Harrogateandruraldistrictccg.nhs.uk

Item 10.1
HARROGATE AND RURAL DISTRICT CLINICAL COMMISSIONING GROUP
Minutes of the Meeting of the Harrogate and Rural District
Clinical Commissioning Group
Quality and Clinical Governance Committee
8 October 2013
14:00 – 16:00
Boardroom, 1 Grimbald Crag Court,
St James Business Park, Knaresborough, HG5 8QB

Present
John Pattinson, Director of Quality/Executive Nurse, HaRD CCG (Chair)
Dr Rick Sweeney, GP Member, HaRD CCG
Dr Peter Johnson, North House Surgery, Ripon
Apologies
Dr Sarah Hay, GP Member, HaRD CCG
Rachel Mann, Vice-Chair and Lay Member, HaRD CCG
Dr Jane Carradine, Beech House Surgery, Knaresborough
Dr Jane Metcalf, Secondary Care Doctor, HaRD CCG
In Attendance
Sasha Sencier, Executive Assistant (Secretariat), HaRD CCG
Katie Smith, Improvement Performance Manager, HaRD CCG
Elaine Wyllie Designated Nurse Safeguarding Children
Lorraine Fox, HDFT
Christopher Ranson, Senior Pharmacist, CSU
1.0 Introductions and Apologies
Apologies were received as noted above.
The Quality and Clinical Governance Committee:
Noted the above.
2.0 Declarations of Interest
John Pattinson’s partner is a Senior Manager in the NHS PCU team.
The Quality and Clinical Governance Committee:
Noted the above.
3.0 Minutes of the Meeting held on 8 September 2013
The minutes for the meeting held on 8 September 2013 were accepted with no
amendments.
4.0 Matter Arising from the Minutes
The action log was reviewed by the Committee and the following was noted:
Item 10.1
John Pattinson informed that the Personal Budgets report from Mel Bradbury will be
on the November agenda.
The Quality and Clinical Governance Committee:
Approved the above.

5.1 Quality and Clinical Governance Committee Timetable
The Committee reviewed the timetable and no changes were made.
The Quality and Clinical Governance Committee:
Noted the above.
5.2 Safeguarding Children
Elaine Wyllie updated the Committee in regarding to the current work within the
children safeguarding agenda.
The CQC recently published their plans to inspect the quality and effectiveness of
the arrangements that healthcare services have made to ensure children are
safeguarded. The CQC will visit at short notice. Sue Roughton (Designated Nurse)
has produced a self-audit tool based on the key lines of enquiry, which can be used
by commissioner and provider organisations to map current arrangements and
identify any service gaps.
Previous reports to the Committee have highlighted progress in respect of
arrangements for Looked After Children (LAC), however it was acknowledged that
for some time the current commissioning arrangements for LAC do not meet the
required national service standards for this vulnerable group of children and young
people. As such, the team is working closely with Helen Billson and others to map
service gaps and also to look at future commissioning plans.
The Safeguarding Children App will be released on to the Apple Store and also for
Android Release via the CSU website later this week. The app contains links to
relevant national and local guidance, details about making child protection referrals,
and local and national self-help groups. The app can be downloaded free of charge.
The first briefing for GPs in respect of the emerging problem of child sexual
exploitation will be held at a meeting in Scarborough in November. Elaine informed
the committee that there is currently no resource for this briefing to be administered
in other areas but Elaine is happy to deliver the training if the CCG can provide the
administration. John Pattinson will discuss this at a Clinical Executive Meeting in the
near future.
The Quality and Clinical Governance Committee:
Noted the above.
5.3 Safeguarding Adults
John Keith updated the Committee in regarding to the current work within the adult
safeguarding agenda.
Item 10.1
In the last report it was noted that there were a number of care homes that had
placements suspended by the CHC team. These homes have now been reviewed in
light of the length of time they have been suspended and an update can be found in
the report.
Following the murder of an individual, a Domestic Homicide Review (DHR) is taking
place to understand lessons learned. The chronology has been completed and the
Independent Management Report has been completed in draft form and is due to be
signed off by both the CCG concerned and the NHS England Area Team. The
Committee will be updated to the recommendations from this DHR to see if there is a
benefit of implementation locally to support patients who may be in similar situations.
NHS England Area Team recently conducted a review of the current capacity of
safeguarding in the area, which looked at the current numbers of designated doctors
and nurses to support both adult and children safeguarding. The review found that
the current capacity was less than the requirement per head of population for the
majority of areas in relation to children safeguarding and significantly less in relation
to adult safeguarding. The safeguarding team will be reviewed in relation to capacity
by the Partnership Commissioning Unit (PCU) to ensure the service is able to deliver
and give robust assurance to the CCGs.
It was note that in the future the safeguarding adults team will be producing a single
monthly report outlining the current and on-going aspects of adult safeguarding, with
specific areas for each of the CCGs that will relate to their requirements. It is
envisaged this report will be presented to the CCG Strategic Collaborative
Commissioning Committee by the Director of the PCU.
John Pattinson expressed concern over the assurance if this report was not brought
though this Committee and informed that he would raise these concerns with
Amanda Bloor, Chief Officer of the CCG.
The Quality and Clinical Governance Committee:
Noted the above.
5.4 HaRD CCG GP Update
Dr Rick Sweeney presented a brief update on his area of work as GP Member, Lead
for Vulnerable People.
The end of life pathway has now been approved by the LMC and is now being
introduced and evaluated for effectiveness.
The Governing Body approved arrangements for the Follow-Up of Patients with
Prostate Disease in Primary Care in 2013-15. The specification for the service was
developed by Miss Rachel Kimber, Consultant Urologist at HDFT and Dr Sarah Hay.
The Quality and Clinical Governance Committee:
Noted the above.
Item 10.1
5.5 Quality Dashboard
John Pattinson provided an update to the progress of the new dashboard.
Discussions are being held with the CSU as there have been some areas of concern
including some errors in the dashboard.
There appears to have been an increase in demand for ambulances and YAS are
struggling to keep up with the level of demand.
There may be some data quality issues with regard to Improving Access to
Psychological Therapies (IAPT) in the proportion of people who have depression
and/or anxiety disorders who receive psychological therapies, which is being
investigated by the provider.
The utilisation level for Choose and Book continues to be below the target
performance level. Issues with both IT and telephone access are being investigated.
In addition, as part of a long term solution to increase their capacity, the Choose and
Book office has recruited three new members to the team. HaRD CCG will continue
to monitor the situation.

The Quality and Clinical Governance Committee:
Noted the above.
5.6 Serious Incident Report
John Pattinson presented the Serious Incident Report which details the number of
open serious incident cases.
It was noted, in relation to a delayed diagnosis of a child heart problem, that there
was a request to remove this from the list as the investigation had concluded that
there wasn’t a missed diagnosis.
The Quality and Clinical Governance Committee:
Noted the above.
5.7 Stroke Accreditation Review
John Pattinson informed that the clinical panel for the stroke accreditation review
were encouraged by the performance and improvement. Full accreditation was
given.

The Quality and Clinical Governance Committee:
Noted the above.

5.8 QIPP Planned/Unplanned Care
Clare Thomason presented an overview of QIPP, the efficiency savings within
healthcare, the challenges faced, and informed of the CCGs QIPP projects, which
are as follows:
• Review of follow-up ratios
• ENT single point of referral and triage service Item 10.1
• Procedures of limited clinical value (PoLCV) / Individual Funding Requests (IFR) • RIPON MIU Review (Minor Injuries Unit) • Prostate Specific Antigen (PSA) shared care model • Care homes.
The Quality and Clinical Governance Committee:
Noted the above.
5.9 NICE Technology Appraisals
Nil received.
The Quality and Clinical Governance Committee:
Noted the above.
5.10 TAG Commissioning Policy Recommendations

1. Insulin degludec for the treatment of diabetes mellitus in adults
The Quality and Clinical Governance Committee reviewed the recommendations and agreed that the above should be considered ONLY as an option in patients presently being managed on the unlicensed U500 Humulin R insulin. It was also noted that Chris Ranson should specify the dose to be considered. The Quality and Clinical Governance Committee agreed in principle to the above and noted that a business case will need to be presented at the Finance, Performance and Commissioning Committee. 2. Hydrocortisone modified release tablets (Plenadren) for the treatment of adrenal insufficiency in adults Not recommended. 3. Co-careldopa 2000mg/500mg intestinal gel (Duodopa) for the treatment of advanced levodopa-responsive Parkinson’s disease with severe motor fluctuations and hyper-dyskinesia when available combinations of Parkinson medical products are not given with satisfactory results Not recommended. 4. Fluticasone propionate / azelastine nasal spray (Dymista) for the relief of symptoms of moderate to severe seasonal and perennial allergic rhinitis if monotherapy with either intranasal antihistamine or glucocorticoid is not considered sufficient Not recommended. 5. Linaclotide for the symptomatic treatment of moderate to severe irritable bowel Item 10.1
The Committee reviewed the recommendations and agreed that the above should be taken as a business case to the Finance, Performance and Commissioning Committee for further discussion.
The Quality and Clinical Governance Committee:
Noted the above.


6.0 Items for Information
6.1 Legal Services Update
Nil to receive.
The Quality and Clinical Governance Committee:
Noted the above.
7.0 Minutes and Briefings of Meetings

7.1 Confirmed Minutes of the NHS 111 Meeting
Nil to receive.
7.2 Briefing from the North Yorkshire Safeguarding Adults Board
Nil to receive.
7.3 Briefing from the Safeguarding Children Board
Nil to receive.
8.0 Any Other Business
None.
9.0 Key Messages to the Governing Body
• LAC; the current specification does not meet the required national service standards for the vulnerable group of children and young people. As such, the team is working closely with Helen Billson and others to map service gaps and also to look at future commissioning plans. • Review of arrangements for reporting adult safeguarding. • Safeguarding inspection forewarning. • Stroke Review positive and accredited. • 2 business cases to be submitted to the Finance, Performance and The next meeting will take place on 12 November 2013 from 14:00 – 16:00 Boardroom, 1 Grimbald Crag Court, St James Business Park, Knaresborough HG5 8QB Item 10.1


HARROGATE AND RURAL DISTRICT CLINICAL COMMISSIONING GROUP
Actions from the Quality and Clinical Governance Committee on 9 October 2013
Appendix A
Meeting Date
Responsibility
Action Completed /
Due to be Completed
(as applicable)
discussed with Amanda Bloor to ensure appropriate assurance with new process.

Source: http://www.harrogateandruraldistrictccg.nhs.uk/data/uploads/governing-body-papers/5-december-2013/10.1-hard-ccg-quality-and-clinical-governance-committee-confirmed-minutes-081013.pdf