Welsh Health Specialised Services Committee (WHSSC) Management Group Minutes of the meeting held on 1st October 2012, in the Boardroom, Bowel Screening Wales Present Mr Stephen Harrhy, Interim Director of Specialised and Tertiary Services (Chair) Dr Paul Buss, Medical Director, Aneurin Bevan LHB Dr Geoffrey Carroll, Medical Director, WHSSC Mr Stuart Davies, Director of Finance, WHSSC Mr David Eve, Assistant Director of Finance, Hywel Dda LHB Mr Darren Griffiths, Assistant Director of Planning, Abertawe Bro Morgannwg UHB Mr Brian Hopkins, Assistant Director of Finance, Cwm Taf LHB Ms Julie Keegan, General Commissioning Manager, Cwm Taf LHB Mr Charlie Mackenzie, Head of SLR and External Commissioning Mr Daniel Phillips, Director of Planning, WHSSC Ms Nicola Prygodzicz, Principle Assistant Finance, Cardiff and Vale UHB Mr Chris Turley, Associate Finance Director, Aneurin Bevan LHB. Ms Pam Wenger, Committee Secretary, WHSSC Via VC Link Mr John Darlington, Director of Development and Performance In attendance Mrs Cathie Steele, Corporate Governance Manager, WHSSC
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WELCOME AND INTRODUCTIONS The Chair, Mr Stephen Harrhy, WELCOMED everyone to the first meeting of the Management Group. He provided a brief background explaining why the Group had been established. He explained that the Group will be reporting to Joint Committee and he suggested that this be through the Director’s report. He did note that there will be other reports developed by the Group which will need to be taken to Joint Committee as stand alone items, for example where ratification is required. The Chair drew attention to Dispute resolution and the need to ensure that there is clarity on areas where there are disputes. Therefore there will be a standing agenda item at each meeting for Disputes. The Chair clarified, following a question from Ms Julie Keegan, that during the early stages of resolution disputes will be discussion between Welsh Health Specialised Services Committee (WHSSC) and the provider.
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APOLOGIES FOR ABSENCE Apologies for absence were RECEIVED from: Mr Paul Stauber, Director of Planning, Abertawe Bro Morgannwg UHB; Mr Mark Thomas, Assistant Director of Finance, Cwm Taf LHB; Ms Ruth Treharne, Director of Planning and Performance, Cwm Taf LHB; Mr Eifion Williams, Director of Finance,
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Abertawe Bro Morgannwg UHB. The Chair emphasised the need for continuity of members/representatives at the meeting. He also emphasised the need for Members to ensure they come with the views of the organisations they are representing. MG12/03
DECLARATIONS OF INTEREST There were no declarations of interest.
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MANAGEMENT GROUP TERMS OF REFERENCE Members RECEIVED the Terms of Reference which were ratified by Joint Committee on 25th September 2012. Ms Pam Wenger highlighted that, unlike Joint Committee, the nominated deputy would count towards the quorum. However if another individual attends they will not be counted towards quorum. Ms Wenger drew members attention to section 8.6: Responsibilities of Members and Attendees. Ms Wenger confirmed that the next meeting will be held on 5th November 2012. Mr Darren Griffiths highlighted that the dates of the meetings scheduled conflicted with Executive meetings in Abertawe Bro Morgannwg UHB and therefore Mr Eifion Williams and Mr Paul Stauber will have difficulty attending. Members RESOLVED to: • RECEIVE the ratified Terms of Reference.
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TEMPLATES FOR REPORTS AND WAYS OF WORKING Members AGREED that a template for reports would be drafted by WHSSC and that the draft template would be circulated to members for comments and suggestions. It was AGREED that the template would be used for papers to be discussed at the next meeting. Members RESOLVED to: • AGREED the proposal for template for meeting papers.
MG12/06
Committee Secretary
a
DRAFT DECISION LOG FROM THE JOINT COMMITTEE 25 SEPTEMBER 2012 Members RECEIVED the draft decision log from the Joint Committee held on 25th September 2012. It was noted that the Prioritisation Framework was to be added to the decision log. Mr Stuart Davies provided, following a query from Ms Julie Keegan, an update with regards to the discussion at the In-Committee Meeting, on the current position of TAVI. Ms Keegan questioned what appeared to be differences between a decision made at the Joint Committee held in June 2012 and a decision made at the 26 Joint Committee held on 25 September 2012. Mr Stuart Davies confirmed that the Joint Committee had agreed in June to the proposal within the totality of the Cardiac resources and therefore it was not a
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different decision at the September meeting. The Chair confirmed that Mr Paul Roberts had questioned, at the September meeting, the differences between Cardiff and Vale UHB and Abertawe Bro Morgannwg UHB. The Chair also reported that at the last Joint Committee meeting there had been an in depth discussion regarding the management of in year decisions regarding funding (which have not been identified in the annual plan) and that it was agreed that evidence of exceptionality and full information was required by Joint Committee to inform their decisions. Members RESOLVED to: • NOTE the Joint Decision Log. MG12/07
Committee
BUSINESS FRAMEWORK Members RECEIVED the Business Framework for WHSSC which was ratified by Joint Committee on 25th September 2012. Ms Pam Wenger explained that the framework had been implemented, at Joint Committee’s request, with immediate effect. The Chair requested that Members highlight to him or Ms Wenger if the framework is not working. Updates can then be discussed at Management Group.
All Members
Members RESOLVED to: • NOTE the Business Framework. Version: Confirmed
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Ms Nicola meeting. MG12/08
Prygodzicz
joined
the
FINANCIAL RECONCILIATION PROCESS Members RECEIVED a tabled report from Mr Huw George regarding the financial reconciliation process. He noted that a reporting protocol had been agreed between Welsh Government and the LHBs and that it has also agreed that the reporting arrangements for WHSSC would be enhanced by WHSSC submitting a monitoring return directly to Welsh Government - the same as for the LHBs. This would ensure that any differences in assumptions will be transparent and can be acted upon. Mr George reported that he had attended the Chief Executives meeting in June following which further work had been undertaken over the summer with regards to the £17.4m and how it would be distributed across the LHBs. He reported that the LHBs have accepted the distribution and that all LHBs are now recognising and reporting their share; there are small timing issues but these are not material. Mr George drew Members attention to the table within the paper. This highlighted the different assumptions being reported by individual Health Boards regarding savings on the revised WHSSC budget. It was agreed that there needs to be early clarity
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from these Boards on what are real savings backed by agreed plans and what are aspirational or forecasting assumptions. Members discussed the risks with regards to not achieving the identified savings and how this should be managed within LHBs. It was AGREED that Mr Stuart Davies would include in the monthly WHSSC finance report to Welsh Government where any reconciliation differences occur. After further discussion it was agreed that a draft paper for Joint Committee will be developed which clearly shows the risks and implications. Mr Stuart Davies AGREED to start this paper and share with colleagues so that they could also provide information for the paper. It was AGREED that the paper will be circulated before the next Management Group Meeting.
Director of Finance WHSSC
Director of Finance WHSSC
Ms Julie Keegan queried an issue within the current Annual Plan for further work required to support WHSSC in the production of access criteria is required to assist with clinical based evidence in relation to patients who require Lumbar Disc Surgery appropriate for Neurosurgery or Orthopaedic Surgery. She highlighted that the need to ensure that there is consistency across the LHBs for example whether the work should be done centrally and provided to the LHBs rather than each LHB doing a piece of work. Version: Confirmed
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Dr Paul Buss questioned whether advice from tertiary specialists within Wales should be sought in developing the access criteria for those who would need to be referred to Neurosurgery. Mr Daniel Phillips confirmed that this work is currently being done within Cardiff and Vale UHB and he AGREED to share the information. Mr Phillips highlighted that there are differences in the availability of services e.g. competency and experience of local surgeons in undertaking the procedure. Therefore he envisaged that there would be a need for each LHB to agree a local pathway.
Director of Planning WHSSC
Director of Planning WHSSC
It was AGREED that following further work the pathway for lumbar disc surgery would be discussed at a future Management Group. Members RESOLVED to: • NOTE the report on the financial reconciliation process. MG12/09
ASSESSMENT OF EVIDENCE AND PRIORITISATION Members received a report on the assessment of evidence and prioritisation, presented by Dr Geoffrey Carroll. Dr Carroll drew Members attention to the Prioritisation Plan Timeline within the paper. He explained that the Panel will receive an initial list of services including other information at the meeting scheduled for mid October. It was AGREED that a summary of this
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information would be provided to the Management Group scheduled for 5th November 2012. Dr Carroll explained that further work would be then undertaken following the October Panel which will lead to the Panel receiving the final list in January 2013. Ms Julie Keegan queried whether any of the work could be brought forward to assist with the in-year work on reducing the £17.4m. Dr Carroll reported that some areas had been worked through during the pilot phase; however the Joint Committee had instructed that the information should not be used until the full project had been completed. Mr Stuart Davies reported that another discussion was needed on whether the information gathered in the pilot could be used before January to inform decisions. The Chair requested that LHBs, who are providers review the report and highlight where there maybe impact. Ms Prygodzicz suggested that Annex (iii), WHSSC Long List for Evidence Evaluation and Prioritisation, of the report be reviewed and information on what is achievable be provided. It was AGREED that Dr Carroll would undertake a further piece of work which would be sent to LHBs formally for response.
Medical Director WHSSC
Members RESOLVED to: • NOTE the report on Assessment of Evidence and Prioritisation. Version: Confirmed
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ANNUAL PLAN PROCESS 2013/14 Members RECEIVED a report, presented by Mr Daniel Phillips, on the Annual Plan process for 2013/14. Mr Phillips drew members attention to the flowchart included as Appendix A. He proposed that the plan parameters be brought to the Management Group meeting scheduled for 5th November in preparation for the In Committee Joint Committee workshop which is th scheduled for 27 November 2012. A letter has been sent to each provider asking that information be received on potential issues for next year. Mr Phillips reported that he expects to be able to produce an early draft of the pan in January 2013. He proposed that the key messages be brought to Management Group and then taken forward to Joint Committee on 28th January 2013. One to One meetings will be held with each LHB in February 2013 and a final draft of the Annual Plan will be brought to the Management Group scheduled for 4th March 2013. Dr Paul Buss suggested that, to ensure clinical input into the plan, the Medical Directors be invited to the January meeting of the Prioritisation Group. Dr Carroll AGREED to raise this at the next Medical Directors meeting.
Medical Director WHSSC
Mr Brian Hopkins suggested that potential savings should be identified Version: Confirmed
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and fed into the process ahead of January 2013. Mr Stuart Davies reported that the process includes the development of a savings plan and this will be discussed at the November meeting. At the Chair’s request, it was AGREED that a Gantt Chart be produced giving clear timescales and what is expected of Management Group Members and LHBs. Mr David Eve suggested that efficiency and performance be included in the Gantt Chart. Dr Buss queried how the impact of the Management Group would be assessed. It was AGREED that a piece of work be undertaken by the WHSSC Executive Team and be brought back to the Management Group at a future meeting.
Committee Secretary
Members RESOLVED to: • NOTE the report on Annual Plan Process for 2013/14. MG12/11
DISPUTES Members were informed by Ms Pam Wenger that there are no current disputes.
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ANY OTHER BUSINESS There were no matters to be discussed as any other business.
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DATE OF NEXT MEETING The date of the next meeting was confirmed as: Monday 5th November 2012, at
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Bowel Screening Wales.
Signed ………………………………………………. Insert Name (Chair) Date …………………………………………………..
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