To receive a presentation on the work of the National Commissioning Board, Arden, Herefordshire and Worcestershire.

The Committee received a presentation from Mrs Sue Doheny, Director of Nursing, Arden, Herefordshire and Worcestershire Area Team, NHS England.  During her presentation, the following areas were highlighted:

•        That the Herefordshire Clinical Commissioning Group (CCG) had been authorised, but with directions that would ensure that additional support would be provided by NHS England to support CCG development.  The CCG’s self-assessment had been considered robust, but the authorisation process had identified that the CCG would benefit from support in developing their integrated plan and their oversight and management of their Quality, Innovation, Productivity and Prevention plan (QIPP).

•        A programme of support had been agreed and it was expected that this would continue over a period of approximately 6 months, after which time it was expected that the CCG would be fully authorised

•        That system wide services would be commissioned locally on the basis of what was being undertaken nationally in order to provide full end to end integration of care.  Services would be patient and carer focused locally using small numbers of patients in order to ensure that they received the right outcomes.  Specialist needs would be dealt with on a regional basis.

•        The Primary Care Pathology Review would be considered in order to ensure that it was both financially and clinically sustainable.  Local CCGs across the region would be involved in this work, and where services were required locally, they would be kept locally.

•        That the Area Team was responsible as the Convener of the healthcare system across the Worcester Joint Services Review, the Wye Valley and George Eliot Trusts. It would convene the Quality Surveillance Group (QSG) which would act as a forum to allow concerns to be discussed across the Area. 

•        The Area Team was member of the Strategic Oversight Board with the National Trust Development Authority in support of local stakeholders who were developing a sustainable solution for Wye Valley Trust.

Ms Marcia Pert, Deputy Director of Finance, Arden, Herefordshire and Worcestershire Area Team reported that the Herefordshire Clinical Commissioning Group (HCCG) was well placed in terms of its financial position.  It was required to comply with national planning requirements and would start out by planning for a surplus, and would include contingencies and change reserve funds.  The Area Team’s role was to coach, develop and hold the HCCG to account.   The assurance role of the LAT was overseen by NHS England.

She went on to say that, to the HCCG’s advantage, there was well developed partnership working in the County.  The financial position for 2013/14 was challenging, but the HCCG’s Quality, Innovation, Productivity and Prevention plan (QIPP) programme was comparable to that of 2012/13, when it had been possible to exceed savings.  The Transformational savings Programme that had been submitted was both robust and challenging, but the HCCG was not alone in their financial position across the region as a whole.

In reply to a Member, Ms Pert said that the focus was very much on the position in 2013/14, but the reversion to 1 year funding allocations meant that it was important that a surplus should be planned for and contingencies set aside.  A return to three year funding allocations would make this form of annual planning unnecessary.  She went on to say that the Wye Valley Trust had received £9.5m funding in 2012/13, and that there were plans to provide an additional £10m in 2013/14.  There were currently no plans for financial support after this point.

The Chairman agreed with a Member’s comments that the total cost of the abolition of the old organisations and the setting up of the new structures should be considered by the Committee, and it was agreed that the matter would be considered at a meeting later in the year.

In reply to a question regarding the stroke services, the Director of Nursing said that the Local Area Teams had been set up in order to provide services that were appropriate to the area. Provision of services would differ between Birmingham and more rural areas. It would not be possible to resource a service in Herefordshire that would be at the cutting edge, but it was important to have effective clinicians on hand who were experts in their fields.  If the volume of work was not present, then the service would be networked out across the region.

The Chairman thanks the Director of Nursing and the Deputy Director of Finance for their presentation.