gloucestershire clinical commissioning group shadow board … · 2015-12-10 · presentation. 7...

Gloucestershire Clinical Commissioning Group Shadow Board

AGENDA Meeting to be held at 2pm on Thursday 15th November 2012 in the

Board Room, Sanger House, Brockworth, Gloucester GL3 4FE No. Item Lead Recommendation 1 Apologies for Absence

Dr Helen Miller

2 Declarations of Interest

Dr Helen Miller

3 Minutes of the Meeting held on Thursday 18th October 2012

Dr Helen Miller Approval

4 Matters Arising

Dr Helen Miller

5 Chair’s Update

Dr Helen Miller Information

6 Presentation: Health & Wellbeing Consultation

Dr Shona Arora Information www.gloucestershire.gov.uk/healthandwellbeing

7 Performance against Commissioning Report

Mary Hutton Information

8 QIPP Programme Update

Mary Hutton Information

9 Any Other Business (AOB)

Dr Helen Miller

10 Public Questions

Dr Helen Miller

Date and time of next meeting: Thursday 20th December 2012 at 2pm in Board Room at Sanger House

CCG Shadow Board Minutes – October 2012 Page 1 of 7

Gloucestershire Clinical Commissioning Group (CCG) Shadow Board

Minutes of the meeting held on Thursday 18th October 2012 in

the Board Room, Sanger House, Gloucester GL3 4FE Present: Dr Helen Miller HM Chair Dr Andy Seymour AS Deputy Clinical Chair Dr Shona Arora SA Director of Public Health Dr Caroline Bennett CBe GP - North Cotswolds Locality Dr Charles Buckley CBu GP - Stroud & Berkeley Vale Locality Alan Elkin AE Non Executive Director Malcolm Gerald MGe GP Martin Gibbs MG GP - Forest of Dean Locality Dr William Haynes WH GP - Gloucester City Locality Sarah Hughes SH Deputy Director of Nursing Mary Hutton MH Deputy Chief Executive Hein le Roux HLR GP - Stroud & Berkeley Vale Locality Cath Leech CL Deputy Director of Finance Richard Lewis RL Deputy Director of Human & Corporate

Resources Liz Mearns LM Medical Director Rob Rees RR Non Executive Director Dr Jeremy Welch JW GP - Tewkesbury Locality In attendance: Mark Branton MB Deputising for the Commissioning Director

Adults and Director of Adult Social Services Kevin Elliott KE Senior Commissioning Manager (Learning

Disability) Emma Simpson ES Board Administrator Mark Walkingshaw MW Locality Commissioning Director Valerie Webb VW CCG Lay Member for Business There were 4 members of the public present. 1 Apologies for Absence 1.1 Jill Crook, Debra Elliott, Nuala Ring, Jan Stubbings, Margaret

Willcox.


2 Declarations of Interest

2.1 Item 6 – MG stated that he is employed by Poplars

Rehabilitation Unit. 3 Minutes of the Meeting held on Thursday 13th September 2012 3.1 The minutes were approved as a true and correct record.

4 Matters Arising Item Description Response Action with 13.9.12 Agenda Item 8

CCG Shadow Board Draft Terms of Reference (TOR)

It was agreed that the wording on page 11 section 13.2 would be replaced with the equivalent for the Cluster Board.

Company Secretary Completed

5 Gloucestershire Clinical Commissioning Group (CCG)

Shadow Board Chair’s Report 5.1 The report highlights some of the activities of the Chair

since the Committee last met. 5.2 A brief outline was given of the CCG authorisation on

September 20th 2012. 5.3 RESOLUTION - The CCG noted the report. 6 Presentation: The Learning Disability Partnership

Board: Quality of Services in Gloucestershire 6.1 KE introduced the presentation and highlighted a number

of headings which included: Expectations around next steps on Winterbourne View Out of county service users

Service users with challenging behaviour Historic lack of quality system in Learning Disability and

Mental Health Services Safeguarding alerts and referrals are on the increase

Commissioning measures Training Safeguarding measures The CQC Projects and pilots in progress


Quality projects The components of the project

Quality assurance reviews

6.2 Questions and discussion points included: 360 degree appraisal – are the results of this in the

public domain? No, information is currently shared back to the provider and any concerns get highlighted directly to the commissioner.

People placed in Gloucestershire by other trusts. Electronic monitoring – system which demonstrates that

a person is where they say they are is being introduced. Concerns that the above could inhibit people from

thriving. Assurance was given to the CCG that attempts are made to manage people in the least restrictive way.

6.3 RESOLUTION - The CCG Shadow Board noted the

presentation. 7

Carers Commissioning Strategy

7.1 MB presented the Joint Carers Commissioning Strategy 2013-2016 for approval which was a supplementary paper to the submission approved at the previous Board in relation to support for carers.

7.2 Questions and discussion points included:

Children as carers – CCG members asked how young people had been involved in developing a strategy. A briefing would be sought on this from Linda Uren but assurance was given that this area has formed a continuous focus during the consultation process, including the Lead Cabinet member for young carers.

A discussion took place about current and future funding levels and strategy. MB explained that the budget indicated in the paper was for a specific area of carer support and that there were many other funding sources and support arrangements in place for carers in Gloucestershire.


7.3 RESOLUTION: The Gloucestershire Clinical Commissioning Group agreed to:

Approve the Joint Carers Commissioning Strategy

Recommend to NHS Gloucestershire and NHS Swindon PCT Cluster Board that the Strategy be formally adopted subject to some clarity regarding children as carers and that MB, MG and SA would ensure that this was included in the final report.

Confirmation will be provided through the CCG Chairs report.

8 Quality assurance during the transition 8.1 The report has arisen from discussions in the

Commissioning for Quality Group about the need to maintain a robust quality assurance process during the transition to develop new systems that meet the statutory responsibilities of the new organisation, to ensure that we measure what matters and provide necessary assurance to CCG Board.

8.2 The background and context was outlined as set out on

pages 3 and 4 of the report.

8.3 A number of key issues were raised including:

Addressing variation around primary care quality. Importance of embedding quality in all that the CCG

does, particularly relating to the development of the new Clinical Programme Groups.

How specialised commissioning quality and outcomes will feed in to assurance frameworks?

8.4 RESOLUTION – the CCG endorsed the proposed

approach as a broad direction of travel.

In due course more detailed proposals will be brought forward, including:

Roles and responsibilities of the Quality sub committee

Quality assurance strategy


Reporting structures Governance frameworks. 9 Commissioning for Quality Report – Quarter 1 9.1 The Deputy Director of Nursing introduced the report

which provided the CCG with a summary of the 3 aspects of quality:

Patient and Carer Experience Patient Safety and Risk Clinical Effectiveness

9.2 Several issues were highlighted including:

The overall quality achievements and assurance provided, in particular the positive impact of CQuINs

CCG members asked how we monitor performance. It was noted that this is a continual review mechanism through the Contract Quality Review Groups

Quality assurance for nursing homes was discussed and MB explained the current arrangements by GCC and proposed improvements

In view of the previous paper the future quality assurance reports will be developed this year.

9.3 RESOLUTION: The CCG noted the report. 10 Performance against Commissioning Report 10.1 The Director of Finance introduced the report which

provides a strategic overview of the financial and service performance issues by exception. It was noted that the report sets out the financial position as at the end of August 2012 and therefore requires an update.

10.2 The CCG noted that an update will be given to a future

meeting regarding retrospective Continuing Healthcare (CHC) claims.


10.3 In relation to performance, several areas are being focussed on:

Percentage of Trauma and Orthopaedic (T&O) admitted Pathways treated within 18 weeks – Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) achieved 89% performance during September. Achieving 90% (full compliance) is now within reach and there is a commitment to achieve this by Quarter 3. List management is improving.

Percentage of patients who have waited more than 6 weeks for one of the 15 key diagnostic tests – this has been dominated by endoscopy. Additional sanctions will be applied. The number of breaches was around 360 in August which dropped significantly to 220 in September. GHT has committed to zero breaches by November.

Percentage of patients seen within 2 weeks of an urgent referral for suspected cancer – positive news regarding this September performance is at 93% which is moving to a green position.

At least 85% of patients receiving first definitive treatment for cancer should be seen within 62 days from an Urgent GP referral – the biggest issue relating to this has been urology where capacity has increased. Performance was at 80% in September. Mitigating actions are outlined in the report.

CDiff – back on target for September and move to green is expected within a month.

Physiotherapy/podiatry targets – green was achieved in September.

10.4 RESOLUTION - The Shadow Board noted the reported

financial position for 2012/13 and the performance against the 2012/13 national targets and the actions taken to ensure that performance is at a high standard.

11 QIPP Programme Update 11.1 The CCG Shadow Board were provided with an update

of progress against the QIPP themes and main programmes of work, identifying progress to date, key risks and proposed remedial actions.


11.2 RESOLUTION - The Shadow Board noted the

performance against planned QIPP programme and the proposed remedial actions.

12 Any Other Business 12.1 There was no other business. 13 Public Questions 13.1 An ambassador for Carers UK stated that she felt the

consultation process relating to the Joint Carers Commissioning Strategy was rushed and that Carers should have been leading the project. Discussion took place on the issue of a carers’ champion sitting on the CCG. It was noted that there are lots of groups wanting a presence on the governing body but this has to be balanced out with competing needs. It was noted that the Voluntary/Third Sector need to engage at Locality Level as the need and availability are different around the county.

14 Date and time of next meeting

14.1 Thursday 15th November 2012 between 2pm and 5pm

in the Board Room at Sanger House. 14.2 The meeting closed at 3.15pm.

Minutes Approved by the CCG Shadow Board. Signed (Chair):____________________ Date:_____________

Agenda Item 4

Page 1 of 1

Matters arising from previous Gloucestershire Clinical Commissioning Group (Shadow Board) Meetings October 2012

Item Description Response Action with 13.9.12 Agenda Item 6

CCG Shadow Board GP Member Reports

It was agreed that a working group comprising GPs and members of the Finance Team be established in order to ascertain which information needs to be reported. Dr Hein le Roux and Dr Jeremy Welch were volunteered to sit on this group. It is likely the group will meet for the first time in November.

Chair Ongoing

18.10.12 Agenda Item 7

Carers Commissioning Strategy

Children as carers – CCG members asked how young people had been involved in developing a strategy. A briefing would be sought on this from Linda Uren but assurance was given that this area has formed a continuous focus during the consultation process, including the Lead Cabinet member for young carers. Mark Branton/Martin Gibbs/Shona Arora to ensure caveats relating to children as carers are worked in to the final report.

MB MB/MG/SA

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Agenda Item 5

Gloucestershire Clinical Commissioning Group

(Shadow Board) Meeting Date 15th November 2012

Title Clinical Commissioning Gloucestershire

(CCG) Shadow Board Chair’s Report

Executive Summary The report highlights some of the activities of the Chair since the Committee last met. The Chair will give a further verbal update on her engagements at the meeting.

Key Issues None. Risk Issues: Original Risk Residual Risk

None

Financial Impact None

Legal Issues(including NHS Constitution)

None

Impact on Equality and Diversity

None

Impact on Health Inequalities

None

Impact on Sustainable Development

None

Patient and Public Involvement

None

Recommendation This report is provided for information only

Author Dr Helen Miller Designation Chair, Clinical Commissioning

Gloucestershire Sponsoring Director (if not author)

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Agenda Item 5

Gloucestershire Clinical Commissioning Group

(Shadow Board)

15th November 2012

Chair’s Report

1 Introduction

1.1 This report sets out some of the key activities of the Chair since the Committee last met.

1.2 GP engagement event on 11/11/12.

Interviews for senior management positions within the CCG.

Leadership Gloucestershire – presentation about the CCG.

CCG GP Consortium Meeting. Forest of Dean Health Forum. National Female Leaders Action Learning set. Practice Managers Event – presentation.

2 Recommendations 2.1 This report is provided for information only.

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Agenda Item 7

Gloucestershire Clinical Commissioning Group (Shadow Board)

Meeting Date 15th November 2012 Title Performance against Commissioning

Report Executive Summary This integrated performance report provides

Gloucestershire Clinical Commissioning Group (GCCG) with a strategic overview of the financial and service performance issues by exception. This report sets out the Financial position is as at the end of October 2012. The Commissioned Service Performance position is dependent upon the availability of the data.

Key Issues

These are set out in the main body of the report

Risk Issues: Original Risk Residual Risk

All risks are identified within the relevant sections of this report.

Financial Impact Not meeting key financial targets

Legal Issues (including NHS Constitution)

Compliance with the NHS Constitution as part of the 18 week referral to treatment commitment

Impact on Equality and Diversity

Not Applicable.

Impact on Health Inequalities

The are no direct health and equality implications contained within this report


The are no direct sustainability implications contained within this report


The Health, Community & Care Overview and Scrutiny Committee receive a report of performance against key targets.

Recommendation The Board is asked to: Take note of the reported financial

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position for 2012/13 Take note of the performance against

national targets and the actions taken to ensure that performance is at a high standard.

Author & Designation

Roy Hewlett, Assistant Director Performance & Planning (NHSG) Steve Perkins, Head of Financial Planning (NHSG)

Sponsoring Director (if not author)

Mary Hutton, Director of Finance

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Agenda Item 7


November 2012

Integrated Performance Report

1 Introduction

1.1 This report sets out NHS Gloucestershire (NHSG) 2012/13 Financial and Commissioned Service performance. It is broken down into two sections covering performance relating to the key commissioning service targets and financial position of NHSG.

1.2 The performance section will also include an update on current performance against the key deliverables outlined in the NHSG Annual Operating Plan as at the end of Quarter 1.

1.3 Only those areas of performance assessed as being at significant risk of failure at year end, or other issues that engendered concerns throughout the year, for which the Board need to be made aware of, are included in the report. Where standards are reported on a quarterly basis, the board will be informed of updates as and when data is available or new information comes to light. The full summary of performance is included in the relevant appendices.

1.4 The supporting appendices provide a full analysis of the PCT’s

Finance position, and performance against our Commissioning performance targets. The 2012/13 commissioning performance scorecard (appendix 3) provides an integrated report describing the performance of NHSG. The scorecard covers the 2012/13 Operating Framework targets, NHS Constitution commitments and key ‘local offer’ commitments. Appendix 8 provides a RAG

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rated report covering progress against delivering the Annual Operating Plan key deliverables.

2 Performance

2.1 A full overview of current performance of NHSG against the national and key local targets is given in appendix 3 that is ordered in the following overarching themes;

Unscheduled Care Planned care Primary and Community Care Public Health Mental Health and Learning Disabilities Quality

All indicators are RAG rated, based on the 2012/13 NHS Performance Framework thresholds. In addition, the Year To Date and Year End Forecast positions are also given to enable the level of risk to better quantified at year end.

2.2 The overall level of performance is very good and a summary of the YTD position is given in the table below. This shows that of the total of 50 indicators reported on; 41 were rated Green (82%), 8 Amber (16%) and just one Red (2%).

Breakdown of current year to date performance by RAG status of indicator

Green Amber Red

NHS Gloucestershire 41 8 1

Percentage 82% 16% 2%

2.3

Areas where performance has been particularly good include:

The 4 hour A&E target is being met by all hospitals in the PCT area.

Both Cat A8 and A19 performance targets have been achieved throughout the year.

Patients are able to receive treatment for Community

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Services in Gloucestershire within 8 weeks of referral. These are some of the best access times in the country.

VTE risk assessment target has been consistently met within all Hospitals within the PCT area.

2.4 The table below provides a fuller position statement for all the

Amber and Red rated indicators. This table outlines current performance, identifies the issues leading to that performance and mitigating actions being taken to recover performance.

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Ref PCT Indicator Status Issue Mitigating Action Planned Care PHQ19 NHS

Glos At least 90% of Trauma & Orthopaedic admitted RTT pathways should be treated within 18 Weeks

RED YTD There has been a significant improvement in performance since June (76.8%) and performance in September for NHSG was 12 percentage points better at 88.8%. This represents the best ever performance for this standard.

Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) has had a persistent backlog of between 200-350 T&O patients that have already waited more than 18 weeks. The bulk of this backlog needs to be cleared, and the average waiting time reduced, to enable the target to be achieved sustainably.

GHNHSFT have restated their commitment to achieve the target by the end of Q3 2012/13. Waiting list management by consultant has improved performance and those consultants not achieving the required standard will have their work plans altered to allow them to clear their backlog. The backlog of patients that have already waited over 18weeks has reduced by over 60% since April 2012 which shows significant improvement in both waiting list and capacity management.

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Ref PCT Indicator Status Issue Mitigating Action Patients suitable for transfer are to being offered alternative providers for their surgery. New Referrals into Orthopaedics have reduced by 10% at month 5 which will help with GHNHSFT capacity pressures.

PHQ22 NHS Glos

Not more than 1% of patients should have waited more than 6 weeks for one of the 15 key diagnostic tests

AMBER YTD 3.3% of patients at the end of September had waited 6 weeks or more. This represents 226 breaches of which 223 were at GHNHSFT. Of these 223

GHNHSFT have not had sufficient endoscopy capacity to meet demand and clear the waiting list backlog. The situation worsened following the departure of a locum and Clinical Fellow. The bowel cancer awareness campaign

GHNHSFT have submitted a revised recovery action plan which states that they are committed to clearing the backlog by the end of November 2012. GHNHSFT have extended the contract of the two locums and increased weekend lists, this additional activity has been

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Ref PCT Indicator Status Issue Mitigating Action breaches at GHNHSFT, 220 where for endoscopy procedures.

also increased referrals at the start of the year.

ring-fenced for over 6 week waiters. The NHSG performance lead is meeting with the GHNHSFT Service lead fortnightly to monitor progress against their recovery plan and currently GHNHSFT are on plan to achieve the target by November.

PHQ24 NHS Glos

At least 93% of patients should be seen within 2 weeks of an urgent referral for suspected cancer

AMBER YTD 91.5% in August

Performance has been impacted by an increase of 11% in 2 week referrals in the first 4 months of 2012/13 compared to the same period the previous year. Additionally many of the breaches are due

Following a performance meeting with GHNHSFT on the 7th September, GHNHSFT will discussing possible solutions to minimise patient choice breaches at the Clinical Programme Group. The increased endoscopy capacity has reduced the

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Ref PCT Indicator Status Issue Mitigating Action to patients choosing to wait longer than 2 weeks. An audit by GHNHSFT of their 93 breaches in June found that 75 (81%) were due to patients being unable or unwilling to attend within 2 weeks. Lack of endoscopy capacity has also led to patients having to wait longer than 2 weeks.

number of lower GI breaches significantly.

PHQ25 NHS Glos

At least 93% of patients should be seen within 2 weeks of an urgent referral for breast symptoms where

AMBER YTD 99.1% in August, 92.3% YTD

Poor performance in April, due to Breast Consultant unavailability, has impacted on YTD performance.

Staffing issues have now been resolved and the target has been achieved in every month since April. It is predicted that the target will be achieved in Q2 and at year end.

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Ref PCT Indicator Status Issue Mitigating Action cancer is not initially suspected

PHQ03 NHS Glos

At least 85% of patients receiving first definitive treatment for cancer should be seen within 62 days from an Urgent GP referral

AMBER YTD 82.9% in August, 83.4% YTD

Main theme for underperformance has been patients not having all diagnostic tests in time. Urology has been the specialty which has seen the majority of breaches.

GHNHSFT have submitted an action plan, primarily around addressing Urology breaches, which accounts for the majority of the breaches, with the following actions: - Increase theatre

capacity (inc. evening & weekend sessions)

- Review of clinical staffing rotas

- Employment of a Consultant and Clinical Fellow

Performance has steadily improved over the last three months and GHNHSFT expect the

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Ref PCT Indicator Status Issue Mitigating Action target to be attained from Q3

Improving Access to Psychological Therapies (IAPT) PHQ13_5 NHS

Glos The proportion of people who have depression and/or anxiety disorders who receive psychological therapies

AMBER YTD 3.8% at Q2 against a plan of 4.5%

This target was achieved in 2011/12 however 2gether NHS Foundation performance in Q1 was significantly below expected levels.

A performance meeting was held with 2gether on the 25th September. Following this meeting an action Plan has been received by 2gNHSFT which includes: - Working closely with

Prison Health - Increasing referrals into

the service - Streamlining initial

assessments by making this part of their referral process

- Training of health visitors to support delivery

2gether are confident that the target will be achieved

PHQ13_6 NHS Glos

The proportion of people who complete therapy who are moving towards recovery

AMBER YTD 47.8% at Q2 against a plan of 51.9%

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Ref PCT Indicator Status Issue Mitigating Action at year end and there has already been a significant improvement in Q2 performance.

Quality PHQ27 NHS

Glos Number of MRSA infections (Health Community)

AMBER YTD 6 against a year end ceiling of just 4 for the year.

NHSG have been set an extremely stretching target to achieve a 60% reduction on the 2011/12 outturn of 10.

The numbers are very low and comparable with the number of infections seen in 2011/12. Most infections are in the community and a root cause analysis is carried out on each case.

PHQ28 NHS Glos

Number of C.Diff infections (Health Community)

AMBER YTD 9 against target of 11 in August, YTD 27 over Plan

Despite improved performance in recent months the July and August figure was above the agreed ceiling level. No specific themes can be identified to account for the increase; however similar levels of

NHSG is working with Primary Care and all health care providers to ensure that anti-biotic prescribing are within guidelines and that RCAs (Root Cause Analysis) are carried out where clinical concerns exist. NHSG are part of a South

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Ref PCT Indicator Status Issue Mitigating Action increases have been experienced in other health communities.

West review group of community infections, to further understand the increases seen across the South West. Local infection control group countywide has been re-established to start discuss strains any identify any reoccurring themes

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3.0

Annual Operating Plan – performance against key deliverables

3.1 The Integrated Annual Operating Plan for NHS Gloucestershire describes the proposed processes and structures for the implementation of the cluster’s key deliverables and reform agenda. The plan outlines how these key deliverables will be performance managed and reported at both Cluster and Clinical Commissioning Group levels.

3.2 The Integrated Annual Operating plan clearly sets out the key priorities for 2012/13 in appendix 1 of the plan and stipulates how performance will be monitored and reported to the Board on a quarterly basis.

3.3 Performance as at the end of quarter 1 is shown in Appendix 8. This covers all of the key deliverables with the exception of those already reported against within commissioning performance scorecard (appendix 3). Progress against each deliverable is RAG rated and, where applicable, a commentary explaining current performance is given.

3.4 The deliverables have been broken down by Priority, area each of which includes a number of Key Performance Indicators.

3.5 Overall more than 75% of indicators are rated green and are on track to be delivered at the end of 2012/13. No indicator has been rated red (failing) or is considered to be a significant amber against which an exception report is required. Actions being taken to improve the performance of the amber rated deliverables are included within the scorecard. .

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4.0 NHS Gloucestershire Financial Overview 2012/13

4.1 NHS Gloucestershire (NHSG) has planned to deliver a surplus of £8.9m for the year 2012/13 against an anticipated revenue resource limit of £961.2m. Appendix 1 shows the income and expenditure position for the year. Appendix 2 illustrates the position for expenditure and outturn variance.

4.2

The income and expenditure year to date position at 31st September 2012 is a surplus of £4.5m. This is in line with the planned year end position of £8.9m surplus. Table 1 below identifies the key variances at Month 06:

Programme area Forecast Outturn Variance £’m

Healthcare Providers Primary Care & Prescribing Admin & Provisions Reserves

(5.6) 0.3

0.0 14.2

Total 8.9

4.3

Gloucestershire Hospitals NHSFT – Contract overview

4.4 The Month 6 year to date position is £2.9m overspent (£2.0m at month 5). GHFT data available at month 6 reporting is complete up to month 5. The following report is based on extrapolation of the month 5 data.

4.5 At this stage in the contract year there are significant variables with assumptions included that will affect the eventual full year contract outturn position. The biggest variable is the £12.3m of planned QIPP (quality, innovation, productivity, prevention) savings within the contract to be achieved.

4.6 A contract forecast outturn overspend of £7.1m (£6.7m at month 5) is reported. Key issues generating the overspend increase

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are Emergency admissions and Outpatient attendance.

4.7 This reported position currently assumes the majority of QIPP is achieved. Assessment of ‘actual’ scheme delivery will be taking place as we progress through the year.

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Finance Section - exceptions based on significant overspend variances in the NHSG outturn variance

(Sign convention – a positive value indicates an underspend, negative (-) value indicates an overspend) Budget area YTD

Variance (£m)

Forecast Variance (£m)

Issue / Financial Risk Mitigating Actions

Secondary Health Care Provision Planned Care GHFT contract – Excluded Drugs

-£0.6m -£1.1m Lucentis Drugs activity is 10% year to date above activity plan at Month 5.

Discussions are currently taking place around supplier discount rate on Lucentis.

On-going assessment of activity trend increase to validate if this growth rate continues or levels

Unscheduled Care GHFT contract – Emergency admissions

-£3.4m -£6.4m The current forecast overspend is based on a review of previous year trends that suggests that the variance will stabilise after

Work has been continuing to better understand root causes of the variance and identify any issues that can be addressed. It has been

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Budget area YTD Variance (£m)



the first half of 11/12. Latest contract monitoring supports this position as most likely. If the increase continued through the second half year there is another £1m risk that would materialize.

identified that a significant proportion of the increase in admissions is in relation to patients under age 9 and patients over age 80 with the prime diagnosis of infectious diseases and diseases of the respiratory system. This combined with early indication that the rate of increase may now be reducing supports the reported position.

GHFT contract – Maternity/other Non-Elective admissions

-£0.6m -£0.9m Increased Obstetric admissions trend above planned levels

This variance is being reviewed. Indication is that the numbers of births have not significantly increased but complexity of births (e.g. increased C-sections) and levels of non-delivery admissions have increased resulting in this variance.

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Other Contractual GHFT contract – QIPP delivery

-£2.4m -£3.6m The reported forecast position currently includes £7.3m of the £12.3m QIPP requirement as ‘assumed’ contract benefit. However, in addition to the assumed QIPP benefit, £1.4m of Emergency threshold adjustment has also been accounted for within the reported contract position. As a result £3.6m lower delivery than the contract plan is reported. The original planned benefit was profiled as being delivered later in the financial year. Overall scheme delivery will be reviewed each month.

Planned Care and Unscheduled Care programme leads will be reviewing each scheme delivery assumption and potential for additional schemes on an on-going basis.

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In County - Tetbury

-£0.1m -£0.3m At month 6 Tetbury is Overspent by £0.1m, part is due to budget pressure and the rest is over activity in both Outpatients and Day surgery within the following specialties:- Ophthalmology, Gynaecology, and Maxillofacial/ Dermatology.

Out Of County Contracts

-£0.3m

-£0.6m

NBT are reporting a year to date overspend of -£0.2m based on month 5 data. Non elective neurosurgery and T&O are over performing, while elective inpatients are underspent (scoliosis surgery and renal transplants).

We continue to work with UHBT and NBT to understand the impact of the information system problems and changes to their cumulative position. NBT have greater issues, and are planning to have worked these through by the end of November. -£0.5m

-£1.0m

UHBT report year to date overspend of -£0.5m based on 4 months data. Overspend relates to elective and non-

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elective cardiac surgery and cardiology, and associated critical care and excluded drugs.

-£0.5m -£1.0m Elsewhere, Great Western forecasts an overspend of -£0.5m on elective T&O and PBR excluded devices. UH Oxford forecasts an overspend of -£0.4m in non-elective T&O and cardiology.

Specialist Commissioning Specialised Commissioning

£0.0m £0.1m Forecast underspend of £0.1m based on month 4 data. This is made up of a forecast underspend of £1m on Mental health, and a forecast overspend of -£0.9m on acute care. The mental health forecast has declined by -£0.3m since last

We will work through SCG information to unpick straight-line variances as they arise and keep in close contact with them in relation to their QIPP delivery. We are requesting a return to the production of specific

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month due to recognition of a new medium secure placement. Low secure accounts for the majority of underspend. The acute position has seen deterioration against the UHBT forecast by £1.0m, (now forecast at -£1.5m over) linked to BMT, NICU and paediatric surgery. Oxford has seen a deterioration in forecast of -£0.5m against cardiac surgery (-£1.5m forecast overspend within a contract forecast overspend of -£0.9m). GHT is forecasting underspend of £1.2m, against morbid obesity and non-specialised elements.

detail on volatile item forecasts such as Neonatal and BMTs.

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Non Acute Continuing Healthcare (CHC)

£1.8m £3.5m As at month 6, low placement numbers and associated costs have resulted in a significant forecast under spend. Month 6 has seen a reduction in numbers of CHC funded placements, thus increasing the forecast under spend by approx. £0.6m from month 5. CHC budgets were reduced by £2.2m for 12/13 due to significant QIPP achievement in 11/12. The £3.5m forecast under spend is against this rebased budget. Deadline for requests for consideration for retrospective CHC funding passed on Sept 30th and over 600 requests were received. As the requests are worked through on an

Continual close monitoring in conjunction with Funded Nursing Care placement numbers and costs, which are likely to rise as CHC costs fall. At present however, there is only a small YTD overspend reported against FNC.

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individual basis, the likely financial impact will become clearer, however NHSG has a small provision remaining to help partly offset this.

Funded Nursing Care (FNC)

-£0.25m -£0.50m Reduction in CHC eligibility has led to increased pressure on FNC budget. Particular increase around Self-funders from m4 to m5

See above (CHC)

Mental Health -£0.33m -£0.65m There are currently a large number of Eating Disorder (ED) placements in out of county placements, if this number continues the financial pressure on the ED budgets could rise.

On-going placement reviews in ED.

Learning Disabilities

-£0.1m -£0.2m Over spend position outlines anticipated slippage against QIPP delivery. Reduction in forecast from month 5 is due to

Discussions around additional Social Transfer related funding are taking place in hope of mitigating

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delay in patients being transferred back in to county.

risk of pressure in this area.

Acquired Brain Injury

£0.1m £0.2m Placement numbers have reduced from 4 to 1 since the beginning of the year. Change in reported position is due to budget reduction of £0.3m.

Primary care Community Pharmacy

£-0.45

£-1.15 Overspend relates to previous year cost pressure. Pattern of spend from previous years indicates claims will be higher as the year progresses.

On-going monitoring and liaising with medicines management team

Dental 1.0

2.36

Dental Budget continues to under spend against budget. Higher dental income in month 4 contributing to higher under spend in month.

On-going monitoring and liaising with Primary care team.

of 26

5 Recommendations 5.1 The Board is asked to:

Take note of the reported financial position for 2012/13 Take note of the performance against national targets

and the actions taken to ensure that performance is at a high standard.

Take note of the performance against the key deliverables in the Annual Operating Plan and the actions taken to ensure that performance is at a high standard.

6 Appendices

6.1 Appendix 1: NHSG Income and expenditure position for 2012/13 as at month 6 Appendix 2: NHSG Year to date expenditure and Outturn variance at month 6 Appendix 3: NHSG Integrated Performance Scorecard Appendix 4: NHSG Capital programme 2012/13 at month 6 Appendix 5: NHSG Better Payment Practice Code Appendix 6: NHSG Cash Reconciliation Appendix 7: NHSG Balance Sheet Appendix 8: NHSG Annual Operating Plan – Q1 performance

Financial Performance Report 2012/13 - Summary Financial Information to September 2012 (M06)

Previous

Month

Forecast

Outturn

Variance Status

Budget Actual Variance

Recurren

t Budget

Non-

recurrent

Budget

Total

Budget Actual Variance

(Adverse) /

Favourable Trend

£'m £'m £'m £'m £m £m £'m £'m £'m

Resource Limit (notified) 902.6 43.0 945.6 936.7 8.9

Anticipated Allocations 0.0 15.6 15.6 15.6 0.0

Revenue Resource Limit 469.0 464.5 4.5 902.6 58.6 961.2 952.3 8.9

Revenue Expenditure

Health Care Providers:

Secondary Health Care Providers 265.7 270.0 (4.3) 513.4 17.3 530.6 539.8 (9.2) (7.5) $

Specialist Commissioning 33.9 33.8 0.0 70.9 (3.2) 67.7 66.9 0.9 1.8 $

Non NHS Contracts (includes BMI) 5.9 5.9 0.0 11.8 0.1 11.8 11.9 (0.0) (0.0) 1

Partnership Budgets including mental health 1.7 1.7 0.1 3.5 0.0 3.5 3.4 0.1 0.1 $

Non-contracted Activity 2.9 3.4 (0.5) 6.3 (0.4) 5.9 6.6 (0.7) 0.0 $

Continuing Health Care & Specialist Placements 29.6 28.4 1.2 48.3 8.9 57.2 53.8 3.4 2.8 #

Public health & Commissioning programmes 3.9 3.9 (0.0) 4.6 3.1 7.7 7.7 0.0 0.0 1

Sub-total 343.7 347.1 (3.5) 658.8 25.7 684.5 690.1 (5.6) (2.8) $

Primary Care:

GP Contracts 36.7 36.9 (0.2) 76.1 1.9 78.0 78.3 (0.3) (0.3) 1

Dental Services 9.9 8.8 1.0 (2.0) 21.7 19.7 19.7 0.0 0.0 1

Prescribing including GP prescribing 43.8 44.0 (0.3) 87.5 0.0 87.5 88.0 (0.5) 0.0 $

Pharmacy 9.3 9.7 (0.4) 11.0 7.6 18.6 19.7 (1.2) (1.2) 1

Ophthalmic Services 2.7 2.5 0.2 0.8 4.7 5.4 3.0 2.3 2.3 1

Clinical PBC Schemes 0.6 0.2 0.4 1.1 0.0 1.1 1.3 (0.2) (0.2) 1

Sub-total 102.9 102.2 0.7 174.6 35.8 210.4 210.1 0.3 0.8 $

Administration & Provisions 10.6 10.6 (0.1) 15.8 4.8 20.7 20.7 0.0 0.0 1

Reserves 11.8 4.5 7.3 53.3 (7.8) 45.6 31.3 14.3 11.0 #

Sub-total 22.4 15.2 7.2 69.2 (2.9) 66.2 52.0 14.3 11.0 #

Total PCT Revenue Expenditure 469.0 464.5 4.5 902.6 58.6 961.1 952.2 8.9 8.9 1

Surplus 469.0 464.5 4.5 902.6 58.6 961.1 952.2 8.9 8.9 1

Year to Date Position Forecast Outturn

Appendix 2 - NHSG Year to date Expenditure and Outturn Variance

0

10

20

30

40

50

60

70

80Se

con

dar

y H

ealt

hca

re P

rovi

sio

n

Spe

cial

ist

Co

mm

issi

on

ing

No

n N

HS

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(in

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des

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tner

ship

Bu

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g m

enta

l hea

lth

No

n C

on

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t A

ctiv

ity

Co

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care

& S

pe

cial

ist

Pla

cem

ents

Pu

blic

Hea

lth

& C

om

mis

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g P

rog

GP

Co

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acts

De

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l

Pre

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bin

g

Ph

arm

acy

Op

hth

alm

ic

Clin

ical

Pb

C S

che

me

s

Ad

min

istr

atio

n &

Pro

visi

on

s

Exp

end

itu

re (

£'m

)

Area of expenditure

NHS Gloucestershire Year to date expenditure as at Month 6 (2012/13)

290

270

250

-12

-10

-8

-6

-4

-2

0

2

4

6

8

10

Seco

nd

ary

Hea

lth

care

Pro

visi

on

Spe

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(in

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ing

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& S

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ist

Pla

cem

ents

Pu

blic

Hea

lth

& C

om

mis

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rog

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Co

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acts

De

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Pre

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Ph

arm

acy

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ic

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Pb

C S

che

me

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Ad

min

istr

atio

n &

Pro

visi

on

s

Co

nti

nge

ncy

Fore

cast

Var

ian

ce (

£'m

)

Area of expenditure

NHS Gloucestershire Forecast Outturn Variance as at Month 6 (2012/13)

Appendix 3

NHS Gloucestershire 2012/13 Integrated Performance Scorecard

Target2011-12

OutturnApr 2012 May 2012

Jun 2012

Q1Jul 2012 Aug 2012

Sept 2012

Q2Oct 2012 Nov 2012

Dec 2012

Q3Jan 2013 Feb 2013

Mar 2013

Q4

Year to

date

Year end

forecast

Perf.

Measured

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

GRH 94.5% 94.5% 98.0% 97.6% 95.8% 95.9% 95.9% 96.3% > 95%

CGH 90.5% 92.1% 97.5% 96.3% 96.8% 98.1% 98.6% 96.7% > 95%

GHNHSFT total 92.8% 93.5% 97.8% 97.0% 96.2% 96.9% 97.0% 96.4% > 95%

GCS - MIU 99.9% 99.9% 99.9% 100.0% 99.9% 100.0% 100.0% 99.9% > 95% C

Target 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75%

GWAS 75.6% 76.2% 77.3% 79.7% 77.4% 78.1% 77.5% 77.7% > 75%

Glos only 76.5% 77.7% 78.6% 79.1% 78.5% 79.5% 80.1% 78.9% > 75%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

GWAS 95.6% 96.6% 96.4% 96.2% 95.6% 96.1% 95.7% 96.1% >95%

Glos only 95.5% 95.9% 95.9% 96.0% 95.6% 95.9% 95.0% 95.7% >95%

Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

Actual 90.9% 91.4% 91.2% 87.8% 94.0% 94.0% 94.0% 92.1% >90%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Actual 98.3% 97.9% 98.4% 98.3% 98.3% 98.1% 97.8% 98.2% >95%

Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

Actual 80.3% 81.3% 80.9% 76.8% 87.0% 88.1% 88.8% 83.6% >90%

Target 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%

Actual 94.1% 94.9% 95.3% 94.7% 94.2% 95.5% 95.4% 95.0% <92%

Target 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%

breaches 1,608 150 361 443 363 366 226 1,909

Performance 2.3% 2.3% 5.4% 6.3% 5.3% 5.3% 3.3% 4.7% <1% in Q4

Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

breaches 932 150 136 89 103 96 574

Performance 92.2% 85.6% 89.1% 91.0% 90.7% 91.5% 89.6% >93%

Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

breaches 165 45 3 0 0 1 49

Performance 88.5% 64.3% 97.8% 100.0% 100.0% 99.1% 92.3% >93%

Target 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96%

breaches 25 0 2 2 1 5

Performance 99.1% 100.0% 99.3% 99.1% 99.6% 100.0% 99.6% >96%

Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94%

breaches 3 0 0 0 1 2 3

Performance 99.4% 100.0% 100.0% 100.0% 98.3% 95.8% 98.8% >94%

Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%

breaches 0 0 0 0 0 0

Performance 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% >98%

Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94%

breaches 0% 0% 0% 0% 100% 100%

Performance 100.0% 100.0% 100.0% 100.0% 98.9% 100.0% 99.8% >94%

Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%

breaches 180 16 19 19 18 21 93

Performance 86.0% 84.8% 86.3% 79.6% 82.0% 82.9% 83.4% >85%

Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

breaches 8 1 1 0 1 2 5

Performance 96.9% 95.5% 96.3% 100.0% 95.0% 92.3% 95.6% >90%

PHQ04Percentage of patients receiving first definitive treatment for cancer within

62 days from an NHS Cancer screening serviceC

PHQ09Percentage of patients receiving subsequent treatment for cancer within

31 days where that treatment is a Radiotherapy TreatmentC

PHQ03Percentage of patients receiving first definitive treatment for cancer within

62 days of an urgent GP referral for suspected cancerC


31 days where that treatment is surgeryC


31 days where that treatment is an Anti-Cancer Drug RegimeC

PHQ25Percentage of patients seen within 2 weeks of an urgent referral for breast

symptoms where cancer is not initially suspectedC

PHQ06Percentage of patients receiving first definitive treatment within 31 days of

a cancer diagnosisC

Diagnostics

PHQ22Percentage of patients who have waited more than 6 weeks for one of the

15 key diagnostic testsC

Cancer Waits

PHQ024Percentage of patients seen within 2 weeks of an urgent referral for

suspected cancerC

PHQ19Percentage of Trauma & Orthopaedic admitted Pathways treated within

18 WeeksC

PHQ21 Percentage of incomplete Pathways that have waited less than 18 Weeks C

PHQ19 Percentage of admitted pathways treated with in 18 Weeks C

PHQ20 Percentage of non - admitted pathways treated within 18 Weeks C

Ambulance

PHQ01

Cat A 8 min response - The percentage of Category A incidents, which

resulted in an emergency response arriving at the scene of the incident

within 8 minutes.

C

PHQ02Cat A 19 min response - The percentage of calls resulting in an

ambulance arriving at the scene of the incident within 19 minutes. C

Principal Delivery Targets

Unscheduled Care

Accident & Emergency

PHQ23

4-hour A&E target - Percentage of A&E attendances where the patient

spent 4 hours or less in A&E from arrival to transfer, admission or

discharge

C

C

Planned CareAcute Care Referral to Treatment

3

Appendix 3


Target2011-12


Jun 2012

Q1Jul 2012 Aug 2012

Sept 2012

Q2Oct 2012 Nov 2012

Dec 2012

Q3Jan 2013 Feb 2013

Mar 2013

Q4

Year to

date

Year end

forecast

Perf.

MeasuredPrincipal Delivery Targets

Unscheduled Care

Target 18.0% 5.0% 5.0% 5.0% 5.0% 10.0% 20.0%

Actual 23.6% 5.6% 5.3% 10.9% >20%

Target 6.1% 1.7% 1.7% 1.7% 1.7% 3.4% 6.7%

Actual 9.1% 2.2% 2.1% 4.3% >6.7%

Target (weeks) 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Ave wait (weeks) 2.6 2.7 2.3 2.7 2.3 2.2 1.7 1.7

Max wait (weeks) 7 11 10 12 9 13 13

Target (weeks) 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Ave wait (weeks) 0.9 1.3 0.6 0.5 0.8 0.6 0.8 0.8

Max wait (weeks) 6 7 5 5 7 5 5

Target (weeks) 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Ave wait (weeks) 2.4 2.8 2.5 2.9 3.1 3.5 2.0 2.0

Max wait (weeks) 7 9 12 10 14 14 14

Target (weeks) 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Ave wait (weeks) 1.5 1.2 1.0 1.0 1.2 1.0 1.2 1.2


Target (weeks) 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Ave wait (weeks) 1.1 1.3 1.1 1.3 1.4 0.7 0.9 0.9


Target (weeks) 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Ave wait (weeks) 1.9 2.0 1.9 1.8 1.8 1.9 1.5 1.5


Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Actual 97.0% 98.0% 99.0% 98.0% 99.0% 100.0% 99.0% 98.8% >95%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Actual 97.0% 95.0% 97.0% 96.0% 100.0% 100.0% 96.0% 97.3% >95%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Actual 99.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% >95%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Actual 96.0% 100.0% 99.0% 97.0% 99.0% 100.0% 99.0% 99.0% >95%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Actual 97.0% 98.0% 97.0% 96.0% 96.0% 95.0% 95.0% 96.2% >95%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Actual 96.0% 98.0% 96.0% 99.0% 99.0% 100.0% 97.0% 98.0% >95%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Actual 99.0% 98.0% 95.0% 92.0% 96.0% 97.0% 97.0% 95.0% >95%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Actual 99.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% >95%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Actual 100.0% 98.0% 100.0% 100.0% 100.0% 98.0% 96.0% 99.0% >95%AMB 09

Percentage of patients referred to the Diabetic Nursing Service who are

treated within 8 WeeksC

AMB 07Percentage of patients referred to the Adult Physiotherapy Service who

are treated within 8 WeeksC

Specialist Nurses

AMB 08Percentage of patients referred to the Parkinson Nursing Service who are

treated within 8 WeeksC

AMB 05Percentage of patients referred to the Podiatry Service who are treated

within 8 WeeksC

AMB 06Percentage of patients referred to the Adult Occupational Therapy Service

who are treated within 8 WeeksC

AMB 03Percentage of patients referred to the Paediatric Physiotherapy Service

who are treated within 8 WeeksC

Adult

AMB 04Percentage of patients referred to the Adult Speech and Language

Therapy Service who are treated within 8 WeeksC

AMB 01Percentage of patients referred to the Paediatric Speech and Language

Therapy Service who are treated within 8 WeeksC

AMB 02Percentage of patients referred to the Paediatric OccupationalTherapy

Service who are treated within 8 WeeksC

LO6Average wait to be seen by the Children's Speech and Language Therapy

ServiceM

Community Care Referral to Treatment

Paediatric

LO4 Average wait to be seen by the Children's Occupational Therapy Service M

LO5 Average wait to be seen by the Children's Physiotherapy Service M

LO2Average wait to be assessed for a wheelchair by the Specialist and Non-

Specialist wheelchair ServiceM

LO3 Average wait to be seen by the Podiatry Service M

PHQ31_05Percentage of people eligible for the NHS Health Check programme that

have received an NHS Health CheckC

Community care

Local 2 Week Offers

LO1 Average wait to be seen by the Adult Physiotherapy Service M

Primary and Community CarePrimary care

PHQ31_04Percentage of people eligible for the NHS Health Check programme who

have been offered an NHS Health CheckC

4

Appendix 3


Target2011-12


Jun 2012

Q1Jul 2012 Aug 2012

Sept 2012

Q2Oct 2012 Nov 2012

Dec 2012

Q3Jan 2013 Feb 2013

Mar 2013

Q4

Year to

date

Year end

forecast

Perf.

MeasuredPrincipal Delivery Targets

Unscheduled CareTarget 3,950 766 1,506 2,272 3,505 766 3,505

Actual 4,003 893 893 >3505

Target 95% 95% 95% 95% 95% 95% 95%

Actual 100.0% 100.0% 100.0% 100.0% >95%

Target 939 255 483 711 939 483 939

Actual 1,844 401 820 820 >939

Target 70 18 36 53 70 36 70

Actual 85 23 46 46 >70

Target 3.9% 2.2% 2.3% 2.5% 2.6% 4.5% 9.6%

Actual 4.8% 1.7% 2.2% 3.8% >9.6%

Target N/A 50.0% 53.8% 53.6% 53.3% 51.9% 52.8%

Actual 50.2% 43.8% 50.7% 47.8% >52.8%

GHT 393 33 0 0 6 0 0 39 39 C

GCS 0 0 0 0 0 0 0 0 0 C

2gether 0 0 0 0 0 0 0 0 0 C

Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

GHNHSFT 92.9% 94.5% 94.0% 92.9% 93.3% 93.5% 93.6% >90%

GCS 95.8% 98.1% 97.8% 94.9% 97.9% 96.3% 97.0% >90%

Glos HC target 14 1 1 1 1 0 0 0 0 0 0 0 0 4 4

Glos HC actual 10 0 2 0 2 1 1 6 >6

GHNHSFT target 5 1 0 0 0 0 0 0 0 0 0 0 0 1 1

GHNHSFT actual 3 0 0 0 0 1 0 1 1

Glos HC target 182 19 16 13 16 13 11 11 11 11 22 20 19 88 182

Acute Hosp 97 6 4 5 10 13 2 40

Comm Hosp 24 1 2 1 2 2 0 8

Community 158 11 10 13 12 14 7 67

Glos HC actual 279 18 16 19 24 29 9 115 >182

GHNHSFT target 73 9 8 5 5 5 5 5 6 6 6 6 7 37 73

GHNHSFT actual 92 6 6 6 8 10 1 37 73

Notes Key to RAG status Key to 'performance measured' Key to abbreviationsPHQ 2012/13 NHS Operating Framework commitments Green On or above plan C = assessed on cumulative performance against plan GNHSFT - Gloucestershire Hospitals NHSFT EC Existing commitment Amber Below plan M = Figure as at end of month GCS - Gloucestershire Care Services

AMB Strategic Health authourity Ambition objective Red Significantly below plan GWAS - Great Western Ambulance ServiceLocal Local target

LO Local offer to Gloucestershire Health Community to reduce waiting times

PHQ28 Number of post 48 hour C Diff infections (Acute Trust) C

PHQ27 Number of post 48 hours MRSA infections post 48 hours (Acute Trust) C

Clostridium Difficile (C.Diff)

PHQ28 Number of total C Diff infections (Health Community) C

PHQ29 Percentage of all adult inpatients who have had a VTE risk assessment C

Cleanliness and HCAIs

Methicillin Resistant Staphylococcus Aureus (MRSA)

PHQ27 Number of MRSA infections (Health Community) C

C

QualityQuality Indicators

PHQ26 Eliminate mixed-sexed accommodation breaches at all providers sites

PHQ13_6The proportion of people who complete therapy who are moving towards

recovery

C

Improving Access to Psychological Therapies (IAPT)

PHQ13_5The proportion of people who have depression and/or anxiety disorders

who receive psychological therapiesC

PHQ10The number of new cases of psychosis served by the Early Intervention

Team

C

PHQ11 Number of home treatment packages delivered by Crisis Team C

C

Mental Health and Learning DisabilitiesAdults of Working Age

PHQ12Proportion of those patients on a Care Programme Approach (CPA)

discharged from inpatient care who are followed up within 7 days

Public Health

PHQ30Number of clients to the NHS Stop Smoking Service who report that they

are not smoking 4 week after setting a quit date

5

Appendix 4 - Capital Programme 2012/13

Capital Programme 2012/13 Year to date

2012/13

Budget

Forecast

Outturn Variance

£'000 £'000 £'000 £'000

Community Hospitals Central Funding 578 11,146 11,146 0

Operation Capital 3,187 8,028 8,028 0

Other Allocations 0 0 0 0

Additional capital sources 0 0 0 0

Receipts from Sales 0 7,550 4,434 (3,116)

Forecast capital resources 3,765 26,724 23,608 (3,116)

Capital Applications

North Cotswolds and George Moore Clinic 207 1,000 1,000 0

Estate improvements 203 6,753 5,909 844

Newent Health centre 98 200 200 0

Capital grants 2,600 5,028 4,632 396

Tewkesbury Hospital 578 11,746 11,746 0

Berkeley Court 0 0 0 0

Other schemes 79 0 79 (79)

Total capital applications 3,765 24,727 23,566 1,161

Resources less applications 0 1,997 42 (1,955)

Month 6 (September 2012)

Appendix 5 - NHSG Better Payment Practice Code

Appendix 6 - NHSG Cash Reconciliation

Cash Performance Indicators

Month: September Month 6

Cash Limit £'000

Total Annual Cash Limit - anticipated 961,528

Cash Drawn down to date 406,000

Prescribing cash 38,461

Dental Services cash 9,406

Pharmacy cash 9,655

Total charge to cash limit 463,522

% of cash drawn down to total annual cash limit 48.2%

Month end balance in bank account (£'000) 2,706

Month end balance as % of cash limit 0.3%

Cash Reconciliation

£'000

Cash drawn down to date 463,522

Less closing bank balance (2,706)

Cash utilised 460,816

% of adjusted cash utilised to total annual cash limit 47.9%

6 months pro-rata of cash limit 50.0%

Appendix 7 - NHS Gloucestershire Balance Sheet

Description

As at 31st

Aug 2012

As at 31st

March 2012

£'000 £'000

NON CURRENT ASSETS

Property, Plant & Equipment 92,317 93,937

Intangible Assets 135 157

TOTAL NON CURRENT ASSETS 92,452 94,094

CURRENT ASSETS:

Inventories -

Trade & Other Receivables 22,621 16,342

Cash & Cash Equivalents 2,706 183

SUB TOTAL CURRENT ASSETS 25,327 16,525

Non Current Assets Held for Sale 5,590 5,590

TOTAL CURRENT ASSETS 30,917 22,115

CURRENT LIABILITIES

Trade & Other Payables (64,917) (49,905)

Provisions (567) (1,109)

TOTAL CURRENT LIABILITIES (65,484) (51,014)

NET CURRENT ASSETS/(LIABILITIES) (34,567) (28,899)

TOTAL ASSETS LESS CURRENT LIABILITIES 57,885 65,195

NON CURRENT LIABILITIES

Trade & Other Payables (205) (205)

Provisions (2,051) (2,051)

Borrowings

TOTAL NON CURRENT LIABILITIES (2,256) (2,256)

TOTAL ASSETS EMPLOYED 55,629 62,939

FINANCED BY TAXPAYERS EQUITY:

General Fund / I & E Reserve 43,545 50,855

Revaluation Reserve 12,289 12,289

Local Government Pension Scheme Reserve (205) (205)

TOTAL TAXPAYERS EQUITY 55,629 62,939

PRIORITY KEY PERFORMANCE INDICATOR Plan (Actual) Q1 Performance Comments

Ensure that 92% of incomplete pathways have not waited longer than

18 weeks (PHQ21)

92% 95% Achieved

Ensure that 95% of direct access audiology patients are seen within 18

weeks

95% 97.90% Achieved

Comply with 18 week RTT best practice ensuring that:

* Breaches, and the reason for the breach, are reported to the Board

* Monitor and validate all patients that have waited over 35 weeks

* Review all planned waiting lists monthly

* Surgical pathways are reviewed to reviewed to minimise diagnostic

and out patient waiting times ensure

N/A

Ensure choice of a consultant led team where available (PHF07) 95% 100% Achieved - Consultant led teams are on

Choose and Book

Increase the proportion of GP referrals for first out-patient appointment

through Choose and Book (PHF08)

90% 80% Although the standard was not achieved

NHSG performance amongst the best

25 performing PCTs in the country

Meeting veterans’ prosthetic needs

Improving mental health services for veterans (this is included in all

MH specifications in the contract)

Improve cancer services and

prevent people from dying

prematurely

85% of patients receiving first definitive treatment for cancer within 62-

days of a consultant decision to upgrade their priority status (PHQ05)

85% 100% Achieved

Improve the effectiveness of

screening programmes

Patients should not wait longer than 14 days for their Bowel screening

diagnostic test

90% of waiters >

2 weeks

100% Achieved

Unplanned re-attendance rate - Unplanned re-attendance at A&E

within 7 days of original attendance (including if referred back by

another health professional) - This target relates to Gloucestershire

Hospitals NHS Foundation Trust for NHSG and Great Western

Hospitals for NHSS

<5% 2.90%

Left department without being seen rate - This target relates to

Gloucestershire Hospitals NHS Foundation Trust for NHSG and Great

Western Hospitals for NHSS

<5% 1.80%

Time to initial assessment - 95th centile - This target relates to



<15 mins 33mins

Time to treatment in department - median - This target relates to



<60 mins 58mins

Total time spent in A and E 95th centile should be <4 hours - This

target relates to Gloucestershire Hospitals NHS Foundation Trust for

NHSG and Great Western Hospitals for NHSS

<4 hrs < 4 hours

Improve access to unscheduled

care also ensuring that national

and local standards are met

Patient Impact Domain - Achieved

Timeliness Domain achieved - despite

time to initial assessment being

underachieved, for performance

management purposes organisations

are considered to have met the

minimum requirements if they have

achieved the threshold in at least one of

the indicators in each domain.

CANCER

UNSCHEDULED CARE

Military and veterans health Complete - This is now in the Local Access Policy of our main acute provider

Achieved / Complete - NHSG ensure that this is embedded as part of each

Service Specification

Maintain national and locally

determined acute care access

standards

There have not been any over 35 week breaches but all of these issues are

reported upon and discussed at the fortnightly RTT meeting with GHNHSFT and

acted upon accordingly

Improve the offer and uptake of

patient choice in line with national

policy

NHSG KEY PERFORMANCE DELIVERABLES QUARTER 1 2012-13 NHS Gloucsetershire

PLANNED CARE



PLANNED CARE Improve data quality and performance against the 4 A&E Quality

Indicators - This target relates to Gloucestershire Hospitals NHS

Foundation Trust for NHSG and Great Western Hospitals for NHSS

Reduce the number of over 20 minute ambulance handover delays Improvement on

2011/12 outturn

Ambulance delays in Q1 have reduced

by 60% compared to the previous year

Achieved

Improve quality of care by ensuring that plans are in place to monitor

and deliver ongoing improved performance against the Ambulance

Service Quality Indicators

Clinical desk expansion and increase in proportion of patients dealt

with in Hear and Treat category

Improvement

against last year

Qtr

Improvement across all Clinical Desk

activity in Q1

Achieved

Develop plans to implement a NHS111 service to be in place by 1st

April 2013

Ensure a robust Winter Plan is in place to ensure that the

Gloucestershire Health Community are prepared for various winter

pressure scenarios

To provide effective health services to support the Olympic 2012 plan

Assistive Technology Number of Telehealth units in use 2000 (420) 298 Underachieved - However the number of

units in use continues to rise and are

now exceed 500. The trajectory is

under review whilst a new model of

delivery and business model are

developed.

End of life Care Increase the percentage of deaths in place of choice on 2011/12 levels

(deaths at home including care Homes)

> 45% 46.10% Achieved

90% of patients admitted with a stroke should spend at least 80% of

their time on a stroke unit

80% 70.70% Underachieved - Our largest provider

(GHNHSFT) moved their stroke service

to one site in June 2012 and have ring

fenced beds. This has led to an

immediate improvement in performance

and it is anticipated that this target will

be achieved from Q2 onwards.

60% of people at high risk of Stroke, who experience a TIA, should be

assessed and treated within 24 hours

60% 53.70% Underachieved - GHNHSFT have

reorganised their internal processes and

this target is now being achieved in Q2

Improve stroke services

LONG TERM CONDITIONS

Plans have been developed and Project team working towards implementation by

April 2013

Emergency preparedness and

resilience planning

Escalation Plan in Place. Winter Plan is being finalised and agreed amongst all

providers

Achieved

On-going monitoring of the commissioniners report from GWAS continues show

improvements against 2011/12

Improve access to unscheduled

care also ensuring that national

and local standards are met

Although this data is collected national data quality if not very robust and no

targets have be set, therefore no conclusions can be drawn from the performance

data at present.



PLANNED CARE

Increase QOF dementia register to 60%. 60% 47% Steady progress being made across the

county currnetly. New prevealance

indicator due to be released in October

2012 will provide improved ability to

monitor activity

Reduction in admissions for dementia

Ensure that providers are compliant with NICE quality standards

Reduced length of stay for dementia

Gloucestershire

NHSFT target 14

Great Western

Hospital target 17

19 Underachieved - Main causes was

patients wating further NHS Care or

placement. GHNHSFT are currently

scoping the development of a whole

systems approach to patient discharges

and expect performance to improve.

Glos Care

Services target

12 SEQOL

target <15

9 Achieved

Reduction in antipsychotic prescribing

Improve dementia standards to support quality improvements

County wide Community Dementia Nurse service and Dementia

Advisor service

Immunisation rate for children aged 1 who have completed

immunisation for diphtheria, tetanus, polio, pertussis, Haemophilus

influenzae type b (Hib) - (i.e. all 3 doses of DTaP/IPV/Hib)

95% 97.20% Achieved


immunisation for pneumococcal infection (i.e. received Pneumococal

booster) (PCV)

95% 97.30% Achieved


immunisation for Haemophilus influenzae type b (Hib), meningitis C

(MenC) - (ie received Hib/MenC booster)

95% 95.90% Achieved


immunisation for measles, mumps and rubella (MMR) - (i.e. 2 doses of

MMR)

95% 96.90% Achieved


immunisation for diphtheria, tetanus, polio, pertussis (DTaP/IPV) (i.e.

all 4 doses)

95% 96.30% Achieved

PRIMARY AND COMMUNITY CARE

Improving health outcomes

through the effective use of

preventative strategies

DEMENTIA

Improve early diagnosis and

treatment of dementia

Community Capacity being strengthened.

Dementia Challenge Bid submitted to enhance rapid response and crisis

management

All providers currently comply with NICE standards

Secondary - Primary Care Audit has shown continual reduction latest figures

shows 10.03% (2012) against 14.3% (2010). Next audit due in Jan 2013

Training and Education Strategy developed to support staff skills development

Completed - Service has been in place since October 2011 working within

Primary Care

LOS for people with Dementia has seen a gradual reduction. The Dementia

Challenge Bid will help to support timely discharge planning

Reduced delayed discharges



PLANNED CARE Immunisation rate for children aged 5 who have completed

immunisation for measles, mumps and rubella (MMR) (i.e. 2 doses)

95% 90.80% Underachieved

Immunisation rate for girls aged around 12-13 years who have

completed immunisation for human papillomavirus vaccine (HPV) (i.e.

all 3 doses)

90% 84.50% Gaining access to independent and faith

schools remains the key stumbling block

with this standard. GCS are working

through an action plan which includes

one-stop shops in locations such as

youth clubs etc in order to improve this

standard.

Immunisation rate for children aged 13 to 18 who have been

immunised with a booster dose of tetanus, diphtheria and polio

(Td/IPV)

90%

Influenza Immunisation for those in the 65 and over plus at risk group

Percentage uptake

75%

Pneumococcal vaccinations for for those in the 65 and over plus at

risk group Percentage uptake

75% for >65s

70% for at risk

Percentage of children in reception recorded as obese < 9%

Percentage of children in year 6 recorded as obese < 17.7%

Reduce adult obesity by supporting GP clusters to develop/procure

community based adult weight management services

Percentage of pregnant women with a BMI >35 BMI >35

Reduce teenage pregnancy rates

Work towards achieving 2400 positive tests per 100.000 of the 15-24

population by 2013/14

towards 2400 1957 Target measurement change from

coverage to diagnostic rate requires a

redesign of screening activity. This is

taking place during 2012/13.

A designated professional is identified to support local safeguarding

boards

Ensure internal systems are in place to escalate and intervene as

required in response to safeguarding alerts

QUALITY

Safeguarding Completed - CCG lead identified for Safeguarding Adults

Completed - Systems witihin NHSG in place to ensure effective responses to

Safeguarding issues

GP clusters in Stroud and Barkeley Vale and FOD developing / delivering WM

services. There is a lack of consistent cover across the county, a paper is to go to

the CCG in October 2012

Maternal healthy weight programme underway from Autumn 2012. Baseline data

to be establisehd in first instance and then reviewed following development and

delvery of care pathway.

Improve delivery of sexual health

services

Final data is provided annually and gives Gloucestershire a rate of 23.3 at end

December 2010. Provisional data produced indicates a rate of by the ONS

shows Gloucestershire falling to a rate of 22.2 end March 2011 and 19.8 end

June 2011.

2012/13 data not available yet



Improving health outcomes

through the effective use of

preventative strategies

Data not available




PLANNED CARE

Implement government strategy outlined in DoH No Health without

Mental Health document (DH 2011)

Learn lessons from SUIs and specific reviews implementing the

necessary improvements

An increase of the number of users completing treatment on that

recorded in 2011/12

Implement an Alcohol Liaison nurse to reduce repeat admissions to

hospital

Re-provision of substance misuse treatment services - revised model

to deliver the recovery agenda

Provide care closer to home

Reductions in admissions to Hospital

Reduction in length of stay

Oversee the transisiton of infomatics to reciever organisation

Move of public Health Intelligence Unit to Gloucestershire CC -

Integration for the service between Health and Social care

Single Informatics Programme Portfolio for Cluster

Cluster wide data warehouse

Full deployment of NHS mail for all commissioning staff

CLOSED - No Longer being developed due to separate CCG development

between Glousetershire and Swindon. As well as the CSU developing a Data

warehouse which includes, but is not limited to, Swindon and Gloucestershire

All executive and administration staff now have NHS.NET. NHSG have

implemented the procedures, processes and structures in order to roll out NHS

mail throughout the organisation. There is no longer a need to ensure all staff are

on NHS.NET, however should this change then everything is in place to deliver

this.

INFORMATICS

Managing Transition NHSG representatives are currently active in attending or chairing many transition

Project Boards providing help advice where needed.

Achieved - Phase I complete

NHS Gloucestershire (NHSG) joint projects with NHS Swindon are now

designated as NHSG_S on the portfolio. These projects are now integrated into

the monthly reporting of the cluster IM&T portfolio.

LEARNING DISABILITIES

Implement the recommendations

of the Winterbourne Review -

provide care closer to home

Developed Multi-Agency Team to address current interim recommendations.

Awaiting final review to address all recommendations produced.

Decommissioning of 5 beds and service modelling ongoing to encourage patients

in hospital to be cared for closer to home and out of a hospital setting.

Tendering Drug and alcohol

service

Data currently unreliable, expectation information will be produced at end of Q2

Completed - Alcohol Liason Service in place since February 2012

Completed - Tendering process at ITT stage with new contract in place

commencing April 2013

MENTAL HEALTH & DRUG AND ALCOHOL SERVICES

Improving safety and access to

Mental Health Services

Progress is being made to capture the objectives laid out in the No Health without

Mental Health Strategy.

Where necessary Action Plans are put in place and processes are altered to

ensure the issue does not arise again. This is continually monitored by our Risk

and Governance Lead



PLANNED CARE Full inventory linking estates and IT infrastructure and contracts

Full roll-out of Summary care Record project to all practices in

Gloucestershire

Patient Access - Work with practices to understand fully the

implications and requirements for wider patient access in anticipation

of national guidance

Ensure the CCG has the necessary commissioning support services to

support it through authorisation; Support the CCG to agree and adopt

final commissioning support arrangements for taking on full statutory

duties

Support the development of the CSU, ensuring that its staff,

infrastructure and operating processes are professional, fit for purpose,

provide value for money and represent excellent customer service.

Put in place appropriate plans for individuals to support their own

transition beyond the PCT. Manage the transition process lawfully and

sensitively; Provide appropriate support and development opportunities

for staff

Health Visitors Increase WTE health visitors to 92.73 in Gloucestershire by March

2013.

92.73 WTE 76.53 vs target of 82.82 in Q1 Underachieved - NHS Gloucestershire

have agreed a trajectory with

Gloucestershire Care Services to meet

the target.

This has been shared and agreed with

the SHA leads for health visiting.

Although we are currently behind

trajectory for 2012/13 but have recruited

through various sources and expect to

make up lost ground later in the year

when the bulk of our new staff become

available for employment following

completion of their training.

CHILDREN, YOUNG PEOPLE AND MATERNITY

NHSG continues in its

commitment to being an

‘Employer of choice’ within the

local market, recognising that

excellence cannot be achieved

without a motivated, engaged

workforce The PCT has achieved all of the relevant transition milestones set by the DoH

Progress is dependent upon system suppliers’ compliance with national

directives, however this has been influenced as a priority via the GPSoC National

Advisory Group.

WORKFORCE

Work undergoing to populate data within the estates web-based application

(LEFInf) is on track. All networking mapped against estates and changes are

being managed by the operational group quarterly.

46 GP practices are live for summary care records. 10 GP practices do not have

compatible systems for SCR

NHSG have a draft programme in place to roll out SCR to the remaining 30

practices. I have not contacted any of these practices to discuss whether or not

they will activate SCR.

Managing Transition



PLANNED CARE A 1% increase in the percentage of mothers giving birth normally

based on 2011/12 levels

61.2%

An increase in the normal birth weight based on 2011/12 levels

100% of women who are smoking in pregnancy to be given the optiojn

to be referred to the smoking cessation service

95%

At least 52% of mothers should be breastfeeding at 6 to 8 weeks. 52% 52% Achieved

Increase breastfeeding at 6 to 8 weeks by 10% in those areas in

Gloucestershire with the lowest rates in 2011/12

10% 10% Achieved

Carers Strategy Agree and sign off Carers Strategy plan with Local Authorities that:

1)Identifies the financial contribution made to support carers

2)Identifies how much of the total is being spent on carers breaks

3)Identifies an indicative number of breaks that should be available

within funding

CARERS

A joint Carers Commissioning Strategy is being developed between NHS

Gloucestershire and Gloucestershire County Council. Publication of this strategy

on the PCT website has been slightly delayed due to scheduling difficulties

associated with getting sign off through both NHS and GCC processes. The

strategy will be published on the PCT website before the end of October 2012

subject to approval at CCG Shadow Board and GCC cabinet in October.

The strategy covers support services for all carers, including the provision of

carers breaks, and provides a break down of the financial contributions made by

both NHSG and GCC, in line with the Operating Plan requirements.

Maternity Data available at end of Q2

Data available at end of Q2

Data available at end of Q2

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Agenda Item 8


Meeting Date Thursday 15th November 2012 Title QIPP Programme Update

Executive Summary This paper provides the GCCG with an

update of progress against the QIPP themes and main programmes of work, identifying progress to date, key risks and proposed remedial actions.

Key Issues

NHSG has planned to deliver a surplus of £8.9m for the year 2012/13.

Risk Issues: Original Risk Residual Risk

Risk: Non delivery of saving and service redesign plans. Addressed by: Close working with the Project Management Office. Identification of additional saving schemes and slippage within other service area budgets. Current rating: 15 Risk: QIPP programme benefits realisation shifts. Addressed By: Project management and performance data utilised to predict benefits realisation, reduce level of risk within assumption. Work programmes continue to drive harder on savings delivery in year. Current Rating: 8

Financial Impact Not meeting key financial targets Legal Issues(including NHS Constitution)

Not applicable.

Impact on Equality Not applicable.

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and Diversity Impact on Health Inequalities

Not applicable.


No sustainable development issues are highlighted by the report.


Not applicable.

Recommendation The GCCG are asked to: Take note of the performance

against planned QIPP programme and the proposed remedial actions.

Author Kelly Matthews Designation PMO Lead Sponsoring Director (if not author)

Mary Hutton

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Agenda Item 8


Thursday 15th November 2012

QIPP Programme Update

1 Introduction

1.1 NHS Gloucestershire has a requirement to deliver £29.8m recurrently from

its QIPP programme, to ensure financial stability moving into 2012/13. NHS Gloucestershire are currently developing QIPP plans to support the planned delivery of a surplus £8.9m in 2012-13. To achieve this position commissioner QIPP schemes are being delivered in conjunction with local providers to ensure whole system reform. To support this change NHSG has identified a source of invest to save funding and maintains uncommitted headroom to pump prime service change. This paper and supporting appendices sets out the key progress to date, key risks and proposed remedial actions and provides an overview of the 2012/13 QIPP programme currently being developed.

2 QIPP Programme Overview

2.1

QIPP Themes The QIPP programme covers the breadth of the commissioning agenda and all themes are underpinned by a core principle of care closer to home, in line with the organisational strategy. The rolling QIPP programme has been split into the following themes and programmes.

QIPP Theme Programme

Unscheduled Care & Long Term

Conditions (Including Community Care)

System wide change Pathway Development

(Assessment, Diagnostics and Ambulatory Care)

Self-Care Management and Prevention.

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Community Provision

Planned Care

Contract Strategy Service Strategy (including use

of clinical programme approach) Demand Management

Reducing variability in Primary Care

General Medical Services Optometry Dental

Prescribing

Best Practice Waste Medication Medicine Optimisation GP Dispensing Joint Formulary

Mental Health and Learning Disabilities

Services

Improve services for clients with challenging behaviour

Improving Health Inequalities

OOC Placements Eating Disorders Access to Psychological

Therapies

Continuing Healthcare

EoL Domiciliary Care Procurement

Testing Eligibility Reducing Referrals

Non Clinical Estates Back Office

The supporting appendices provide a detailed overview of the programme and individual projects.

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3 Finance Savings Plan 2012/13 Against a requirement to deliver £29.8m worth of savings in 2012/13, across the QIPP programme plans are in place to deliver £30.5m of cashable savings, as shown in table below.

The over planning of savings allows for risk mitigation in relation to shifts in the potential realisation. Alongside the savings shown above further benefits in relation to avoiding growth equates to an additional £1.8m of benefit. Based on the application of assumed timescales for delivery of individual QIPP schemes, the table below demonstrates expected phasing of savings delivery by quarter throughout 2012/13. (Note: all figures are shown in £000’s in all tables)

Theme Target SavingsPlanned

Savings (Rec)

Planned Savings (Non

Rec)Grand Total

Savings Gap (In Cash Terms)

Unscheduled Care / Long Term Conditions £5,043

£4,252 £791 £5,043 £0Planned Care £5,691 £5,547 £50 £5,597 -£94Prescribing £7,526 £7,526 £0 £7,526 £0Primary Care £1,500 £0 £1,500 £1,500 £0Community Care £3,000 £3,109 £0 £3,109 £109Mental Health £1,200 £850 £0 £850 -£350Learning Disabilities £2,500 £2,500 £0 £2,500 £0

Continuing Health Care £2,200£2,200 £0 £2,200 £0

Non Clinical £1,150 £0 £650 £650 -£500Contract Contributions £0 £1,523 £0 £1,523 £1,523Grand Total £29,810 £27,507 £2,991 £30,498 £688

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Theme Q1 Q2 Q3 Q4 Unscheduled Care / Long Term Conditions £556 £1,449 £1,589 £1,448

Planned Care £220 £1,382 £1,973 £2,023

Prescribing £4,132 £1,132 £1,132 £1,132

Primary Care £0 £0 £750 £750

Community Care £750 £786 £786 £786

Mental Health £0 £0 £175 £675

Learning Disabilities £0 £833 £833 £833

Continuing Health Care £1,750 £150 £150 £150

Non Clinical £0 £0 £0 £650 Contract Contributions £381 £381 £381 £381

Grand Total £7,788 £6,113 £7,769 £8,828

26% 20% 25% 29%

Savings Position as at end September 2012. At month 6 the projected savings delivery within 2012/13 is £27.2m of cashable savings, as shown in the table below. This is consistent with Month 5.

Theme Target Savings

Assumed Savings (Rec)

Assumed Savings (Non

Rec)

Assumed Grand Total

Savings Gap (In Cash

Terms) Unscheduled Care / Long Term Conditions

£5,043 £2,309 £1,396 £3,705 -£1,338

Planned Care £5,691 £4,139 £25 £4,164 -£1,528

Prescribing £7,526 £7,526 £0 £7,526 £0

Primary Care £1,500 £0 £1,426 £1,426 -£75 Community Care £3,000 £2,487 £0 £2,487 -£513

Mental Health £1,200 £675 £0 £675 -£525

Learning Disabilities £2,500 £2,000 £0 £2,000 -£500

Continuing Health Care

£2,200 £3,080 £0 £3,080 £880

Non Clinical £1,150 £0 £590 £590 -£560 Contract Contributions

£0 £1,500 £0 £1,500 £1,500

Grand Total £29,810 £23,716 £3,436 £27,152 -£2,658

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The gap from financial requirement can be addressed with non recurrent contingent resources. The mitigating actions to address the projected £2.7m shortfall on a recurrent basis can be noted as:

1) Continue to increase the planned savings position to over plan beyond requirement; building in contingency for slippage in scheme delivery.

2) Review of in year delivery to assess if the benefits realisation from existing projects can be increased.

3) There is a focus on understanding the increased unscheduled care acute admissions; to ensure QIPP programmes are in place to effectively impact upon the increased spend and ensure services are developed to care for people at right time, in right place.

4) The Your Health, Your Care strategic implementation plan is modelling the impact from the priority areas for change, including key components of the QIPP programme, over the next 5 years to ensure recurrent change into 2013/14 and beyond.

4

Current Key Risks and Proposed Remedial Actions The key risks from across the QIPP programme can be noted within the table below, alongside their remedial actions:

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Key Risks (L) (1-5)

(C) (1-5)

Total Remedial Actions

Insufficient plans for reassurance regarding financial stability moving into 2013/14.

3 5 15

Director and clinical leadership at theme level, further projects in development for additional saving. Contingency and non-recurrent slippage identified to support delivery of control total. Further ideas under development.

Insufficient engagement across the health community with regards to savings plans.

2 4 8

Theme directors responsible for ensuring contractual engagement, QIPP health community groups in place to ensure senior clinical, management and financial sign up. Joint approach to inclusion in contracts for 2012/13. Alignment to Gloucestershire Strategy for Care.

Insufficient detail to map impact in relation to workforce and provider capacity.

3 4 12

Business case process requires that all projects are fully scoped for service outcomes including workforce and bed impact. Routine performance management of both business case preparation and project implementation ensures consistent and targeted focus on these areas. The Resources Steering Group routinely review system workforce and capacity impacts as part of the strategic review for the health community operating framework and plan.

5. QIPP Programme Updates A robust programme management process has been developed to ensure governance mechanisms are in place to performance manage delivery.

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Programmes and projects are assessed in relation to the following 2 perspectives:

Project Management. Robustness of project plan and ability to deliver against key milestones for implementation.

Benefits realisation. Ability to deliver financial outcome as proposed within the original project plan assumptions.

Currently there are 71 QIPP projects included within the programme, assigned as Raised, Open (Implementation) and Open (Performance Management) of which the % assessed as red, amber of green rating for project management are shown in the chart below.

Since the previous report the projects assessed as green have increased to 33% (from 31%), amber risk rating has decreased to 50% (from 53%) and a subsequent slight increase in red schemes to 14% (from 13%).

Red14%

Amber50%

Green33%

n/a3%

Project Management

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Since the previous report the projects assessed as green remained at 44%, amber risk rating has increased to 48% (from 47%) and a subsequent slight decrease in red schemes to 6% (from 7%). There is a noted maintained position benefits realisation as this is currently consistent with Month 5 analysis. The current highlight programme report is attached within appendix A, detailing:

Key Achievements Red or significant amber risk programme areas and mitigating actions.

5 Supporting Documents

Appendix 1: QIPP Highlight Performance Report (October 2012)

Red6%

Amber48%

Green44%

N/A2%

Benefits Realisation (by value £)

08/11/2012

Green

Amber

Red

Green

Amber

Red

Significant

Amber Risks

Project

Status:

Project documentation well developed programme of

work on track.

Further work required within project documentation,

some slippage in milestones.

Limited project documentation completed or project

implementation delayed.

Advice &

Guidance

Benefits

Realisation:

KPIs on track, high level of confidence in ability to

deliver outcome, contract mechanisms are in place.

The scheme is on track but concerns around benefits

to be realised.

Limited or no confidence in delivery of outcome.

Red ProgrammeReasons and Actions

Community IV Service

(Planned Procedures)

Operational pathway issues still occuring and therefore less activity in the

community service than expected.

Case mix and delivery model being reviewed by Gloucestershire Care

Services including service proposal for remainder of 2012/13.

Programme Management Office

QIPP Highlight Performance Report October 2012

Overview

Key

Significant Progress to Date

Planned Care(Red rating based on both project management and benefits realisation

assessment, dependent on size, priority and complexity of workstream)

GP Peer Review

GP Peer Review (3 specialty min.) went live countywide in November 2011,

with all practices in the county signed up to a form of peer review (in house

design or NHSG QoF QP Scheme). Performance data from Nov -11 to

September - 12 indicates a 7% reduction in GP referrals for those specialties

selected. The 12-13 scheme will aim to expand to all practices peer reviewing

all specialty referrals by September 2012 - currently 86% of practices have

signed up to the LES scheme.

Consultant to

Consultant Referrals

Consultant to Consultant Referral Policy was not agreed with GHNHSFT

in 2011-12 and therefore benefits were not realised. Project has been

rolled forward for 2012-13, 100% risk share to NHSG, £250k saving.

Assurance will be required as to approach to agreeing policy with

GHNHSFT and timescale.

NHS Gloucestershire programme lead is currently exploring opportunity

across all 'other' referrals i.e. midwifery alongside additional service

redesign plans.

Prescribing growth rate currently -0.95%, 5th best in South West region.

T&O Programme

NHSG are committed to developing a joint programme with GHNHSFT to

deliver agreed financial impact alongside alignment to the savings and

18wk RTT target. Generic MSK pathway mapping and specific pathway

mapping for spinal pathways have been developed and considered by

the CPG. The CPG have also supported the development of a trial

programme including Advice & Guidance and triage, for 2013/14 ahead

of procurement to commission an integrated service model in future

years.

Risk Stratification

Advice and Guidance commenced with Dermatology in June 2012. Initial

uptake and feed back has been positive in both primary and secondary care. At

the end of September 2012 100 referrals for Dermatology Advice & Guidance

had been received, 57% were returned to primary care and 29% onwardly

referred to secondary care. The joint working group (NHSG & GHNHSFT) have

idenitifed Haematology and Renal as the next specialties to go live in

November 2012.

NHS Gloucestershire CCG have endorsed procurement of risk stratification tool

to support development of integrated community teams

CHCIn terms of benefits realisation this QIPP Programme is forecast to over deliver

against the initial target set.

Enhanced Community

Provision

The Enhanced Community Provision Programme equates to £2.4m of

the USC programme in 2012-13, with a two thirds risk share to NHSG.

Projects within the programme include Living Well and Use Of

Community Hospital Beds. The overall delivery of this programme is

amber reflecting the USC activity position to date,

Telehealth (LTC Theme)

As at 24th October 2012, 601 patients have been referred to telehealth

within the county - the deployment of units across Gloucestershire

remains challenging. A robust communication and engagement plan is

in place and will be need to be further developed throughout 2012-13 in

order to reach 2000 unit deployment trajectory. Additional resource has

been agreed to support clinical engagement. GCS are on track with

recommendations for referral target.Prescribing

Red 14%

Amber 50%

Green 33%

n/a 3%

Project Management

Red 14%

Amber 41%

Green 34%

Est 0% n/a

11%

Benefits Realisation (no. of projects)

Red 6%

Amber 48%

Green 44%

N/A 2%

Benefits Realisation (by value £)

N:\Cluster Governance\6) Gloucestershire CCG\2012\Meeting Papers\2012-11 November\AI 8 - 1 20121101 Appendix A QIPP Programme Overview

Telephone renumbering project NHS Gloucestershire, Gloucestershire Care Services and Gloucestershire Hospitals NHS Foundation Trust telephone numbers are changing on 26th November. The 0845 prefix which is currently used will change to an 0300 prefix. The DoH has mandated that this change is made to ensure that patients and the public pay local call rates when phoning the NHS. 0845 numbers are charged at higher rates, whilst 0300 numbers are charged at local rates. Extension numbers for individuals and departments (the last four digits) will remain largely unchanged – it is just the first part of the number which will change. 0845 numbers will be redirected for a period of six months to ensure a smooth transition. In practice, numbers will change as follows: Organisation Current number New number Extension (4

digits) NHS Gloucestershire 0845 422 0300 421 unchanged Gloucestershire Care Services*

0845 659 0300 421 unchanged

Gloucestershire Hospitals NHS Foundation Trust

0845 422 0300 422 unchanged

*In addition to the 0845 number changes, some geographical and some 0345 numbers used by Gloucestershire Care Services’ community hospitals will also be changing Telephone numbers have been allocated for Gloucestershire Clinical Commissioning Group and the NHS National Commissioning Board Local Area Team, and these will be listed in the BT phone directory (published in February 2013) along with the Dental Helpline and 3 Counties Cancer Network numbers. A communications programme will be carried out to ensure that these changes are promoted effectively across the county. This will include advertising in local media and communication with primary care, stakeholders and the public. A webpage explaining the changes and providing detailed information will be hosted on the NHS Gloucestershire website.