Agenda and minutes

The Chair welcomed those present to the meeting and noted apologies.

The Chair advised that the quoracy had not been satisfied for the CCG side, but decisions could be made in good faith.

The Strategic Commissioning Board noted the information.

The Chair reported that the CCG and Council both have statutory responsibilities in relation to the declarations of interest as part of their respective governance arrangements.

It was reported that the CCG had a statutory requirement to keep, maintain and make publicly available a register of declarations of interest under Section 14O of the National Health Service Act 2006 (as inserted by Section 25 of the Health and Social Care Act 2012). The Local Authority has statutory responsibilities detailed as part of Sections 29 to 31 of the Localism Act 2011 and the Relevant Authorities (Disclosable Pecuniary Interests) Regulations 2012.

The Chair reminded the CCG and Council members of their obligation to declare any interest they may have on any issues arising from agenda items which might conflict with the business of the Strategic Commissioning Board. 

Declarations made by members of the Strategic Commissioning Board are listed in the CCG’s Register of Interests which is presented under this agenda and is also available from the CCG’s Corporate Office or via the CCG website.

•       Declarations of interest from today’s meeting

The Cabinet Member, Environment and Climate Change, Bury Council declared that he had retired and that his employment could be removed from the Declaration of Interest Register.

•       Declarations of Interest from the previous meeting

There were no declarations of interest from the previous meeting raised.

The Strategic Commissioning Board noted the published register of interests.

•       Minutes

The minutes of the Strategic Commissioning Board meeting held on 7 June 2021 were agreed as an accurate record.

•       Action Log

The following updates were provided in respects of the Action Log:

•       A/04/09 – Noted that a paper on initial thoughts and proposals for the Radcliffe model would be brought to the Board’s meeting in October.

The Strategic Commissioning Board approved the minutes of the meeting held on the 7 June 2021

There were no public questions raised.

The Strategic Commissioning Board noted the information.

The Chief Executive, Bury Council / Accountable Officer, NHS Bury CCG provided an update on the latest CCG and Council developments.  It was reported that: -

·         Announcements were expected soon regarding changes to social care funding and a second extension of funding for hospital discharges. It was noted that once the detail had been released a report would be brought to the Board outlining the effect on the pooled budget.

·         Pressures continued for Fairfield hospital from the high levels of demand and acuity of cases in addition to staffing absences. The partnership was coping well so far in addressing those pressures and work was underway to support weekend discharges.

·         Current Covid infection rates were 300 per 100,000 and were on the cusp of increasing owing to easing of restrictions and schools going back. With regards to schools reopening, it was noted that the bubble system had ended to address school absences.

·         Vaccinations continued to go well and were on a par with national figures. It was noted that the pop-up clinics and other efforts had been successful in significantly closing the gaps in hard-to-reach populations, and now similar work was planned in gaps presenting in younger cohorts.

·         Finally, it was noted that two of the largest areas of concern for the Board, elective care and mental health, were on the agenda this meeting, as was an update on the work establishing the ICS and locality boards which would be in shadow form from October.

Members discussed the update, noting the positive change that social care was being discussed alongside health issues, but that they were still being considered as distinct areas rather than interdependent. If additional monies were to be made available, discussions around financial flows would be key to ensure the entire system would benefit. It was also agreed that the workforce in social care was as important as funding.

The Strategic Commissioning Board noted the information.

The Joint Executive Director of Strategic Commissioning, Bury Council & NHS Bury CCG presented three reports which set out the GM ICS arrangements and work underway, local partnership arrangements being developed, and the neighbourhood target operating model. 

The Board discussed the reports, including the position statement regarding GM financial flows, and noted that updates on this would be reported to future meetings when more detail was finalised. With regards to the neighbourhood model, it was noted that the lack of clarity around definitions had led to some confusion but the focus was on engaging with patients in a different way with Community Hubs as a focus. It was agreed that describing patient journeys was a way to help residents visualise themselves using the service and make the changes meaningful to service users.

The Strategic Commissioning Board noted the contents of the reports, and endorsed the documentation as indicated.

The Clinical Director, NHS Bury CCG presented the report which outlined the current position within NHS Bury CCG for the management of requests for funding for services that were not currently commissioned and sought approval for Proposed Process to be set up in Bury to manage funding requests that fell outside the remit of the GM EUR team who were currently handling them on a goodwill basis.

In response to questions, it was noted that the proposed solution was a two-step change with the initial change to commence as soon as is practicable and to continue until the end of March 2022, and the second step to be decided once the GM model for management of Individual Funding Requests is agreed.

The Strategic Commissioning Board:

1.   Acknowledged the current issues within the system relating to work undertaken on a good will basis by the GM Effective Use of Resources Team.

2.   Approved the Proposed Process (Appendix 1) to be set up in Bury to manage funding request that fall outside the remit of the GM EUR team.

3.   Requested that the Executive Director of Strategic Commissioning identify a resource to act as the SPOC and establish a timeline for the pathway to commence.

4.   Agreed the that next steps for the identified SPOC closely with Work stream Leads and Clinical Leads to establish principles for approving individual requests, based on NICE guidance, the current pathways of care in GM, best use of resources and the CCG agreed criteria for exceptionality.

The Cabinet Member for Communities and Director of People & Inclusion, Bury Council presented a report regarding the preparations for Bury to continue to support those that are serving/have served in the Armed Forces and their families, by way of a refreshed Armed Forces Covenant and associated Action Plan.

The Board discussed the report, noting that the Council could identify some individuals from questions asked as an employer and broader statistical data could be picked up from the census, but work was ongoing regarding sharing that information on a service-based approach. Members discussed the differences the new Steering Group from the previous one and noted that regular updates from the Group could be provided to SCB.

The Strategic Commissioning Board:

1.   Approved the proposed Armed Forces Covenant, to complement the Greater Manchester Armed Forces Covenant.

2.   Agreed that that Bury Council and NHS Bury Clinical Commissioning Group (CCG) refresh and re-sign the Armed Forces Covenant.

3.   Agreed that delivery of the Armed Forces Covenant will be monitored by a working group comprising officer champions across the Council and Bury CCG, reporting to the Armed Forces Covenant Steering Group, with an annual report on progress being submitted to the Strategic Commissioning Board.

The Joint Executive Director of Strategic Commissioning, Bury Council & NHS Bury CCG presented a report regarding the tender for the Bury Care at Home service, which was the result of a review of the service in advance of its initial 3-year contract end to ensure the contract was both effective and high performing for its final year and beyond.

The Strategic Commissioning Board:

1.   Approved the request to award the contract to those providers successful in the tender for the Bury Care at Home service for both Lots 1 and 2.

2.   Approved an extension of up to 2 months to the current care at home contract to allow sufficient time for a smooth and successful transition from the current service to the new.

The Joint Executive Director of Strategic Commissioning, Bury Council & NHS Bury CCG presented a report regarding the updated arrangement to maintain sufficient designated COVID beds in the Bury system. Members discussed the report, noting that although agency staff was used for the ‘hot’ site resulting in higher staffing costs, uniting with Rochdale mitigated this significantly.

The Strategic Commissioning Board:

1.   Approved retrospectively the commissioning of designated units for COVID positive patients at Millfield House in line with the request from the DHSC, with awareness of the financial risk resulting from the misaligned national funding guidance.

2.   Agreed to continue to support the responsive rapid commissioning of additional capacity in forthcoming months should it be required. This will take the form of additional designated care home beds and home care, accepting a paper will be presented for retrospective approval and members of Bury Council and Bury Clinical Commissioning Group briefed beforehand.

The Joint Executive Director of Strategic Commissioning, Bury Council & NHS Bury CCG presented a report on the work of the IDC Board to create the structures and environment to enable the IDC to operate in shadow form through 2021/22, and to be fully operational from April 2022.

The Strategic Commissioning Board considered and noted the Integrated Delivery Collaborative Programme Update for August 2021.

The Joint Executive Director of Strategic Commissioning, Bury Council & NHS Bury CCG presented a report which provided a summary of an improvement programme NHS Bury CCG has commenced with the Bury Care Organisation (BCO) in Orthopaedics. The improvement programme of work aligned to the wider Elective Care Transformation Programme, co-developed and delivered with Northern Care Alliance (NCA), for which the Board received a comprehensive briefing at their last formal meeting in June 2021.

Members discussed the report, welcoming the emphasis on waiting well and noting that although the situation was worrying it was a national problem and the prioritisation of cases and improvement programme was the best way to address it. It was also noted that knowledge from lessons learned was being shared through workshops, but problems remained in sharing these systemwide.

The Strategic Commissioning Board noted the content of the briefing and work to date.

The Joint Executive Director of Strategic Commissioning, Bury Council & NHS Bury CCG presented a report relating to the service pressures and impact of Covid on Emotional Health and Wellbeing and Mental Health and introduced how mental health pathways for adults and children/young people will be redesigned moving forward from Covid. The Board also heard from the Commissioning Programme Manager, NHS Bury CCG regarding the care system for young people and the need for greater capacity and guidance to build a better model of support.

Members discussed the report, noting the oversubscribed counselling services in schools and lifelong benefits mental health services could have for young people. It was agreed that mental health would be an issue for the ICS to address early on, and it was noted that although there were non-recurring monies to fund this for this year there were implications to be worked through regarding medium term finances.

The Strategic Commissioning Board:

1.   Approved part 1 of the ‘Enhanced Staffing options proposal’ which will allow the recruitment of 6 Mental Health Practitioner posts (NHS Band 6).

2.   Approved part 2 of the ‘Enhanced Staffing options proposal’ - further requirement of an additional 9 staff (NHS Band 6) to make the service safe. Recruitment is likely to take place in Quarter 4 2021/22 for an intention to employee 2 Mental Health Practitioners.

3.   Recognised the expansion of the service with the redesign of the CMHT service and development of the Community Mental Transformation.

4.   Approved the actions and investment set out within this report for Children’s and Young Peoples Mental Health investment.

5.   Acknowledged the complexity and timeliness of the task at hand and endorse the use of any additional slippage in recruitments to be redirected to shore up the children’s system within the ascribed financial costs

The Executive Director of Finance, Bury Council & NHS Bury CCG presented the report regarding the 56 contracts that were due to end before March 2024 and identifying the commissioning intention for each to provide stability and enabling planned service redesign to continue whilst ensuring that no nonrecurrent funding commitment extends beyond the period that funding is available.

The Strategic Commissioning Board approved the Commissioning Intentions in line with the Greater Manchester Contracting Principles.

The Executive Director of Finance, Bury Council & NHS Bury CCG presented the report which provided a summary of the financial position of the Bury Integrated Commissioning Fund (ICF) in 2021/22 for quarter 1. It was noted that H2 allocations were expected for the end of September, but the situation would be challenging.

The Strategic Commissioning Board:

1.   Noted the ICF financial position at quarter 1.

2.   Noted the financial risk in the position reported in particular as a result of the uncertain CCG finance regime beyond September and the Councils current unachieved savings targets.

The Executive Director of Finance, Bury Council & NHS Bury CCG presented the report which provided an update in respect of the five strategic risks which are captured on the CCG’s Governing Body Assurance Framework (GBAF) which have been assigned to the Strategic Commissioning Board for oversight.

The Strategic Commissioning Board received the Strategic Commissioning Board Risk Registers and reviewed the information presented.

Minutes of the Bury System/Transition Board meeting held on 15th April 2021 were noted.

The Strategic Commissioning Board noted the minutes.

The Chair summarised the main discussion points from today’s meeting and thanked members for their contributions. Board members also welcomed Dr Cathy Fines to her first SCB meeting as Chair of the CCG.

The Strategic Commissioning Board noted the information.