare when appropriateTo declare when appropriateTo declare when appropriateNo further action requiredNo further action requiredTo be declared as necessaryTo be declared as necessaryTo be declared as necessaryTo be declared as necessaryTo be declared as necessaryTo be declared as necessaryTo be declared when appropriate DirectOngoing Leave to Apr 23 DirectOngoing Leave to Apr 23To be declared when sYesYesYesYesTo be declared when appropriateYesYesYes
Meeting of West Suffolk CCG Governing Body held in public on Wednesday 25 May 2022via Microsoft Teams and live streamed for members of the public.PRESENT:Dr Christopher BrowningDr Zohra ArmitageGeoff DobsonEd GarrattPaul GibaraAmanda LyesLisa NobesJane PaylingDr Godfrey ReynoldsSandie RobinsonDr Bahram TalebpourDavid TaylorDr Firas WatfehRichard WatsonDr Andrew YagerCCG ChairGP MemberLay Member for GovernanceChief ExecutiveDirector of Performance ImprovementDirector of Corporate Services and System Infrastructure (Part)Director of NursingDirector of FinanceGP MemberInterim Director of IntegrationGP MemberCommunity Engagement Group ChairGP MemberDirector of Strategy and Transformation (Part)GP MemberIN ATTENDANCE:Dr Andrew HassanDr Andrew KelsoLianne JoyceJo MaelClare SymmsEnhanced Associate GP MemberMedical Director, ICBAssociate Director of Nursing (Part)Corporate Governance ManagerNorfolk and Waveney CCG (Part)22/032WELCOME AND APOLOGIES FOR ABSENCEThe Chair welcomed everyone to the meeting and apologies for absence werereceived from;Steve ChickenAmanda LyesDr Victoria WilsonLay MemberDirector of Corporate Services and System Infrastructurewould be arriving late.GP MemberAs the meeting was the final one before a short scheduled meeting to officially closethe CCG, the Chair thanked Jo Mael for her work over the last nine years inproviding administration to the Governing Body.22/033DECLARATIONS OF INTEREST AND HOSPITALITY AND GIFTSNo declarations of interest were received.22/034MINUTES OF PREVIOUS MEETING
The minutes of the meeting held on 23 March 2022 were approved as a correctrecord.22/035MATTERS ARISING AND ACTION LOGThere were no matters arising and the action log was reviewed and updated.22/036GENERAL UPDATEThe Chief Executive reported; It had been a pleasure to be part of the CCG Governing Body from creation toclosure and thanked were extended to the Chair for his balanced approach.Transition to Integrated Care Board was due to take place from 1 July 2022 andthe recruitment of Board members continued. Jane Payling, Director of Financewas thanked for her leadership within the finance function and best wishes wereextended for the future.Elective recovery and waiting list performance was improving.Urgent and emergency care pressures – the system was resilient and generallyoperated at Opal 3 level although was currently now at Opal 2. There was a lotof focus on ambulance response and handover delays.A key issue was the latest Care Quality Commission (CQC) report in respect ofNorfolk and Suffolk NHS Foundation Trust whereby the Trust had been ratedas ‘inadequate’. The CQC had visited in 2021 and planned to visit again in thecoming months. The Trust had been informed by the CQC that it did not tolerateinadequate services and a lot of work was underway to ensure improvement.The Governing Body noted the update.22/037PATIENT STORYNo patient story was received.22/038PATIENT AND PUBLIC INVOLVEMENT AND EXPERIENCE Q4 ACTIVITYREPORTThe Governing Body was in receipt of the fourth quarterly patient and publicinvolvement report for the year of 2021/22. The report set out quarter four activityof the Patient and Public Involvement and Experience Team and recorded thescope of the activity, number of people involved and impact or outcome achieved.Points highlighted included; The number of MP contacts had decreased from those experienced during thevaccination programme and were now returning to normal levels.A key current focus was review of the effectiveness of the community mentalhealth practitioners. Feedback was being sought.Use of the digital engagement platform was increasing.Development of a citizen involvement forum as part of the ICB was underway.The forum would be a formal sub-committee of the ICB board withrepresentation from provider and user forums.The Governing Body noted the report.22/039WEST SUFFOLK ALLIANCE UPDATE
The report provided an update to the Governing Body on the West Suffolk Alliancework to transition to the new Integrated Care System.As today’s report was the final paper coming to the Governing Body, the authors,on behalf of the Alliance, wished to thank the Governing Body for its support withthe establishment and operation of the Alliance. That support had been critical forour partnership throughout the past five years, and many of the decisions madethrough the Governing Body had created the conditions for our current transition tobeing an integral element of the Integrated Care System, able to deliver inpartnership at place, and with an ambitious programme ahead of us.Key points highlighted included; The Alliance Committee’s first formal meeting was arranged for 12 July 2022.Expressions of interest were currently being sought for GP representation.The Alliance Delivery Group had already met and signed off priorities for2022/23. The Alliance Strategy was to be refreshed and governance reviewedand reset to ensure a collective approach to key enablers.National planning framework – work had been agreed as the Alliance was keento progress and mature Integrated Neighbourhood Teams, focus on communityassets, strengthening social prescribing and embeding digital and technology.The Alliance was committed to the roll out of an End of Life application.There was commitment to build on work carried out to date together withensuring continued engagement with system partners. Members were thankedfor their contribution.The Governing Body noted the report.22/040RESEARCH STRATEGY FOR SUFFOLK AND NORTH EAST ESSEXINTEGRATED CARE SYSTEMThe Research Strategy, the first for the Suffolk and North East Essex IntegratedCare System (SNEE ICS), set out a vision to build a culture of research that wasresponsive to those in most need in the communities that it served, building on whathad already been achieved. The strategy outlined five key aims:1. To build a flexible, system-wide approach to research across the Suffolk andNorth East Essex Integrated Care System (ICS).2. To build on our academic partnerships to develop research ideas and achieveresearch funding3. To empower research teams, services, service users and carers to work aspartners to help deliver, develop and support high quality research4. To embed a culture of research, innovation and use of evidence across the ICS5. For research to be visible, meaningful and accessible42 attendees (excluding facilitators) had taken part in two stakeholder workshopsto inform the development of the strategy. A wide range of stakeholders wererepresented including representatives from Healthwatch and other patient andpublic involvement representatives, as well as representatives from the Suffolk andNorth East Essex CCGs, SuNEE Trusts, GP practices, academic partners, NationalInstitute for Health and Care Research (NIHR) Clinical Research Network (CRN)East of England, and Public Health.Across the workshops, stakeholders explored: where we currently were as asystem; our strengths, weaknesses, opportunities, and challenges; what we wouldlike to see in a successful research system; and what steps we might need to taketo get there.
Individuals who expressed an interest in helping to draft the strategy following theworkshops had been given the opportunity to review a draft of the strategy and anumber of changes had been made as a result.Comments included; Dr Andrew Kelso incoming Medical Director for the ICB was present and wouldbe leading on research going forward. Having noted there was no reference to the school of medicine at Cambridgewho received funding from the CCG via the clinical academic reserve, it was feltthat might be an oversight and inclusion going forward could be facilitated. In light of the timing of the report and the move to an ICB, it was queried howresearch would develop under the new system, ie would there be a ring fencedbudget, and how progress would be monitored. It was explained that there wasan existing infrastructure for research in place and therefore additional costshould not be incurred. There were however many strands of research andattempt would be made to bring them all together. It was thought that Pharmacies might be a good area to explore. It was reported that higher education had researchers and key projects thatwere disseminating information to clinicians and it was hoped we could link andhave clinicians doing research and fellowships with reference to the local areagoing forward. Retention of staff key was key. There were Fellowships aroundfor staff interested in doing research themselves although more promotion wasrequired. There was support for the work and going into transition thought should be givento development of the workforce and how we move forward to use research ineveryday work. Dr Andrew Kelso reported support for the practice based research. Researchwas a broad area which touched on all clinical practice. The Integrated CareAcademy had a programme of its own and sought to accelerate learning. It wasan exciting time for research and he would be keen to discuss training hubs. The Governing Body was informed that a cancer research hospital was plannedfor Cambridge and would be built on the Papworth site with a regional focus. Itwas highlighted that often the most interesting research that could really alterthe way you think might come from a little project. The ICS Strategy was being refreshed in terms of governance. The report waswelcomed and there was confidence that the ICB would adopt the Strategy from1 July 2022.The Governing Body approved adoption of the strategy with a view to it beingtaken forward as we move from CCGs to an ICB.22/041KEY WORKING FUNCTIONThe Key working Function had been developed as a response to the NHS England& NHS Improvement Long Term Plan (LTP) commitment that by 2023/24, childrenand young people with a learning disability, autism, or both, with the most complexneeds would have a designated keyworker.
Key workers would not be delivering care, education, or treatments to children andyoung people or their families and could not replace services that were alreadycommissioned.The Key worker Function was funded by NHS England and Suffolk had beenallocated 345,000.00 in 2022/23 and 505,000.00 in 2023/24. Funding beyond2023/24 had not been confirmed yet.Key issues were highlighted in Section 2 of the report and patient and publicengagement in Section 3.It was recommended that Suffolk County Council should host the Key workerFunction which had been supported at both the Ipswich, East & West Suffolk CCGsChief Executive Boards.It was also recommended that as there was a clear benefit to be gained frommaintaining continuity with an earlier project, i.e., CHRIS, and that the benefit ofcontinuity outweighed any potential financial advantage of going out to tender, thata waiver should be granted to going out to competitive tender as attached to thereport at Appendix 2.The Governing Body:1. Approved the recommendation that the CCG commissioned Suffolk CountyCouncil (SCC) to provide the key working function in Suffolk2. Approved the sanction of a waiver to competitive tendering on the groundsthat: there was a clear benefit to be gained from maintaining continuity with anearlier project.22/042PROCUREMENT UPDATE: SUMMARY OF ACTIVITY 2022The Governing Body was provided with an update on the procurements completedsince the last procurement update and those currently in progress and planned for2022.Key points highlighted from the report included;Pathology Services - the CCG currently commissioned Pathology Services acrossthe Integrated Care System through a contract with North Essex & East SuffolkPathology Services (NEESPS). The specification and an approach to procurementhad been agreed by Clinical Executive.Mental Health Assurance - in the summer of 2020 the assurance process formental health, learning disabilities and autism commenced, concentrating on crisisservices. Since then the assurance of Children, Young people and Families,Community and Learning Disabilities and Autism started. At the start of the processthe emphasis was about gaining assurance that the services were safe anddeveloping to deliver against the needs of Suffolk, by asking Norfolk and SuffolkNHS Foundation Trust (NSFT) and partners to respond to a series of questionswithin a workbook.In the last two years the world had changed considerably and relationships withinthe health and social care systems had developed faster. That had led todevelopment of the assurance process to embrace that change and to work jointlyto look to develop mental health services together. The process was now being
considered taking into account the recently released Care Quality Commissionreport.Mental Health Procurement - the Mental Health Procurement included theestablishment of the Mental Health and Learning Disabilities & Autism Framework,the sourcing of the Daytime Wellbeing Hub and Evening Safe Haven Service andthe Suffolk Community Connector Network. Each were a separate evaluationprocess within a single tender.Documentation was released on the 19 November 2021 and responses werereceived on the 14 January 2022. The outcomes of the procurement had beenratified and participating organisations informed of the outcome.Secure Mental Health Transport - an approach to sourcing secure mental healthtransport had been agreed with colleagues from Norfolk and Suffolk NHSFoundation Trust (NSFT), and the specification was being reviewed by NSFT. The14 providers who responded to the Prior Information Notice had now received thedraft specification for comment and a questionnaire which sought to understandhow they believed the procurement and subsequent contract arrangements shouldwork.The report went on to provide information on future procurements and otherupdates.The Governing Body noted the report.(Amanda Lyes joined the meeting)22/0432022/23 PLANAt its meeting in March the Governing Body was provided with an update on theplanning process for 2022/23. That report had noted the timetable for planningwhich required final submissions to be made on 28 April 2022. Today’s reportincluded the submissions made in April for sign-off, those being; Narrative Plan (appendix A)Activity & Performance plan (appendix B)Workforce Plan (appendix C)The planning processes had not formally concluded, due in the main to issuesregarding to financial balance. The report explained the progress made to date andthe expected next steps. The opening budget for the CCG was presented forapproval for audit purposes at Appendix D.The report went on to detail planning guidance and process and timetable.Comments included;It was noted from the report that West Suffolk NHS Foundation Trust (WSFT) hadapplied for capital funding to convert newmarket hospital into a ring fenced ward forelective surgery. Having queried whether that was from central funding, theGoverning Body was informed it was a proposal for centralised capital fundingwhich although not supported at the current time would likely be retained in theevent that further funding became available.The workforce plan had been developed from a partnership of all system playersand had ended up being a robust triangulated workforce plan. There was a plan to
increase the establishment by 5% in total and by 2% by March 2023. It was anambition of the People Board to have a one workforce approach with keycomponents being support of the current workforce, belonging and new ways ofworking and future supply line. There was a systemic approach to integratedplanning and a move away from yearly to a more sustainable longer term 3-5 yearplanning process. The plan had been worked through with the integrated careacademy as a partner.Since the budget had been set in Autumn 2021, inflation had been a factor and theplanning round had been affected with plans now showing the impact of inflation.There was a need to upload the opening budget for CCGs and the report set outhow the opening budget had been put forward.Additional resources were expected although they would not close all the gap. Workwas underway to better understand their impact and how they would be allocated.The Governing Body;1) Approved the following plans subject to final changes Narrative Plan (appendix A) Activity & Performance plan (appendix B) Workforce Plan (appendix C) Opening CCG Budget (appendix D)2)22/044Delegated any final changes to its Finance Committee.INTEGRATED PERFORMANCE REPORTThe Governing Body was in receipt of the Integrated Performance Report.Points highlighted included; Elective recovery – there were to be no 104 week waits after June 2022. Therewere currently 150 patients waiting in excess of 104 weeks and the situationwas being monitored closely. Mutual aid had seen support from theindependent sector and ESNEFT.The total number of patients movedcollaboratively across the system was in excess of 1000.78 week waits – were slightly ahead of trajectory and the situation was beingmonitored, key areas being orthopaedics, gynaecology and general surgery.Inequity in access was reducing in part due to mutual aid and the reopening oftheatres. There was a growth in the overall waiting list.The Trust was committed in meeting outpatient transformation elements andmonitoring going forward.Urgent care – last week had seen national step down from Opal level 4 to Opallevel 3 which was good news. The local system had spent 10 days at Opallevel 4 and was now at level 2. Pressures remained but it felt moremanageable. Key drivers were Covid-19 numbers and yesterday there were62 Covid-19 patients across the system with 29 being in West Suffolk NHSFoundation Trust (WSFT). The situation continued to be monitored carefully.Although WSFT Covid-19 patient numbers appeared high which compared toESNEFT that was due to a different testing strategy being in place as a resultof the estate which made it harder to manage outbreaks. WSFT was testingasymptomatic patients.Patient flow had been maintained well due to joint working at an Alliance leveland focus on discharge.The East of England Ambulance Service NHS Trust (EEAST) continued to givecause for concern in relation to C1 and C2 performance. Key issues were
workforce and capacity. There was lots of work underway to address thesituation which included minimising delays at the front door and facilitatingassistance urgent care response.Comments included;Cancer workstream – three pathways were currently struggling, those being; skin,breast and colorectal cancer. Skin had improved new analytics, breast waslooking at new pain pathways, and colorectal was struggling nationally due toendoscopy service constraints and with the advent of FIT. There was currently acall for increased prioritisation of FIT testing in primary care pre-referral. CT coloncapacity was challenging and help was being explored.Direct accesscolonoscopy for primary care was being explored via a unit in Ipswich. Innovationbids were in in respect of money from cancer alliances. Bids included a primarycare prioritisation referral tool, cyto sponge in the community, and a communitytrial of a skin analytics platform. Work on an upper GI pathway was progressing.East of England Ambulance Service NHS Trust (EEAST) – given that west Suffolkwas doing well and there was money to pass onto the ambulance service it wasqueried why there was poor performance when handover performance was good.It was reported that across the region there were many lost hours as the regionflexed due to capacity and demand. Workforce remained a key issue and demandimpacted on wider performance elements. West Suffolk was ensuring itmaintained flow by facilitating the timely offload of patients. Despite money for callhandling and winter pressures, EEAST had struggled overall to achieve financialbalance. Although not in a position to direct what money was used for there wasawareness of the issue re handovers and work was underway to address thesituation.Clinical Quality and Patient SafetyNorfolk and Suffolk NHS Foundation Trust (NSFT) – rated ‘inadequate’ by theCare Quality Commission (CQC) and served with a Section 29 warning notice with109 ‘must do’ actions and reinspection within 5-6 months. Should there not besufficient action to safeguard patients in the interim period the CQC could takefurther enforcement actions including the issue of a Section 31 enforcement action.There had been some areas of improvement around staff culture and learningdisability services in Suffolk, although there were more areas of deterioration. Ithad been recommended that the Trust remain in Category 4 of the oversightframework which was led by NHSI with local stakeholder and commissionersupport. An improvement board set up by NSFT would oversee the improvementplan.The first draft of the improvement plan had been presented to a Quality Summityesterday and the system was looking at how NSFT could be supported withimprovements going forward. There would be oversight through a weeklyimprovement board. There were challenges around waiting times and WSFT hadindicated that it was seeing an increase of adults with mental health crisis.East of England Ambulance Service NHS Trust (EEAST) – there had been areduction in serious incidents reported recently. There had been an incidentreported and media coverage associated to the misuse of social media which wasbeing overseen by EEAST with NHSI support.Learning D
passed to the Suffolk and North East Essex ICB from 1 July 2022 Amanda Lyes Report No: WSCCG 22-31 . 10 Emergency Preparedness, Resilience and Response (EPRR) To note . the statutory responsibilities for EPRR being passed to the Suffolk and North East Essex ICB from 1 July 2022 Paul Gibara Report No: WSCCG 22-32 . 11 Annual Report and Accounts .
