Enclosure Siii

Finance, Performance and QIPP (FPQ) Monthly Meeting Wednesday 28 September 2016 10:00 – 12:00

Room BG.01 The Woolwich Centre

Present:

Maggie Buckell (MB) Chair Registered Nurse Member (Chair FPQ Committee)

NHS Greenwich CCG

Jim Wintour (JW) Lay Member NHS Greenwich CCG

Ellen Wright (EW) Chair NHS Greenwich CCG

Annabel Burn (AB)

Chief Officer NHS Greenwich CCG

Ian Fisher (IF) Interim Chief Finance Officer NHS Greenwich CCG

Dave Mountford (DM) Interim Deputy Chief Finance Officer NHS Greenwich CCG

Seelan Gunaseelan Head of Finance

NHS Greenwich CCG

Liz James (LJ) Interim Director of Commissioning NHS Greenwich CCG

Ranil Perera (RP) Lead GP Clinical Commissioner NHS Greenwich CCG

Maggie Aiken (MA)(for Diane Jones) Diane Jones

Director of Integrated Governance NHS Greenwich CCG

Dave Mountford (DM) Interim Deputy Chief Finance Officer NHS Greenwich CCG

Nick Varney PMO

NHS Greenwich CCG

In Attendance

Ada Howie Executive Assistant NHS Greenwich CCG

Apologies for Absence

Diane Jones (DJ) Director, Integrated Governance NHS Greenwich CCG

Gina Shakespeare (GS) Turnaround Director/Acting Director of Delivery and Service Transformation

NHS Greenwich CCG

Chris Soltysiak Associate Director Strategy and Performance

NHS Greenwich CCG

1. Welcome And Introductions Action:

MB welcomed members to the meeting.

2. Apologies For Absence

As noted above.

3. Declaration Of Interests

None

4. Agree Minutes of Last

The minutes of the 31 August 2016 were agreed as an accurate record of the meeting.

5. Matters Arising not covered in the Agenda

None.

6. Financial Performance

Financial performance update: Month 05 (IF)

IF thanked the Finance Team for their hard work in producing the Month 05 report. IF asked the Committee to note the update on the CCG’s financial position for the first five months of 2016/17, the period 1st April to 31st August 2016. IF advised that:

The position at Month 05 is a £2.02m surplus and in line with the M5

plan.

The forecast outturn is a deficit of £1.294m which is in line with

the Financial Recovery Plan (FRP) that agreed with NHSE; and is

reflected in our QIPP performance against plan.

The CCG is currently meeting all NHSE financial Business Rules with

the exception of a 1% year end surplus.

IF highlighted these issues to the committee:

1. Acute contract financial forecast is based on M4 validated data.

2. Non Elective Block contract agreed with LGT for Q1 and Q2 requires a detailed audit in respect of counting, coding & charging to establish contract basis for Q3 and Q4. On the basis of current information , the block for M7 is under discussion along with the financial expectations for M8 –M12

3. Continued focus on implementation and delivery of QIPP for 16/17 and building pipeline for 17/18.

4. The CCG has utilised £4.1m of reserves to bolster its forecast outturn financial position. The only reserve available to support any further pressures is the £1.9m 0.5% contingency. This will be a key point of note within the assurance process.

5. The 1% Non-recurrent reserve remains unallocated. 6. Additional tables & sections have been added to this report as

discussed at Month 4 Finance and Performance Committee IF advised that on the report Private Healthcare relates to Greenbrook, which has a forecast of £567k overspend. The finance team is now working with the commissioning team to analyse and understand the reason for the variances and will be readdressed next month. LJ added that she is currently investigating the reasons for the overspend whilst reviewing the Greenbrook Contract; especially the CCG’s expectations from the service. Bailey & Moore report also explored the reasons for this and has provided helpful recommendations. LJ advised that her team is looking into the reason for the over-performance at Greenbrook and report to the Committee. Action: LJ to investigate the over-performance at Greenbrook and report to the Committee. IF also highlighted that the Continuing Health Care (CHC) Budget is being monitored weekly and a management accountant is now working with the CHC team to assess their finances, cost and forecasts. RP and JW asked for clarification on variances on the block for LGT and Kings. IF explained that expenditure was the subject of a block contract for the first six month and the CCG should be in an under spending position. He also advised that activity had been below the agreed block but he anticipates that the CCG will benefit following re-negotiations for the second six months. IF added that the CCG’s current financial position includes a £1m contingency for additional activity that may be necessary to clear any RTT excesses. MB commended the Finance team for the detailed Month 05 report. The Committee notes the updates.

LJ

Noted

7. QIPP & FRB Update

QIP Update September 2016 (NV) NV asked the Committee to note the CCG’s QIPP activity for September

2016. NV’s presentation highlighted that:

• The QIPP Programme has moved its main focus from identifying

opportunities and building a QIPP Pipeline to ensuring the robust

and timely delivery of schemes.

• QPDM is now formally holding project leads to account through

rolling programme of project lead attendance.

• Detailed Project delivery tracking has been continued and is having

an impact on driving implementation

• Contract due diligence work is continuing with a detailed deep dive

on invoices paid to suppliers in 2016/17 taking place

• MSK Contract has been awarded and weekly mobilisation meetings

are taking place

• Three Commissioning Intentions workshops have been held with

Staff and GP’s, Providers and Patients.

• The CMOS Procurement has been evaluated and is on hold

pending a separate FRB decision.

NV asked the Committee to note that:

The Consultant Connect scheme will go live on 01 October with

two specialities, Paediatrics and cardiology.

The contract reduction for RMBS has been negotiated and the

scheme has been rated financially as green.

The GP Access Hubs will go live on 1st October 2016 at sites in

Eltham and Thamesmead

TAPS Adherence Referral forms have been changed to highlight

thresholds and are currently being tested. Notice of change is

being given to LGT with a planned go live date in December

TAPS Extension: Patient engagement has been planned for

October. Other CCG’s are not currently involved. The scheme is

expected to deliver savings in 2017/18

Escalation: Two projects are being escalated to FRB on the grounds

of implementation failure as set out in the Deloitte report. These

are a separate item on the agenda.

NV emphasised that halfway through the Financial year it is necessary to

place an urgent emphasis on how the remaining QIPP gap of £3.88m will be addressed; stating that Executive capability will need to be focussed on the following:

• Continued keen exploration of expenditure with Oxleas NHSFT and contract quantum for the second half of 20016/17

• Realistic appraisal of financial outturn against BCF schemes in 2016/17

• Securing agreement on non-elective quantum for months 8 – 12 at LGT

• Review of likely outturn in Medicines Management schemes once data flows from 1 October

• Due diligence review of continuing healthcare packages and controls

• Continued focus on the residual contract due diligence target • Review of extension to evidence based TAP following failure to

agree measures across South East London. NV also pointed out the commission priorities for 2017/18:

1. Primary Care: Deliver improved primary care access through

extended access at weekends in two hubs (Eltham and

Thamesmead)

2. Medicines Optimisation: Over The Counter (OTC) De-prescribing

3. Planned care and cancer care: Improve the Cancer referral

pathway within primary care

4. Urgent care: Increasing the proportion of NHS 111 calls handled by

clinical advisors

5. Adult Integrated care: Patients will be enabled to understand and

effectively manage their own conditions

6. Children and Maternity care: To deliver the aims of the CAMHS

Transformation Plan to increase in-reach to schools and the

development of the Parenting Programme across the borough

7. Adult mental health: Strategically review and redesign the Older

People’s Mental Health Services to develop a reconfigured

pathway shifting some resource from inpatient and specialist

services to enhanced generic community based services

MB asked for clarification on the situation with Community Health Services. LJ advised that in terms of contracting for the delivery of the services, the CCG is currently with Oxleas. If we can agree a two and half year contract that delivers benefits to us, then we anticipate getting some benefits.

NV advised that the figure of £3.85 on page 10 of his presentation, ‘QIPP Financial Planning Assurance as at 25th September 2016’; should be 3.88m not 3.55m. The Committee notes the QIPP update.

Noted

8. RISK REGISTER

Risk register update (MA) MA presented the Risk Register update in Diane Jones’s absence. MA highlighted that the main risks to the CCG are the ability of the Governing Body to meet its statutory duties, particularly around managing the Emergency Department (ED) 4 hour wait target; the CCG’s delivery on its quality, innovation, productivity and prevention (QIPP) target of £15.45m for 2016/17 while recovering its financial balance. MA also provided a summary of remedial actions, which has been approved by the Financial Recovery Board (FRB). She advised that the remedial actions are being implemented and a weekly progress meeting is held by the Interim Director of Commissioning. The CCG’s action plan is closely monitored for its delivery by NHS England on a monthly basis. MA highlighted that the CCG’s recovery plan recognises that it must deliver on the following 4 key areas to manage these risks:

1. Manage acute over-performance more effectively

2. Deliver QIPP programmes more consistently

3. Manage budgets more effectively not spending more money than

we have

4. Build the capacity and capability to deliver this larger change programme

Financial recovery remains a priority of the CCG, which is detailed in the Financial Report. MA flagged the Risk Register Activity since the last meeting of 31 August as below:

a. New risks: Since the last FPQ committee meeting on 31 August 2016, no new risks have been closed.

b. Closed risks: No risks have been closed since the last meeting.

c. Reduced risk scores: No risks have had their scores reduced since

the last meeting.

d. Increased risk scores: One risk has had its score increased since

the last report.

On risk number 258 (To effectively manage and monitor the contracts commissioned by the CCG), EW asked whether the Commissioning team have an idea of the number of patients on LGT MSK waiting list and if they will have the option of transferring to Circle. LJ responded that the aggregate figure/activity for the LGT waiting list is on the system. And when the MSK contract goes live, there will continue to be a backlog on the LGT side. If the patient is already on the MSK pathway with LGT, we will continue to pay for it. But new referrals will go via Circle. But GPs may decide to move their patients to the Circle pathway but it is a conversation LGT may decide with the patient. JW suggested that it would be helpful for the Committee to have an idea of the number of patients already on the MSK pathway so we can compare this with new referrals going to Circle. Action: LJ to find out the number of patients already on the MSK pathway before the contract with Circle begins. MA concluded by highlighting that the FPQ’s risk register has identified risks that may prevent the organisation from achieving its financial statutory duties e.g. QIPP delivery and recovering its financial position. But actions have been identified to mitigate this risk. The Committee notes the updates and will continue to monitor the progress on the action plans.

LJ

Noted

9. PERFORMANCE REPORT

Performance update (LJ) LJ provided an overview of the CCG’s performance against the key national targets and acute and community contracts. Her report highlighted the following issues for the Committee:

Greenwich CCG patients are not receiving access to acute

emergency services in line with the four hour access to treatment

target (95%). A&E performance at Lewisham and Greenwich Trust

(LGT) against the 4 hour waiting time standard (all types) improved

between June (83.2%) and July (85.1%).

Greenwich CCG patients are not receiving access to treatment in

line with the 18 weeks Referral to Treatment (RTT) standard

(92%). The July 2016 rate for Greenwich patients deteriorated to

90.7% from 91.0% in June 2016. Additionally, there were 13

Greenwich patients waiting over 52 weeks for treatment at Kings

College Hospital (12) and Guy’s and St Thomas’s. A full update is

available on pages 7 & 8 on the performance report.

LJ advised that LGT as a Trust met the RTT target overall but the

issue for Greenwich is KCH (which has agreed with NHSE not to

meet the target this year). These two providers, although the

relatively small in referral numbers, are impacting on the overall

Greenwich position.

Greenwich patients are not receiving access to cancer services in line with the 62 day standard. Performance against all cancer standards fell in July with the exception of the two week wait and 62 day standard. The 62 day standard has been below the 85% threshold since March 2016. LJ reported that LGT is also working with SEL providers to bid for access funding from the National Diagnostics Capacity Fund as diagnostic capacity is one of the key enablers in meeting the national waiting times.

Greenwich patients are expected to receive a dementia diagnosis in line with the national diagnosis standard of 67% – for August 2016 the CCG rate was calculated as 69.7%. Dementia performance had previously been below the standard for June (57.2%) and July (56.3%). Reporting issues of dementia cases were identified in at least two GP practices that implicated the measurement of achievement. LJ advised that the CCG is in the process of rectifying this retrospectively and the issue has been discussed with NHSE. A recovery plan has also been formulated to improve the rate of diagnosis. This is under the leadership of the mental health GP Executive.

LJ also reported that the plan will include:

Assisting GP Practices to review lists in line with recently diagnosed patients to ensure lists are up to date.

Liaising with Care Homes to ensure dementia patients are recorded on local GP records.

NHS Oxleas Foundation Trust (Oxleas) dementia specialist nurse to visit care homes and diagnose patients.

The Committee expressed concerns that LGT was not attaining the required target. But anticipates that the task force in place now will make speedy headway on ways of improving the system; especially as the winter months draw near. The Committee highlighted that the Bailey and Moore report will be helpful in resolving these issues. The Committee notes the CCG’s current performance, assurance and plans for service improvement.

Noted

10 ANY OTHER BUSINESS

1. Timing of the future FPQ meetings:

It was agreed that: 1. FPQ meetings should happen at least a week before the Governing

Body meeting especially in November.

2. FRB should take place before the FPQ. So for October, FRB and FPQ

time should be swapped – FRB 10:00 and FPQ 14:00.

9. Date of next meeting: 19 October 2016, 14:00– 16:00 Venue: BG.01, The Woolwich Centre 35 Wellington Street London SE18 6ND