Agenda and minutes

The Chair welcomed those present to the meeting and noted apologies of:

·       Cllr Tahir Rafiq, Cabinet Member Corporate Affairs & HR, Bury Council

The Chair advised that the quoracy had been satisfied.

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 a personal interest as his son and daughter are both employed by the NHS and he is a member of the Down’s Syndrome Association. It was noted that both these interests were also included on 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 of the last Meeting and Action Log (including supplementary paper on Drug Related Deaths)

• 4 January 2021

•       Minutes

The minutes of the Strategic Commissioning Board meeting held on 4 January 2021 were agreed as an accurate record, subject to the amendment of “Autistic Spectrum Condition” to “Adult Social Care” at item 7.

•       Action Log

The following updates were provided in respect of the Action Log: -

•       A/11/01 - The supplementary paper in relation to Drug Related Deaths appended to the minutes was noted.

The Strategic Commissioning Board: Approved the minutes of the meeting held on the 4 January 2021.

There were no public questions raised.

The Strategic Commissioning Board: Noted the information.

The Chief Executive, Bury Council / Accountable Officer, NHS Bury CCG presented a paper which provided an update in respect to a minor change to the voting membership of the Strategic Commissioning Board following the appointment of a new Clinical director to the Governing Body of the Clinical Commissioning Group. It was reported that: -

·       The Board was made up of nine voting members for the Council Cabinet and Governing Body respectively, in addition to the three joint Executive officer roles.

·       The Governing Body’s allocation of votes in June 2020 excluded the long-standing vacant Clinical Director post, however as this had recently been appointed to, it was proposed that a vote be made available to this post holder and removed from the Governing Body Secondary Care Consultant member, therefore maintaining an equilibrium within the approved Terms of Reference.

·       With regards to the recruitment of the new Executive Director of Finance an offer had been made. It was noted that once they were in post, they would become a voting post holder.

The Strategic Commissioning Board: Supported the re-allocation of a vote to the new Clinical Director post from the Governing Body Secondary Care Consultant.

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

·       The consultation period for the 2030 plan, now called ‘Let’s Do It’, had concluded and it would come to the Board meeting in March. It was noted that integration of health and care, particularly at community level, was a core part of this 10-year vision and action plan.

·       The Board’s response to the NHSE guidance regarding the long-term future of integrated care had been submitted including caveats around the implementation of financial, governance and staffing arrangements, and work across the North West and at a national level continued. It was noted that a report would be brought to a future meeting of the Strategic Commissioning Board.

·       Proposals for the Council’s Budget would be issued tomorrow evening for consideration by the Council’s Overview and Scrutiny Committee, before going to Cabinet and then to full Council. It was noted the budget was a result of the joint work carried out by this Board and reflected the positive direction of travel as set out in the locality plan.

The following comments / observations were made by Strategic Commissioning Board members: -

·       With regards to the shadow board, it was agreed that until there was clarity around financial flows and governance it would be premature to move to shadow arrangements. It was noted that a revised timetable would be brought to a future meeting.

·       The Local Care Organisation (LCO) had been working to join up service and support safe discharge of admissions, and their further development was a key part of ethos of the 2030 plan. Integration of health and social care would continue, and the scale of care management developed to GP level.

·       It was noted that neighbourhood development was broader than health, with hubs providing coordination so separate strands of people needing additional support could come together in single neighbourhood model. Work was underway regarding what component parts would look like including planned engagements particularly with primary care networks, schools, all age, and neighbourhoods.

·       The ‘Let’s Do It’ model and draft strategy would be circulated after the meeting, and a deep dive into the roadmap/timetable would be scheduled for a future Board meeting.

The Strategic Commissioning Board:

·       Noted the update.

·       The ‘Let’s Do It’ model and draft strategy be circulated, and a report on ‘Let’s Do It’ to be brought to a future meeting including the roadmap/timetable.

·       A report on the work underway regarding the long-term future of integrated care be brought to a future meeting, including a revised timetable for shadow arrangements.

The Chief Executive, Bury Council / Accountable Officer, NHS Bury CCG gave a presentation detailing the Covid-19 emergency response. He advised of the mortality and infection rates as well as the vaccination rollout, which had been going well with over 23,000 vaccinations delivered in centres and a united, fast and effective response through social care networks. Hospital pressures had increase since Christmas as well as work in the community (GPs, care homes, and families providing care). This pressure was likely to continue for several weeks.

With regards to containing transmission, engagement work was ongoing to ensure everyone understood and followed restrictions, and it was noted that lateral flow testing was being rolled out in schools and workplaces etc. The Board was advised that support was being given to health and care services, including care homes and home care services, and Primary Care. It was noted that the wider of harms of Covid and lockdown restrictions also needed to be addressed, specifically the impact on mental health and lack of opportunities (particularly for young people). This had been compounded by existing inequalities, which would also affect the recovery of Bury’s economy, and anti-poverty services were being developed.

The Board was advised that organisations and community groups in Bury had pulled together well, with effective communication and engagement and organisations being more decisive and collaborative. Reflections were needed to determine how these effective ways of working could be embedded. For now, the focus was on continuing the rollout of vaccinations and reducing infections, after which the track and trace process would take effect. Bury had to be ready to manage the Government’s lifting of restrictions, though it was noted that we would be living with aspects of Covid for some time yet.

The following comments / observations were made by Strategic Commissioning Board members: -

·       The borough was on track in terms of the rollout of vaccines for priority groups. It was noted that this did not include teachers, but Special Educational Needs (SEN) schools were being looked at. It was noted that ‘long Covid’ was being addressed through a separate piece of work.

·       It was agreed that issues were wider than clinical need, including isolation and loneliness. Work with Pennine Care NHS Foundation Trust and others was underway with regards to the mental health offer, and a specific work programme had been developed as demand was anticipated to increase.

·       The demand on community hubs had increased since autumn but was not as high as previous levels. It was noted that since last year support had been given to upwards of 3000 which had now reduced to 650 people receiving support. It was also noted that hubs were supporting more than the clinically vulnerable, with the effects of unemployment being observed.

·       The South Asian community was showing a reluctance to take up the vaccine, and there was a need to develop and sustain community relationships in order for community leaders to be seen actively participating and leading by example. Praise was  ...  view the full minutes text for item 7.

The Clinical Director, NHS Bury CCG presented the report which recommended that the Getting Help Line be commissioned for a further 12 months from 1st April 2021 to 31 March 2022 at the current capacity, costing £158,368. The service underpinned the wider mental health provision, supporting Bury residents with their emotional wellbeing through the provision of non-clinical interventions and helping them to navigate a complex mental health system. Funding to continue the extension of the service had been approved by Finance Leads as part of Bury’s commitment towards it’s 2021/22 Mental Health Minimum Investment Standards.

National data indicates that demand for mental health services could increase by up to 40% due to the effects of the pandemic. It was unclear which services this would impact but remaining flexible and adapting the mental health approach accordingly would be crucial in addressing any surge. It was noted that the BME community had proved difficult to reach and it was agreed that that when contacts were being made for Covid vaccines the mental health offer should be built in at the same time.

The Strategic Commissioning Board: Approved the recommendation to commission the Getting Help Line for a further 12 months from 1st April 2021 to 31 March 2022 at the current capacity, costing £158,368.

The Director of Nursing and Quality Improvement, NHS Bury CCG presented the report which highlighted barriers limiting the CCG’s ability to act on the learning generated from local mortality reviews completed under the Learning Disability Mortality Review (LeDeR) programme and recommended changes that would improve the quality of health and care services for Bury residents with a learning disability.

There were a number of recommendations contained within the report which the SCB were asked to note and support progression through due process and relevant governance arrangements in order to achieve change and improve the quality of health and social care services for Bury residents with a learning disability. These recommendations included: -

•       Recommendation one: Governance and oversight arrangements are put in place to enable learning from the LeDeR programme to be held jointly by the CCG and by the Local Authority, as One Commissioning Organisation

•       Recommendation two: Consideration of resource requirements to appoint a learning disability lead within the One Commissioning Organisation with responsibility to oversee the implementation of the learning from the LeDeR programme.

•       Recommendation three: A process is developed for local learning from each review to be shared with involved services, with mechanisms to confirm recommendations have been acted on. 

Recommendation four: Governance arrangements include formal partnership working with wider partners, including PCFT, PAHT, social care providers and self-advocacy user groups are put in place.

Recommendation five: Learning from the LeDeR programme is held by all relevant workstreams in the CCG, including Primary Care, Urgent Care and Integrated Care Workstreams. 

Recommendation six: Local LeDeR contract quality requirements are developed for primary care services.

•       Recommendation seven: Local LeDeR contract quality requirements are developed for social care providers

It was noted that providers were engaged within this area but that a coordinated approach was needed. It was recommended this be facilitated through a Learning Disability Lead as outlined in the above recommendations; funding of such a post was discussed and would be looked at further outside of the meeting as this not fall within the jurisdiction of the SCB

The Strategic Commissioning Board:

·       Received this paper and noted the recommendations and supported progression through due process and relevant governance arrangements in order to achieve change and improve the quality of health and social care services for Bury residents with a learning disability

·       The affordability of a Learning Disability Lead be investigated in line with organisational governance arrangements.

The Deputy Chief Finance Officer, NHS Bury CCG presented the report on the financial outlook with regards to the NHS regime and OCO savings. It was noted that the finance regime for 2021/22 and beyond was still uncertain. Planning, financial and operational guidance originally expected at the end of January was likely to be delayed and the evolution of the Greater Manchester Integrated Care System (ICS) and what that means for financial management at a locality level was still at design stage.

In the meantime, the OCO and LCO have continued to concentrate on things they have direct financial control over, i.e. the savings and transformation programmes, although progress has been affected by the emergency pandemic response and the national introduction of the temporary financial regime.

Progress continued regarding OCO savings and transformation plans, although they were short of the underlying deficit and it was unclear how deliverable they are in terms of real cash benefits to the OCO. However, as we move into an ICS, it is important to drive forward system transformation and savings plans regardless organisational boundaries.

The Board discussed the paper and agreed that the result of transformation work needed to be seen in budgets throughout the year. Assurance was given than transformation plans were on track, but conversion of those schemes into savings was challenging given the lack of clarity of funding/budget moving forwards.

The Strategic Commissioning Board:

·       Noted the key emerging issues in terms of the future financial regime and the OCO savings plans and supporting detail for 2021/22.

·       A report on the financial trajectory and outcomes and how we measure ourselves against what we set out be brought to a future meeting.

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

It was noted that three risks had remained the same, one had reduced, one had reached the target level, and one new risk had been added regarding the Integrated Care System for which mitigating actions had been identified.

The Strategic Commissioning Board: Received and noted the Strategic Commissioning Board Risk Registers.

The Executive Director of Strategic Commissioning, NHS Bury CCG presented the report which was a summary of the information presented to the CCG’s Quality and Performance Committee in January 2021. It was noted that as we are emerging from urgent care challenges of covid, strategic consideration was being made for planned care, in particular the hundreds of Bury patients waiting in excess of 52 weeks to commence treatment.

Collaborative work was underway between the Northern Care Alliance (NCA) and North East Sector (NES) CCGs to clinically review, validate, and secure capacity, as well as progress changes within planned care designed to aid improvement. It was noted this would be long term work and a further report would be presented to the CCG’s Quality and Performance Committee in February.

The following comments / observations were made by Strategic Commissioning Board members: -

·       Owing to the mental and physical strain of coping with Covid, it was noted it would take a long time for services to return to normal. The trauma and exhaustion faced by frontline staff across practices, community services, social care etc. would need to be addressed with compassion, kindness, and time to recuperate.

·       Waiting list inequality was discussed and it was noted that the NCA was looking at ways of addressing this through alternative management, possibly looking at time on the list balanced against clinical need.

The Strategic Commissioning Board: Noted the update.

The Chair summarised the main discussion points from today’s meeting and thanked members for their contributions.

The Chair asked that thanks be recorded to the outgoing Joint Chief Finance Officer, for all his work assisting the Board in terms of finance and governance.

The Strategic Commissioning Board: Noted the information.