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Meeting-in-common of the City & Hackney Clinical Commissioning Group and City of London Corporation

Integrated Commissioning Board Meeting on Wednesday 2 August,

Tomlinson Centre, Queensbridge Road, E8 3ND

City Integrated Commissioning Board Meeting

Item no.

Item Lead and action for

boards

Documentation Page No.

Time

1. Apologies/introductions Chair

Verbal - 10.15-10.20

2. Declarations of Interest Chair For noting

2 – Register of Interests 1-6

3. Minutes of Previous Meeting Chair For approval For information For noting

3.1 – Minutes of City ICB Meeting, 28 June 2017 3.2 – Minutes of Hackney ICB Meeting, 28 June 2017 3.3 – ICB Action Log

7-23

10.20-10.25

4. Integrated Finance Report

Philippa Lowe / Mark Jarvis For noting

4 – Integrated Finance Report

24-37 10.25-10.35

5. Any Other Business

Chair

Verbal 10.35-10.40

Attached for Information: ICB Forward Plan (Paper 6, p.38-42)

Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interest23/03/2017 Transformation Board Member - CHCCG City & Hackney CCG Chief Officer Pecuniary Interest

CoLC ICB Member - CHCCG NHS England Spouse is Regional Director of People & Organisational Development (London)

Indirect interest

LBH ICB Member - CHCCG Hackney Health & Wellbeing Board Board Member Non-Pecuniary Interest

City of London Health & Wellbeing Board Board Member Non-Pecuniary Interest

NEL STP Board Board Member Non-Pecuniary Interest

N/A Resident of Westminster & Registered with Westminster GP Non-Pecuniary Interest

Integrated Commissioning2017/2018 Register of Interests

Paul Haigh

City ICB Page 1

Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interest25/03/2017 Transformation Board Member - DPH, LBH & CoLC London Borough of Hackney Director of Public Health Pecuniary Interest

City of London Corporation Director of Public Health Pecuniary InterestAssociation of Directors of Public Health Member Non-Pecuniary

InterestBritish Medical Association Member Non-Pecuniary

InterestFaculty of Public Health Member Non-Pecuniary

InterestNational Trust Member Non-Pecuniary

Interest23/03/2017 Transformation Board Member - CoLC City of London Corporation Acting Director of Community and Children’s Services Pecuniary Interest

CoLC ICB Member - CoLC Hackney Volunteer & Befriending Service Volunteer Non-Pecuniary Interest

n/a Tenant - De Beauvoir Road, Hackney Non-Pecuniary Interest

n/a Registered with the De Beauvoir Practice Non-Pecuniary Interest

30/03/2017 Transformation Board Member - Healthwatch City of London

Healthwatch City of London Officer Pecuniary Interest

Royal College of Pathologists Public Affairs Officer Pecuniary Interest

Janine

Penny

Neal

Adridge

Hounsell

Bevan

City ICB Page 2

Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interest23/12/2016 Transformation Board Member - CHCCG

CoLC/CCG ICB ChairLBH ICB Member - CHCCG

City & Hackney CCG Chair Pecuniary Interest

Body and Soul Daughter in Law works for this HIV charity. Indirect interest

CHUHSE Sorsby and Lower Clapton Group Practice's are members Pecuniary Interest

GP Confederation Sorsby and Lower Clapton Group Practice's are members and shareholders

Pecuniary Interest

Local residents Myself and extended family are Hackney residents and registered at Hackney practices, 2 grandchildren attend a local school.

Non-Pecuniary Interest

Lower Clapton Group Practice (CCG Member Practice)

Partner at a GMS and an APMS practices which provide a full range of services including all GP Confederation and the CCG's Clinical Commissioning and Engagement contracts, and in addition child health, drug, minor surgery and anticoagulation clinics. We host CAB, Family Action, physiotherapy, counselling, diabetes and other clinics. The buildings are leased from PropCo, and also house community health services. The practices are members of CHUHSE and the GP Confederation. Lower Clapton is a teaching, research and training practice, and I am a GP trainer. I am a member of the BMA and Unite. One partner is a member of the LMC.

Pecuniary Interest

Sorsby Group Practice (CCG Member Practice) Partner at a GMS and an APMS practices which provide a full range of services including all GP Confederation and the CCG's Clinical Commissioning and Engagement contracts, and in addition child health, drug, minor surgery and anticoagulation clinics. We host CAB, Family Action, physiotherapy, counselling, diabetes and other clinics. The buildings are leased from PropCo, and also house community health services. The practices are members of CHUHSE and the GP Confederation. Lower Clapton is a teaching, research and training practice, and I am a GP trainer. I am a member of the BMA and Unite. One partner is a member of the LMC.

Pecuniary Interest

Tavistock and Portman NHS Trust Husband is Medical Director of Tavistock and Portman NHS FT which is commissioned for some mental health services for C&H CCG.


N/A Daughter is a trainee Psychiatrist, not within the City and Hackney area.


Clare Highton

City ICB Page 3

Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interest22/12/2016 Transformation Board Member - CHCCG

CoLC ICB Attendee - CHCCGLBH ICB Attendee - CHCCG

City & Hackney CCG Joint Chief Finance Officer Non-Pecuniary Interest

GreenSquare Group Board Member, Group Audit Chair and Finance Committee member for GreenSquare Group, a group of housing associations. Greensquare comprises a number of charitable and commercial companies which run with co-terminus Board.


NHS Oxford Radcliffe Hospital Member of this Foundation Trust Non-Pecuniary Interest

PIQAS Ltd Director at PIQAS Ltd, dormant company. Non-Pecuniary Interest

Honor Rhodes 05/04/2017 Member - City / Hackney Integrated Commissioning Boards

Tavistock Relationships Director of Strategic Devleopment Pecuniary Interest

The School and Family Works, Social Enterprise Special Advisor Pecuniary Interest

Oxleas NHS Foundation Trust Spouse is Tri-Borough Consultant Family Therapist Indirect interestEarly Intervention Foundation Trustee Non-Pecuniary

Interestn/a Registered with Barton House NHS Practice, N16 Non-Pecuniary

InterestGary Marlowe 06/04/2017 GP Member of the City & Hackney CCG Governing Body City & Hackney CCG Governing Body GP Member Pecuniary Interest

De Beauvoir Surgery GP Partner Pecuniary Interest

City & Hackney CCG Planned Care Lead Pecuniary Interest

Hackney GP Confederation Member Pecuniary Interest

British Medical Association London Regional Chair Non-Pecuniary Interest

n/a Homeowner - Casimir Road, E5 Non-Pecuniary Interest

City of London Health & Wellbeing Board Member Non-Pecuniary Interest

Local Medical Committee Member Non-Pecuniary Interest

Unison Member Non-Pecuniary Interest

CHUHSE Member Non-Pecuniary Interest

Philippa Lowe

City ICB Page 4

Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interestDhruv Patel 28/04/2017 Chair - City of London Corporation Integrated

Commissioning Sub-Committeen/a Landlord Pecuniary Interest

Clockwork Pharmacy Group SSAS, Amersham Trustee; Member Pecuniary Interest

Clockwork Underwriting LLP, Lincolnshire Partner Pecuniary Interest

Clockwork Retail Ltd, London Company Secretary & Shareholder Pecuniary Interest

Clockwork Pharmacy Ltd Company Secretary Pecuniary Interest

DP Facility Management Ltd Director; Shareholder Pecuniary Interest

Clockwork Farms Ltd Director; Shareholder Pecuniary Interest

Clockwork Hotels LLP Partner Pecuniary Interest

Capital International Ltd Employee Pecuniary Interest

Land Interests - 8/9 Ludgate Square215-217 Victoria Park Road236-238 Well Street394-400 Mare Street1-11 Dispensary Lane

Pecuniary Interest

Securities - Fundsmith LLP Equity Fund Class Accumulation GBP

Pecuniary Interest

East London NHS Foundation Trust Governor Non-Pecuniary Interest

City of London Academies Trust Director Non-Pecuniary Interest

The Lord Mayor's 800th Anniversary Awards Trust

Trustee Non-Pecuniary Interest

City Hindus Network Director; Member Non-Pecuniary Interest

Aldgate Ward Club Member Non-Pecuniary Interest

City & Guilds College Association Life-Member Non-Pecuniary Interest

The Society of Young Freemen Member Non-Pecuniary Interest

City Livery Club Member and Treasurer of u40s section Non-Pecuniary Interest

The Clothworkers' Company Liveryman; Member of the Property Committee Non-Pecuniary Interest

Diversity (UK) Member Non-Pecuniary Interest

Chartered Association of Buidling Engineers Member Non-Pecuniary Interest

Institution of Engineering and Technology Member Non-Pecuniary Interest

City & Guilds of London Institute Associate Non-Pecuniary Interest

City ICB Page 5

Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interestAssociation of Lloyd's members Member Non-Pecuniary

InterestHigh Premium Group Member Non-Pecuniary

InterestAvanti Court Primary School Chairman of Governors Non-Pecuniary

InterestJoyce Nash 06/04/2017 Member - City Integrated Commissioning Board City of London Corporation Deputy Pecuniary Interest

Neaman Practice Registered Patient Non-Pecuniary Interest

Feltmakers Livery Company Lifemember of Headteachers' Association Non-Pecuniary Interest

Peter Kane 12/05/2017 Attendee - City Integrated Commissioning Board City of London Corporation Chamberlain Pecuniary Interest

Randall Anderson 13/06/2017 Member - City Integrated Commissioning Board City of London Corporation Deputy Chair, Community and Children’s Services Committee Pecuniary Interest

n/a Self-employed Lawyer Pecuniary Interestn/a Renter of a flat from the City of London (Breton House,

London)Non-Pecuniary Interest

City of London School for Girls Member - Board of Governors Non-Pecuniary Interest

Neaman Practice Registered Patient Non-Pecuniary Interest

Andrew Carter 05/06/2017 Attendee - City Integrated Commissioning Board City of London Corporation Director of Community & Children’s Services Pecuniary Interest

n/a Spouse works for FCA (fostering agency) Indirect interest

City ICB Page 6

Paper 3.1

Meeting-in-common of the City & Hackney Clinical Commissioning Group and City of London Corporation

City Integrated Commissioning Board

Meeting of 24 May 2017

MEMBERS Clare Highton –Chair of the City & Hackney CCG Governing Body (Chair) Cllr Dhruv Patel – Chair, Community and Children’s Services Committee, City of London Corporation Cllr Randall Anderson – Deputy Chair, Community and Children’s Services Committee, City of London Corporation Paul Haigh – Chief Officer, City & Hackney CCG Honor Rhodes – Governing Body Lay Member, City & Hackney CCG

FORMALLY IN ATTENDANCE Neal Hounsell – Assistant Director, Commissioning & Partnerships, City of London Corporation (attending on behalf of Andrew Carter)

Sunil Thakker – Joint Chief Finance Officer, City & Hackney CCG

STANDING INVITEES Penny Bevan – Director of Public Health, London Borough of Hackney Prakash Kakoty – City of London Healthwatch

OFFICERS PRESENT Richard Bull – Programme Director - Primary Care, City & Hackney CCG (Item 7) Amaka Nnadi – Integrated Commissioning Finance Manager, City & Hackney CCG (Item 8) Matt Hopkinson – Integrated Commissioning Governance Manager, City & Hackney CCG (Minutes)

City ICB Page 7

Paper 3.1

APOLOGIES Members Cllr Joyce Nash - Member, Community and Children’s Services Committee, City of London Corporation Formally in Attendance Philippa Lowe – Chief Finance Officer, City & Hackney CCG Andrew Carter – Director of Community & Children’s Services, City of London Corporation Mark Jarvis, Director of Finance, City of London Corporation Gary Marlowe – Governing Body GP Member, City & Hackney CCG Officers in Attendance Ellie Ward – Integration Programme Manager, City of London Corporation Devora Wolfson – Integrated Commissioning Programme Director

1. Apologies and Introductions

1.1.1.The Chair welcomed members and attendees to the meeting.

2. Declarations of Interest

2.1.1.The Board NOTED the register of members’ interest. Clare Highton declared an interest in Item 7 – Primary Care Commissioning Model, as a GP. There was no apparent conflict, however, and it was agreed that she should take part in discussions as usual.

3. Questions from the Public

3.1. There were no questions from members of the public.

4. Minutes of the City ICB Meeting, 23 May 2017

4.1. The Board APPROVED the minutes of the previous meeting as an accurate record.

City ICB Page 8

Paper 3.1

4.2. The Board NOTED the minutes of the Hackney ICB meeting on 24 May 2017.

4.3. The Board discussed matters arising and progress on actions recorded at the previous meeting.

Action HICB1705-3: To bring a paper to the City ICB on the possible implications of a retained business rate pilot scheme in London – It was noted that this was not going to happen in the foreseeable future, so it should be removed from the action log.

5. Updated Scheme of Reservation and Delegation

5.1. Matt Hopkinson reported that further to the receipt of legal advice, the ICB scheme of reservation and delegation had been further amended to make specific mention of the fact that the Better Care Fund plan must be approved by the Health & Wellbeing Board, and NHS England.

5.2. The Board NOTED the amendment to the Scheme of Reservation and Delegation.

6. Protocol for Meetings in Public

6.1. Matt Hopkinson presented an updated version of the protocol first presented to the City ICB on 23 May. Additional content had been included to clarify the definitions of confidentiality and to ensure the protocol was in line with the Data Protection Act (1998) and the Freedom of Information Act (2000).

6.2. The ICB APPROVED the Protocol for Meetings in Public.

7. Primary Care Commissioning Operating Model

7.1. Richard Bull presented an update on primary care activity since 1 April 2017, under delegated authority from NHSE for the commissioning of primary care medical services (general practices). The report set out the achievements of work to date, noting that Hackney and the City had the highest GP-to-Patient ratio in London, some of the best clinical outcomes in the country, and good value for money per consultation. The CCG’s ability to manage performance through the GP Confederation was very effective, and lower-performing practices in particular had improved significantly, while a scheme for awarding

City ICB Page 9

Paper 3.1

achievement had provided motivation for higher-performing practices. The CCG was currently establishing its local operating model and priorities for the Primary Care Commissioning Committee and the Primary Care Quality Board (one of the care workstream enabler groups), and this model was presented for endorsement, having been discussed by the Transformation Board on 9 June.

7.2. It was noted that in light of the national shortage of GPs, it would be challenging to maintain workforce performance at its present level. City and Hackney was seen as a good place to work, with a good range of services to refer into, and excellent consultant advice lines at the Homerton Hospital, but the lack of affordable housing was discouraging to potential recruits. Working conditions for partners in GP practices were also discouraging, with very long hours being standard.

ACTION CICB 2806-1: To share information with members about the increased salaried GP capacity at the Neaman Practice. (Richard Bull)

7.3. Prakash Kakoty observed that City and Hackney lost out under the national GP allocation formula, which does not currently make adjustments for deprivation.

7.4. It was noted that practices are no longer required in the core contract to have Patient and Public Groups, and that has affected performance in this area. A new approach would require additional resources.

7.5. The Board NOTED the update on Primary Care Activity; and ENDORSED the draft local operating model and priorities for the Primary Care Commissioning Committee and Primary Care Quality Board.

8. Integrated Commissioning Finance Report

8.1. Amaka Nnadi introduced the integrated finance report for April to May 2017. London Borough of Hackney figures were not available at the time of reporting, and the figures presented only related to the City of London. Performance at month 2 was broadly in line with the plan, and the forecast for year-end was also in line with the annual budget. More data as the year progressed would show trends and enable better forecasting.

8.2. The Board NOTED the report.

City ICB Page 10

Paper 3.1

9. Quality, Improvement, Productivity & Prevention Update

9.1. Sunil Thakker presented the report, which provided a high-level introduction to Quality, Innovation, Productivity and Prevention (QIPP), explaining the context and the challenges. The paper outlined the links with the Capped Expenditure Programme (CEP) and the Sustainability and Transformation Partnership (STP), and detailed the current QIPP savings portfolio in terms of savings already included in the CCG’s 2017/18 operating plan, additional schemes developed, and the pipeline of further opportunities. The report also set out principles and gateway processes for further development of QIPP, and its implementation via the four care workstreams. It was noted that the workstreams would be taking a lead on QIPP, and this would necessarily involve all partners, rather than being driven by the CCG.

9.2. Members sought clarification on whether QIPP schemes could have a disproportionate impact upon City residents and on health inequality in the City, given the very different structure and the relative size of the City of London population. Consideration was also needed on the impact of savings on the apportionment of funding. The paper was not clear how the proposed QIPP savings were being found between City and Hackney, and it was noted that the City Board would need to agree the savings to the City budget and the Hackney Board to the Hackney budget. At the moment the level of savings required by each board could not be judged.

9.3. ACTION CICB 2806-2: To bring a report back to a future meeting of the City ICB on the specific impact of current QIPP programmes on the City of London and its residents (Sunil Thakker / David Maher)

9.4. The Board NOTED the report, ENDORSED the gateway process for developing new QIPP opportunities, and ENDORSED the principles for future system spending.

10. Minutes of the Transformation Board

10.1. The Board NOTED the minutes of the Transformation Board.

11. ICB Forward Plan

City ICB Page 11

Paper 3.1

11.1. The Board NOTED the forward plan.

12. Reflection on the ICB Meeting

12.1. The Board discussed progress made to date.

12.2. ACTION 2806-3: To bring a paper to the ICBs on the process for evaluating the integrated commissioning governance arrangements in September 2017. (Devora Wolfson)

12.3. Honor Rhodes noted that there was currently a disproportionate amount of CCG-related business on the agenda and forward plan. It will be a test of integration going forward to have a stronger focus on local authority work, although it was noted that the local authority contracts did not work on the same timescales as those of the CCG.


13.1. Clare Highton updated the Board on the current position of the development of the Sustainable Transformation Partnership (STP) and the Accountable Care Systems (ACS).

13.2. There was a proposal promoted by NHS England (NHSE) to appoint a single Accountable Officer (AO) for all seven of the North East London CCGs, and this would be formally put to the Governing Bodies in September. It was assumed that the Accountable Officer would also be the STP lead, and it was possible that aa single Chief Finance Officer role could be created . Their rationale for this was that a single AO would increase strategic coherence between the CCGs, and lines of accountability and reporting to NHSE would be simplified. There would also be greater clarity on the financial risk-share arrangements.

13.3. It was noted that under the proposed arrangements City & Hackney would be part of a system with generally poorer levels of performance, which would expose the CCG to additional risk.

13.4. The CCGs Chairs were due to discuss the matter at their meeting later on 28 June, and issues around the potential confusion of working relationships and

City ICB Page 12

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responsibilities, and the status of Integrated Commissioning would be raised there.

ACTION CICB2806-4: To share with ICB members the STP paper discussed by the CCG Chairs on 28 June 2017 (Clare Highton)

13.5. There was a tension between the statutory responsibility of CCGs to spend their resource allocation for the benefit of local service-users, and the national Capped Expenditure Process, which could see City & Hackney CCG finding additional cost-savings in order to balance regional deficits.

13.6. Hackney Scrutiny Committee had raised concerns about the prospect of further cuts to services and about the lack of transparency in the development of the STP. It is vital that there should be no loss of local accountability. It was also noted that it was likely that local authorities would be represented on the recruitment panel for the AO, and consideration should be given to including public representatives also.

13.7. Members noted that the CCG Governing Body would retain all of its statutory authority, which included approval of budgets. It would be up to the Governing Body to determine what powers it would delegate to the Accountable Officer.

13.8. Members noted that from a City point of view, the STP would be difficult, since its voice would necessarily be marginalised. It was noted that the CCG was looking to improve working relationships with University College Hospital (UCH).

13.9. Paul Haigh reported that on 27 June there had been a session on ACS development with Chris Ham, the Chief Executive of the Kings Fund. Whilst nationally, NHSE has launched eight pilot ACSs, little progress has been made, and it is within the gift of partners in City and Hackney to design a system that works locally and to take it forward.

13.10. Discussions at the session had touched on the possibility of enhancing the involvement and the responsibility of service-users within the new system. Members favoured this notion, and noted that user involvement should be representative of the population.

13.11. Paul Haigh reported on the current state of the so-called ‘pause’ to the signing of s75 agreements between the CCG and the local authorities. The outcome

City ICB Page 13

Paper 3.1

of the governance review was still pending, but the CCG Chief Officer and Chair had met with NHS England to discuss the outcomes of the legal review. NHSE are now comfortable with the governance arrangements in place for integrated commissioning (with the exception of some minor adjustments to the s75 agreement), and are increasingly comfortable that City & Hackney will continue in their current direction and identify further areas in which to pool budgets. Discussions are currently taking place with workstreams to identify potential areas of focus. As greater clarity on this is developed, it will be brought to the Transformation Board and the Integrated Commissioning Board for approval before being shared with NHS England.

13.12. ACTION CICB2806-5: To bring a paper to the ICB for decision outlining further proposals for pooled budgets in support of the Integrated Commissioning Programme. (Paul Haigh / Devora Wolfson)

City ICB Page 14

Paper 3.2

Meeting-in-common of the City & Hackney Clinical Commissioning

Group and City of London Corporation

Hackney Integrated Commissioning Board

Meeting of 24 May 217

MEMBERS Cllr Jonathan McShane – Chair, Lead Member for Health, Social Care and Devolution, London Borough of Hackney Cllr Anntoinette Bramble – Lead Member for Children’s Services, London Borough of Hackney Clare Highton –Chair of the City & Hackney CCG Governing Body Paul Haigh – Chief Officer, City & Hackney CCG Honor Rhodes – Governing Body Lay Member, City & Hackney CCG FORMALLY IN ATTENDANCE Haren Patel - Governing Body GP Member, City & Hackney CCG

Anne Canning – Group Director, Children, Adults and Community Health, London Borough of Hackney

Ian Williams – Group Director, Finance , London Borough of Hackney Sunil Thakker – Joint Chief Finance Officer, City & Hackney CCG STANDING INVITEES Penny Bevan – Director of Public Health, London Borough of Hackney Jon Williams – Director, Hackney Healthwatch Jake Ferguson – Chief Executive, Hackney Council for Voluntary Services OFFICERS PRESENT Devora Wolfson – Integrated Commissioning Programme Director Amaka Nnadi – Integrated Commissioning Finance Manager Dr Mark Rickets – Clinical Lead for Primary Care (Item 7) Matt Hopkinson – Integrated Commissioning Governance Manager, City & Hackney

City ICB Page 15

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CCG (Minutes) APOLOGIES Members Cllr Geoffrey Taylor – Lead Member for Finance & Corporate Services, London Borough of Hackney Formally in Attendance Philippa Lowe – Chief Finance Officer, City & Hackney CCG

1. Apologies and Introductions

1.1.1.The Chair welcomed members and attendees to the meeting, and invited Catherine Macadam (attending as a member of the public) to sit at the table and take part in discussions.

2. Declarations of Interest

2.1.1.The Board NOTED the register of members’ interest. Haren Patel and Clare Highton declared an interest in Item 7 – Primary Care Commissioning Model, as they were both GPs. There was no apparent conflict, however, and it was agreed that both should take part in discussions as usual.

3. Questions from the Public

3.1. There were no questions from members of the public.

4. Minutes of the Hackney ICB Meeting, 24 May 2017

4.1. The Board APPROVED the minutes of the previous meeting as an accurate record.

4.2. The Board NOTED the minutes of the City ICB meeting on 23 May 2017.

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4.3. The Board discussed matters arising and progress on actions recorded at the previous meeting.

Action HICB1705-1- To consider whether the Hackney and City ICBs are able to conduct joint meetings as standard practice – Paul Haigh reported that City ICB members had suggested that the two ICBs should continue to be separate, but that Hackney ICB should meet first, with a verbal update to be given at the City ICB, to avoid duplication of discussion. The Board NOTED this arrangement for future meetings, and agreed to close the action.

5. Updated Scheme of Reservation and Delegation

5.1. Amaka Nnadi reported that further to the receipt of legal advice, the ICB scheme of reservation and delegation had been further amended to make specific mention of the fact that the Better Care Fund plan must be approved by the Health & Wellbeing Board, and NHS England.

5.2. The Board NOTED the amendment to the Scheme of Reservation and Delegation.

6. Protocol for Meetings in Public

6.1. Matt Hopkinson presented an updated version of the protocol approved by the Hackney ICB on 24 May. Additional content had been included to clarify the definitions of confidentiality and to ensure the protocol was in line with the Data Protection Act (1998) and the Freedom of Information Act (2000).

6.2. The ICB APPROVED the Protocol for Meetings in Public.

7. Primary Care Commissioning Operating Model

7.1. Mark Rickets presented an update on primary care activity since 1 April 2017, under delegated authority from NHSE for the commissioning of primary care medical services (general practices). The report set out the achievements of work to date, noting that Hackney and the City had the highest GP-to-Patient ratio in London, some of the best clinical outcomes in the country, and good value for money per consultation. The CCG was currently establishing its local

City ICB Page 17

Paper 3.2

operating model and priorities for the Primary Care Commissioning Committee and the Primary Care Quality Board (one of the care workstream enabler groups), and this model was presented for endorsement, having been discussed by the Transformation Board on 9 June 2017.

7.2. Clare Highton noted that this report represented a significant amount of work over a long period of time. The CCG’s ability to manage performance through the GP Confederation was very effective, and lower-performing practices in particular had improved significantly, while a scheme for awarding achievement had provided motivation for higher-performing practices.

7.3. It was noted that in light of the national shortage of GPs, it would be challenging to maintain workforce performance at its present level. Although, City and Hackney was seen as a good place to work, with a wide range of services to refer into, and excellent consultant advice lines at the Homerton Hospital, but the lack of affordable housing was discouraging to potential recruits.

7.4. Jake Ferguson asked whether thought had been given to greater use of the voluntary sector to support primary care. It was noted that it would be useful to develop a more strategic approach to working with the voluntary sector.

7.5. Jon Williams expressed concerns regarding the level of public consultation for the merger of the Tollgate Surgery with Springfield Practice. Mark Rickets responded that both practices operated on the same type of contract and the merger had been driven in part by estates issues. The process had been led by NHS England and it was hoped that in future there would be greater public consultation. It was noted that the GP Confederation had done a lot of work on compliance with the Information Accessibility Standard, but there was more to be done.

7.6. It was noted that practices are no longer required in the core contract to have Patient and Public Groups, and that has affected performance in this area. A new approach would require additional resources.

7.7. The Board NOTED the update on Primary Care Activity; and ENDORSED the draft local operating model and priorities for the Primary Care Commissioning Committee and Primary Care Quality Board.

8. Integrated Commissioning Finance Report

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8.1. Amaka Nnadi introduced the integrated finance report for April to May 2017. London Borough of Hackney figures were not available at the time of reporting, and the figures presented only related to the City of London and the CCG. Nevertheless, performance as at month 2 was broadly in line with the plan, and the forecast for year-end was also in line with the annual budget. More data as the year progressed would show trends and enable better forecasting.

8.2. Members asked for a brief session from Finance leads on how to read finance reports and what to look for.

8.3. ACTION 2806-1: To arrange a short ‘masterclass’ session for ICB members, before an ICB meeting on how to read finance reports. (Ian Williams / Sunil Thakker / Matt Hopkinson)

8.4. The Board NOTED the report.

9. Quality, Improvement, Productivity & Prevention Update

9.1. Sunil Thakker presented the report, which provided a high-level introduction to Quality, Innovation, Productivity and Prevention (QIPP), explaining the context and the challenges. The paper outlined the links with the national Capped Expenditure Programme (CEP) and the Sustainability and Transformation Partnership (STP), and detailed the current QIPP savings portfolio in terms of savings already included in the CCG’s 2017/18 operating plan, additional schemes developed, and the pipeline of further opportunities. The report also set out principles and gateway processes for further development of QIPP, and its implementation via the four care workstreams.

9.2. Members noted the risk of services having to be decommissioned if the STP area is unable to achieve financial balance. Members questioned whether there would be the political will to force such cuts to services in the current national context, but it was noted that Barking, Havering and Redbridge CCG were already consulting on stopping all IVF treatments, as well as rationing hip and knee replacements.

9.3. In order for QIPP schemes to be effective, they need to achieve savings across the wider system, rather than simply shifting cost pressures from one area to another. It was noted that the Transformation Board was due to receive an update in July from Homerton University Hospital Foundation Trust (HUHFT) and

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East London Foundation Trust (ELFT) on their respective financial positions and cost improvement plans.

9.4. Jon Williams noted that it is difficult to persuade the public of the necessity of making savings which are not then reinvested in services, particularly where these savings have a negative impact on health and health inequality.

9.5. It was requested that in future proposals about QIPP initiatives needed to be in more detail to understand the impact of the schemes, although the ICB noted that the Transformation Board had looked at the schemes in detail and were part of workstream plans

9.6. The Board NOTED the report, ENDORSED the gateway process for developing new QIPP opportunities, and ENDORSED the principles for future system spending.

10. Minutes of the Transformation Board

10.1. The Board NOTED the minutes of the Transformation Board.

11. ICB Forward Plan

11.1. The Board NOTED the forward plan.

12. Reflection on the ICB Meeting

12.1. The Board discussed progress made to date.

12.2. ACTION 2806-2: To bring a paper to the ICBs on the process for evaluating the integrated commissioning governance arrangements in September 2017. (Devora Wolfson)


13.1. Clare Highton updated the Board on the current position of the development of the Sustainable Transformation Partnership (STP) and the Accountable Care Systems (ACS).

City ICB Page 20

Paper 3.2

13.2. There was a proposal promoted by NHS England (NHSE) to appoint a single Accountable Officer (AO) for all seven of the North East London CCGs, and this would be formally put to the Governing Bodies in September. It was assumed that the Accountable Officer would also be the STP lead, and it was likely that there might be a move to appoint a single Chief Finance Officer. Their rationale for this was that a single AO would increase strategic coherence between the CCGs, and lines of accountability and reporting to NHSE would be simplified. There would also be greater clarity on the financial risk-share arrangements.

13.3. It was noted that under the proposed arrangements. City & Hackney would be part of a system with generally poorer levels of performance, which would expose the CCG to additional risk.

13.4. The CCGs Chairs were due to discuss the matter at their meeting later on 28 June, and issues around the potential confusion of working relationships and responsibilities, and the status of Integrated Commissioning would be raised there.

13.5. ACTION HICB2806-3: To share with ICB members the STP paper discussed by the CCG Chairs on 28 June 2017 (Clare Highton)

13.6. There was a tension between the statutory responsibility of CCGs to spend their resource allocation for the benefit of local service-users, and the Capped Expenditure Process, which could see City & Hackney CCG finding additional cost-savings in order to balance regional deficits.

13.7. Jon Williams expressed Healthwatch concerns about the prospect of further cuts to services in Hackney and about the lack of transparency in the development of the STP. It is vital that there should be no loss of local accountability. He suggested that there should be public representatives on the recruitment panel for the AO. It was also noted that it was likely that local authorities would be represented on the recruitment panel.

13.8. Members noted that the CCG Governing Body would retain all of its statutory authority, which included approval of budgets. It would be up to the Governing Body to determine what powers it would delegate to the Accountable Officer.

City ICB Page 21

Paper 3.2

13.9. The Board sought assurance that the Integrated Commissioning work being done in Hackney and the City would not be hindered by forthcoming changes to the management of the CCGs.

13.10. Paul Haigh reported that on 27 June there had been a session on ACS development with Chris Ham, the Chief Executive of the Kings Fund. Whilst nationally, NHSE has launched eight pilot ACSs, little progress has been made, and it is within the gift of partners in City and Hackney to design a system that works locally and to take it forward.

13.11. Discussions at the session had touched on the possibility of enhancing the involvement and the responsibility of service-users and residents within the new system. Members of the ICB supported this.

City ICB Page 22

City and Hackney Integrated Commissioning Boards Action Tracker - 2017/18

Ref No Action Assigned to Assigned from Assigned date

Due date Status Update Update provided by

CICB1705-1 To invite the CoLC Social Value Panel to a future meeting of the City ICB to discuss their work, alongside a wider discussion on sustainability.

Matt Hopkinson / Ellie Ward


23/05/2017 20-Sep-17 Open In progress. An item has been provisionally placed on the forward plan for the September meeting and discussions are taking place to confirm.

Ellie Ward

CICB1705-4 To bring a paper on joint commissioning intentions, including the local authority procurement plans, to the Integrated Commissioning Board meetings in September 2017.

Paul Haigh / Anne Canning


23/05/2017 20/09/2017 Open In progress. Item added to Forward Plan for September 2017.

HICB1705-1 To give consideration to how to procure to achieve social value, and to come back to a future ICB meeting with a discussion paper.

Devora Wolfson Hackney Integrated Commissioning Board

24/05/2017 15/11/2017 Open In progress. Item added to the Forward Plan for November 2017.

Devora Wolfson

HICB2806-1 To arrange a short ‘masterclass’ session for ICB members, before an ICB meeting on how to read finance reports.

Ian Williams / Sunil Thakker / Matt Hopkinson

Hackney Integrated Commissioning Board

28/06/2017 15.11/2017 Open In progress.

HICB2806-2 / CICB2806-3

To bring a paper to the ICBs on the process for evaluating the integrated commissioning governance arrangements in August 2017. (Devora Wolfson)

Devora Wolfson Hackney Integrated Commissioning Board

28/06/2017 02/08/2017 Open Complete. Please refer to Joint Session Agenda Item 9.

Devora Wolfson

HICB2806-3 / CICB2806-4

To share with ICB members the STP paper discussed by the CCG Chairs on 28 June 2017 (Clare Highton)

Clare Highton Hackney Integrated Commissioning Board

28/06/2017 02/08/2017 Open

CICB2806-1 To share information with members about the increased salaried GP capacity at the Neaman Practice.

Richard Bull City Integrated Commissioning Board

28/06/2017 02/08/2017 Open

CICB2806-2 To bring a report back to a future meeting of the City ICB on the specific impact of current QIPP programmes on the City of London and its residents

Sunil Thakker / David Maher


28/06/2017 13/10/2017 Open Added to the Forward Plan for October 2017.

CICB2806-5 To bring a paper to the ICB for decision outlining further proposals for pooled budgets in support of the Integrated Commissioning Programme.

Paul Haigh / Adevora Wolfson


28/06/2017 18/10/2017 Open This will be included in Care Workstream Assurance Point 2.

Devora Wolfson

City ICB Page 23

Paper 4

Title: Consolidated Finance (income & expenditure) report as at June 2017 - Month 3

Date: 2 August 2017

Lead Officer: Anne Canning, London Borough of Hackney (LBH) Paul Haigh, City & Hackney Clinical Commissioning Group (CCG) Neal Hounsell, City of London Corporation (CoLC)

Author: Integrated Finance Task & Finish Group CCG: Dilani Russell, Deputy Chief Finance Officer CoLC: Mark Jarvis, Head of Finance, Citizens’ Services LBH: Jackie Moylan, Director – Children’s, Adults’ and Community Health Finance

Committee(s): City Integrated Commissioning Board Hackney Integrated Commissioning Board

Public / Non-public

Public

Executive Summary:

This reports on finance (income & expenditure) performance for the period from April to June 2017 across the CoLC, LBH and CCG Integrated Commissioning Funds. Year to date or cumulative finance performance as at month 3 (June) is reporting a variance of £4.2 m from plan on combined pooled and aligned budgets. The forecast as at month 3 is £3.6m adverse relating to the LBH position (outlined). The risks to the position have been flagged in the risk schedule which will be updated and reported on monthly.

Recommendations: The Integrated Commissioning Board is asked:

To NOTE the report

Links to Key Priorities:

The key aims and objectives of Integrated Commissioning are aligned to the delivery of priorities in the City Joint Health & Wellbeing Strategy and the Hackney Joint Health & Wellbeing Strategy.

Specific implications for City and Hackney

Reported consolidated performance as at June relates to the CCG, LBH and City of London Corporation (Month 2 report did not include LBH which was unavailable at the time)

City ICB Page 24

Paper 4

Patient and Public Involvement and Impact:

N/A

Clinical/practitioner input and engagement:

N/A.

Impact on / Overlap with Existing Services: N/A Supporting Papers and Evidence:

Integrated Finance Report – Month 3

Sign-off:

London Borough of Hackney _____Anne Canning, Group Director of Children’s, Adults and Community Services City of London Corporation _____Neal Hounsell, Assistant Director of Commissioning & Partnerships City & Hackney CCG _____Paul Haigh, Chief Officer

City ICB Page 25

DRAFT FOR DISCUSSION DRAFT FOR DISCUSSION

1

City of London Corporation

London Borough of Hackney

City and Hackney CCG

Integrated Commissioning Fund

Financial Performance Report Month 03 Year to date cumulative position

Paper 4

City ICB Page 26

Table of Contents

1. Consolidated summary of Integrated Commissioning Budgets

2. Integrated Commissioning Budgets – Performance by Workstream

3. YTD Position Summary – City and Hackney CCG

4. YTD Position Summary – City of London Corporation

5. YTD Position Summary – London Borough of Hackney

6. Forecast – Run Rate performance

7. Risks and Mitigations tracker – City and Hackney CCG

8. Risks and Mitigations tracker – City of London Corporation

9. Risks and Mitigations tracker – London Borough of Hackney

10. Savings Performance

Paper 4

City ICB Page 27

Consolidated summary of Integrated Commissioning Budgets

Accruals are included in the CCG YTD and forecast position , however they are only included in the forecast position of LBH and CoLC.

Notes:

Unfavourable variances are shown as negative. They are denoted in brackets & red font

ICF = Integrated Commissioning Fund – comprises of Pooled and Aligned budgets

Summary Position at Month 03

The reported position for theIntegrated CommissioningFund at Month 03 (June) is£4.2m adverse with a forecastvariance of £3.7m adverse atyear end.

Driving the YTD and forecastposition is LBH, which to dateis 16% over spent. Theadverse position owes toLearning Disabilitiescommissioned care packages.The CoL ASC budget is alsoover spent (11%)

The Pooled budgets reflect thepre-existing integrated servicesof the Better Care Fund (BCF)including the IntegratedIndependence Team (IIT) andLearning Disabilities.

At present LBH budgets arenot split between pooled andaligned due to the fact thatpooled funds are contributingto towards the services inaligned funds.

1

Organisation Annual

Budget

£000's

Budget

£000's

Spend

£000's

Variance

£000's

Fcast

Spend

£000's

Fcast

Variance

£000's

City and Hackney CCG 24,947 6,237 6,237 - 24,947 -London Borough of Hackney Council City of London Corporation 462 53 3 49 462 -

25,409 6,289 6,240 49 25,409 -

City and Hackney CCG 366,016 90,431 90,431 (0) 366,016 0London Borough of Hackney Council City of London Corporation 5,778 1,272 1,468 (196) 6,001 (223)

371,794 91,703 91,898 (196) 372,017 (223)

City and Hackney CCG 390,963 96,667 96,667 (0) 390,963 0London Borough of Hackney Council 104,516 26,129 30,195 (4,066) 108,053 (3,537)City of London Corporation 6,240 1,324 1,471 (146) 6,463 (223)

501,719 124,121 128,333 (4,212) 505,479 (3,760)

Organisation Annual

Budget

£000's

Budget

£000's

Spend

£000's

Variance

£000's

Fcast

Spend

£000's

Fcast

Variance

£000's

CCG Primary Care co-commissioning 43,963 10,991 10,991 - 43,963 -43,963 10,991 10,991 - 43,963 -

Total

ICF

Total

In

Col

lab

Total

YTD Performance Forecast

Pool

ed

Budg

ets

Total

Alig

ned

LBH split between pooled and aligned not available.

LBH split between pooled and aligned not available.

Paper 4

City ICB Page 28

Consolidated Integrated Commissioning Budgets – by Workstream

Performance by Workstream.

The report by workstream combines‘Pooled’ and ‘Aligned’ services butexcludes CCG corporate services,CoL IBCF and Non - exercisablesocial care services for LBH (income).

At Month 03, the combinedworkstream performance is anadverse position of £4.1m and aforecast outturn position of £490magainst a budget of £486.5m resultingin a year end forecast variance of£3.7m.


Integrated Commissioning Budgets – Performance by workstream

2

WORKSTREAMAnnual

Budget

£m

Budget

£m

Actual

£m

Variance

£m

Fcast

Spend

£000's

Fcast

Variance

£m

Unplanned Care ICF 120.1 30.0 31.0 (1.0) 120.1 0.0Planned Care ICF 282.0 70.3 71.6 (1.4) 285.5 (3.7)Childrens and Young People ICF 43.9 11.0 11.0 0.0 43.9 (0.0)Prevention ICF 40.6 10.0 11.7 (1.7) 40.6 0.0All workstreams 486.5 121.2 125.3 (4.1) 490.1 (3.7)

Corporate services 20.6 4.3 4.2 0.1 20.7 0.1IBCF - City of London 0.2 0.0 0.0 0.0 0.2 0.0Non - exercisable Local Authority services (income) (5.6) (1.4) (1.1) (0.2) (5.6) (0.1)Not attributed to Workstreams 15.2 2.9 3.1 (0.2) 15.4 0.0

Grand Total 501.7 124.1 128.3 (4.2) 505.4 (3.7)


Paper 4

City ICB Page 29



City and Hackney CCG – Position Summary at Month 3

At Month 03 the CCG is reporting ayear to date break even position .

Pooled budgets reflect the pre-existingintegrated services of the Better CareFund (BCF) including the IntegratedIndependence Team (IIT), LearningDisabilities. Spend here is to plan.

• Aligned budgets: The Planned Careworkstream is reporting an overspendof £70k. This is due to a £48koverspend on London AmbulanceServices, driven by increased activity.Continuing Health Care and FundedNursing Care (FNC) is overspent, as aresult of increases in patient numbers.

• Unplanned Care overspend is driven bycost pressures at Mildmay hospital (HIVCharity) £35k.

• QIPP delivery for Month 3 is reported toplan with a green RAG rating (a smallslippage of £19k or 1.5%).

• At Month 03, the CCG contribution tothe ICF increased by £2.9m due to anadditional allocation from NHSE.Service details for the additionalfunding are being finalised.

3

Primary Care Co-commissioning

Primary Care Co- commissioning services passed on to the CCG on 1 April 2017 with a budgetof £43.9m. At Month 03, the YTD position including all GP Medical Service budgets have beenreported as break even

At Month 03, the budgets are based on 1st April 2017 list sizes. Work is currently underway toestimate the additional costs in property charges (included as a potential financial risk in risk slide). Any variation to plan will be factored into the forecast outturn position once quantified.

ORG WORKSTREAM AnnualBudget

Budget£000's

Spend £000's

Variance£000's

Fcast Spend

Variance£000's

Unplanned Care 18,738 4,684 4,684 0 18,738 0

Planned Care 6,189 1,547 1,547 0 6,189 0

Prevention 20 5 5 0 20 0

Childrens and Young People 0 0 0 0 0 0

24,947 6,237 6,237 0 24,947 0

Unplanned Care 97,084 24,271 24,299 (28) 97,104 20

Planned Care 200,838 50,017 50,087 (70) 200,755 (83)

Prevention 3,548 887 887 (0) 3,548 0

Childrens and Young People 43,910 10,970 10,963 8 43,879 (30)

Corporate and Reserves 20,636 4,286 4,196 90 20,730 94

366,016 90,431 90,431 (0) 366,016 (0)

390,963 96,667 96,667 (0) 390,963 (0)

Primary Care Co-commissioning 43,963 10,991 10,991 0 43,963 0

434,926 107,658 107,658 (0) 434,926 (0)

Forecast

Po

ole

d B

ud

gets

Pooled Budgets Grand total

GRAND TOTAL OF POOLED, ALIGNED & PRIMARY CARE CO-

COMMISSIONING

In Collab

YTD Performance

Alig

ned

Aligned Budgets Grand total

Com

mis

sion

edC

omm

issi

oned

SUBTOTAL OF POOLED AND ALIGNED

Paper 4

City ICB Page 30



City of London Corporation – Position Summary at Month 3

At Month 03 the CoLC reports anoverspend of £146k.

Pooled budgets (pre- existing S75services) are under spent by £49kdue to BCF services - MentalHealth reablement/Floating supportworker, and the Care NavigatorService.

Aligned are over spent by £196k.The Prevention workstream is overspent as a result of pressures onthe adult social care budget(largely driven by the cost of homecare), along with increasedcontract costs for the public healthservice. The public health pressurefollows expanded use of existingservices. A request for additionalfunding to cover the overspend isto be made.

In addition there has been abroadening of the substance misuse and healthy weight / exercise services that are being offered and taken up by City residents. This is impacting the year end forecast variance of £223k adverse.

4

ORGSplit

WORKSTREAM AnnualBudget

Budget£000's

Spend £000's

Variance£000's

Fcast Spend

Variance£000's

Unplanned Care 65 13 3 10 65 -

Planned Care 208 37 - 37 208 -

Prevention 10 3 - 3 10

IBCF funding 179 - - - 179 -

462 53 3 49 462 -

ORGSplit

WORKSTREAM AnnualBudget

Budget£000's

Spend £000's

Variance£000's

Fcast Spend

Variance£000's

Unplanned Care 29 - - - 29 -

Planned Care 3,850 956 988 (32) 3,854 (4)

Prevention 2,170 361 510 (150) 2,305 (135)

Childrens and Young People - - -

Non - exercisable social care services (income) (271) (45) (31) (14) (187) (84)

5,778 1,272 1,468 (196) 6,001 (223)

6,240 1,324 1,471 (146) 6,463 (223)

* DD denotes services which are Directly delivered .

Pooled Budgets Grand total

Aligned Budgets Grand total

Grand total

Com

mis

sion

ed

& *D

DPoo

led

Bud

gets

A

ligne

d B

udge

ts

Com

mis

sion

ed

& *D

D


It should be noted that overspends relating to Public health will be met by the public healthreserve at the end of the financial year, this has been reflected in the forecast.

The adverse forecast position includes a 31% shortfall against the chargeable incomeprojections.

Note: Local Authority YTD position does not include accruals and prepayments. Commentaryis provided on the forecast outturn position (which takes into account any timing differences).

Paper 4

City ICB Page 31


At Month 03 LBH reports a forecastoverspend of £3.5m

The Pooled budgets reflect the pre-existing integrated services of theBetter Care Fund (including theIntegrated Independence Team IIT)and Learning Disabilities.

Learning Disabilities commissionedcare packages within the PlannedCare workstream are the main areaof overspend, with a £4m full yearpressure.

The LD pressure includesundelivered savings from previousyears (£3m) and increases incomplexity of clients resulting inhigher cost packages.

Management actions through theimplementation of initiatives such asthe Care Funding Calculator (CFC)will seek to mitigate some of thispressure .This overspend is partiallyoffset by forecast underspendselsewhere within planned careservices reducing the overalloverspend to £3.5m

London Borough of Hackney – Position Summary at Month 3

5

Public Health, which represents the totality of LBH budgets within the Prevention workstreamis forecasting a breakeven position.

Note: Local Authority YTD position does not include accruals and prepayments so do notprovide a full view of the variances thus, no commentary will be provided on these numbers.Commentary is provided on forecast outturn position which includes prepayments andaccruals.

ORGSplit

WORKSTREAMTotal

AnnualBudget £000's

Pooled AnnualBudget £000's

Aligned AnnualBudget £000's

Budget£000's

Spend £000's

Variance£000's

Fcast Spend £000's

Variance£000's

LBH Capital BCF (Disabled Facilities Grant) 1,299 1,299 - 325 396 (71) 1,299 -

LBH Capital subtotal 1,299 1,299 - 325 396 (71) 1,299 -

Unplanned Care 4,146 1,008 3,138 1,037 2,049 (1,012) 4,144 2

Planned Care 69,568 23,402 46,166 17,392 18,609 (1,217) 73,107 (3,539)

Prevention 34,867 - 34,867 8,717 10,251 (1,535) 34,867 -

Non-excisable* social care services (income) (5,364) - (5,364) (1,341) (1,110) (231) (5,364) -

LBH Revenue subtotal 103,217 24,410 78,807 25,804 29,799 (3,995) 106,754 (3,537)

104,516 25,709 78,807 26,129 30,195 (4,066) 108,053 (3,537)

* DD denotes services which are Directly delivered .

Grand total

YTD Performance

104,516

Forecast

Com

mis

sio

ned

& *D

D

Po

ole

d a

nd

Alig

ned

Bu

dg

ets

Paper 4

City ICB Page 32



Forecast Run Rate at Month 03

6

• At Month 03 the CCG isforecasting a breakeven positionat year end. The CCG contributionto the ICF increased by £2.9m dueto an additional allocation fromNHSE for services.

• At Month 03 LBH is forecasting a£3.5m adverse position at yearend. This is being driven byLearning Disabilitiescommissioned care packages.Mitigating actions are beingundertaken by management toreduce the overspend, which islargely underpinned by unmetsavings targets in previous years.The budgets are reported net ofsavings.

• At Month 03 the CoLC isforecasting an adverse position of£0.2m for year end due to increasing cost of homecare and a31% shortfall against the incometarget.

Month FY Bud£m

FOT£m

FOTVariance

£mM01 432 432 -M02 432 432 -M03 435 435 -

Month FY Bud£m

FOT£m

FOTVariance

£mM01 105 105 -M02 105 105 -M03 105 108 (4)

Month FY Bud£m

FOT£m

FOTVariance

£m

M01 6 6 -M02 6 6 -M03 6 6 (0)

London Borough of Hackney Forecast Summary

City of London Forecast Summary

City and Hackney CCG Forecast Summary

£430£431£432£433£434£435£436

M01 M02 M03

FYBud£m

FOT£m

CCG Forecast Outturn

£102£103£104£105£106£107£108£109

M01 M02 M03

FYBud£m

FOT£m

LBH Forecast Outturn

£6£6£6£6£6£6£6£6£7£7

M01 M02 M03

FYBud£m

FOT£m

CoL Forecast Outturn

Paper 4

City ICB Page 33

Consolidated Integrated Commissioning Budgets – by Workstream Integrated Commissioning Fund – Risks and Mitigations Risks and Mitigations - City and Hackney CCG

7

Ref: Description RiskOpp£

'000

Prob.% Adj.

risk/opp

Recurring

£'000

Adj.

risk/opp

Non

Recurrin

g £'000

1 Risk 1,500 39% 585 02 Risk 2,000 21% 410 0

3 Risk 1,700 0% 0 0

4 Risk 2,100 9% 193 05 Risk 500 0% 0 06 Risk 2,500 24% 600 07 Opp 1,000 3% 30 0

9 Risk 3,600 74% 0 2,664

10 Risk 750 0% 0 011 Risk 250 0% 0 012 Risk 900 0% 0 013 Risk 700 0% 0 0

1 Opp (2,000) 50% (1,000) 0

2 Opp (458) 45% (206) 03 Opp (2,200) 0% 0 04 Opp (500) 22% (112) 05 Opp (1,400) 43% (600) 06 Opp (4,000) 64% 0 (2,564)

7 Opp (500) 0% 0 0

8 Opp (500) 0% 0 0

9 Opp (1,400) 0% 0 0

Net cumulative brought forward

surplus

Headline forecast outturn

cumulative

(30,198)

(30,198)

Narrative

HUH Acute contract Gross position based on historic trend. Net risk based on the trend relating to claims and challenges.Bart's contract performance Gross position reflects over-performance risk and possible NHSE disputed misattribution.Net risk based on the

trend relating to claims and challenges.

Outer sector - Acute contracts Increased NCL provider over-performance risk contained by reserves

Primary Care - Rent Revaluation Consequence of retrospective rent increases in 2017/18Primary Care - Rates

Acute contract Claims and Challenges

Release of reserve to offset activity pressures.Contingency (0.5%) Release of contingency.

NCA Gross position reflects uncertainty of costs, including mental health choice, resulting in a recognised cost pressure.

Based on historic trend.

Acute Reserve

Additional headroom declared to contain non acute pressures and QIPP delivery on a year to go basis

Risk relating to activity increase above plan,high cost patients packages and service provision. Gross risk high given worsening 2016/17 trends and increased FNC tariff pressure.

Prescribing

Continuing Healthcare, LD & EOL

Historic trend indicating possible underspend in 2017/18

Non Acute performance

8 Risk Programme Costs 1,000 0% 0 0Possible in-year non-recurrent costs in support the integrated commisisoning programme and other non-recurrent schemes

Non acute cost pressure across the portfolio.

Consequence of increased rateable value on properties in 2017/18

Expectation is minimum on-plan delivery of £5.0m QIPP declared in the Operating Plan.

Property Costs

QIPP Over Delivery

Property services potential cost pressure

Running Costs

Non Recurrent Investment slippage Reviewed and risk assessed with position contained at month 3.

Non Recurrent Investment Cost Pressure

Prior year Items Opportunities arising from settlement of disputed items, accruals etc. invoices provided for in prior year resulting in an upside available 2016/17

Underwriting NR investment programme, dispute resolution and LAS pressures

Homerton Identification Rule (IR) changes

Potential estimate for impact of Identification Rule changes relating to high cost drugs within the Homerton acute portfolio.

Total Risks 18,500 24% 1,818 2,664

QIPP Under Delivery Potential under-delivery for schemes phased on a year to go basis.

QIPP - new schemes / CEP Programme

QIPP in addition to the £5.0m recognised within the Operating Plan, to be ring-fenced and deployed on a year to go basis as directed by NHSE.

0Net underlying forecast outturn

35% (1,918) (2,564)

Net Risk & Opportunities 5,542 0% (100) 100

Total Opportunities (12,958)

Paper 4

City ICB Page 34



Integrated Commissioning Fund – Risks and Mitigations

Full Risk

Value

Probability of risk

being realised

Potential Risk

ValueProportion of Total

£'000 % £'000

%

TOTAL RISKS 0 0 0 0

Full

Mitigation

Value

Probability of

success of

mitigating action

Expected

Mitigation

Value

Proportion of Total

£'000 % £'000

%

Uncommitted Funds Sub-Total 0 0 0 0

Actions to Implement

Actions to Implement Sub-Total 0 0 0 0

TOTAL MITIGATION 0 0 0 0

Cit

y o

f L

on

do

n C

orp

ora

tio

n

Risks

Mitigations

Risks and Mitigations - City of London Corporation

8

Paper 4

City ICB Page 35



Integrated Commissioning Fund – Savings Dial Risks and Mitigations - London Borough of Hackney

9

Paper 4

City ICB Page 36



Integrated Commissioning Fund – Savings Performance

10

City and Hackney CCG

The recurrent QIPP savings of £5m have been removed fromthe respective budget areas in M3. Therefore the budgetsreported are net of QIPP.

The CCG has identified an additional QIPP of £1.4m which isover and above the £5m target is not reflected in the M3 positionas advised by NHSE.

All identified schemes are reported to deliver on target.

The savings dial represents the QIPP delivery against theprofiled annual plan. At Month 03 the CCG has achieved its yearto date QIPP target of £1.2m.

Delivery of the annual QIPP totalling £5.0m is on plan to be metfor the full year basis.

There is some risk around the achievement of the £5m stretchtarget (see mitigations table).

London Borough of Hackney

• LBH has agreed saving of £3.5m for 2017/18 (this includesdelayed telecare charging implementation from 2016/17 of£0.3m).

• We anticipate that we will deliver £3.2m for 2017/18. This isbeing kept under review.

Total of pre GW3 CRES ideas - valued at 35% which is the % required to be achieved of general CRES schemes

QIPP PERFORMANCE vs PLAN

CCG QIPP Dashboard

Paper 4

City ICB Page 37

Business Items

Item Type (For Info / Monitoring / Decision /

Approval - Pooled Budget / Approval -

Aligned Budget)

Reporting Flow Reporting Lead Business Items

Item Type (For Info / Monitoring / Decision /

Approval - Pooled Budget / Approval -

Aligned Budget)

Reporting Flow Reporting Lead

Transformation Board Update For Information Standing Item Paul Haigh Monthly Finance Report For discussion Standing Item Ian Williams / Philippa Lowe

Monthly Finance Report For discussion Standing Item Ian Williams / Philippa Lowe

Transformation Board Update For information Standing Item Paul Haigh

Commissioning Intentions 2018/19 For endorsement GB 27-10 Commissioning Intentions 2018/19 For endorsement GB 27-10

Right Care - Draft business cases - Circulation & Mental Health

For Approval TB 11/8TB8/9

Anna Garner Right Care - Draft business cases - Circulation & Mental Health


Anna Garner

Joint Commissioning Intentions (including Local Authority Procurement Plans)

For discussion and endorsement

Paul Haigh / Anne Canning / Andrew Carter

Joint Commissioning Intentions (including Local Authority Procurement Plans)

For discussion and endorsement

Paul Haigh / Anne Canning / Andrew Carter

CoLC/CCG Integrated Commissioning BoardLBH/CCG Integrated Commissioning Board

20-Sep20-Sep

City ICB Page 38

Reflection on Progress For discussion Standing Item May to October

CoLC Social Value Panel and Sustainability For discussion Requested by May ICB Natalie Evans, Responsible Procurmenet Manager

Forward Plan For noting Standing Item Reflection on Progress For discussion Standing Item May to October

Right Care - Draft business cases - Circulation & Mental Health


Anna Garner Right Care - Draft business cases - Circulation & Mental Health


Anna Garner

Forward Plan For noting Standing Item Matt Hopkinson Forward Plan For noting Standing Item Matt Hopkinson

Quality & Performance Report 2017/18 Q1 Monitoring GB 27-10 CCG Fwd Plan Quality & Performance Report 2017/18 Q1 Monitoring GB 27-10 CCG Fwd Plan

Integrated Commissioning Risk Register For discussion and agreement

Integrated Commissioning Risk Register For discussion and agreement

Monthly Finance Report For discussion Standing Item Monthly Finance Report Standing Item

18-Oct18-Oct

City ICB Page 39

QIPP Update For discussion Transformation Board 13.10


QIPP Update and Report on Impact of QIPP on City Residents

For discussion Transformaiton Board 13.10


Transformation Board Update For Information Standing Item Transformation Board Update Standing Item

2016/17 Assessment for cancer, dementia and mental health

For discussion Transformation Board 13.10

Siobhan Harper 2016/17 Assessment for cancer, dementia and mental health

For discussion Transformaiton Board 13.10

Siobhan Harper

Children and Young Peoples Workstream Ask For approval TB September 2017 Devora Wolfson Children and Young Peoples Workstream Ask For approval TB September 2017 Devora Wolfson

Integrated Commissioning Governance - 6 Month Review

Evaluation n/a Integrated Commissioning Governance- 6 Month Review

Evaluation n/a

RightCare - Evidence of Quick Wins/High Priority project Implementation

Noting TB 13/10 Anna Garner RightCare - Evidence of Quick Wins/High Priority project Implementation

Noting TB 13/10 Anna Garner

Workstream Assurance Review Point 2 - Assurance of 17/18 workplans, financial plans and capability, manamgement of risk, competence and capacity for delivery

Discussion & Agreement TB 13 October 2017 Devora Wolfson / Workstream SROs

Workstream Assurance Review Point 2 - Assurance of 17/18 workplans, financial plans and capability, manamgement of risk, competence and capacity for delivery

Discussion & Agreement TB 13 October 2017 Devora Wolfson / Workstream SROs

Risk For discussion Standing Item Risk Standing ItemTransformation Board Update For Information n/a Monthly Finance Report Standing Item

Monthly Finance Report For discussion Standing Item Transformation Board Update Standing Item

15-Nov 15-Nov

City ICB Page 40

Workstream Assurance Review Point 3 - 18/19 worksplans, financial plans and capability, manamgement of risk, competence and capacity for delivery

For approval TB 10 November 2017 Devora Wolfson / Workstream SROs

Workstream Assurance Review Point 3 - 18/19 worksplans, financial plans and capability, manamgement of risk, competence and capacity for delivery

For approval TB 10 November 2017 Devora Wolfson / Workstream SROs

Procuring for Social Value For discussion Requested by May ICB Devora Wolfson to coordinate

Procuring for Social Value For discussion Requested by May ICB Devora Wolfson to coordinate

Primary Care Prescription Guidance For discussion TB 10 November 2017 David Maher Primary Care Prescription Guidance For discussion TB 10 November 2017 David Maher

Contract Award for Evaluation of Integrated care

For approval Devora Wolfson Contract Award for Evaluation of Integrated care

For approval Devora Wolfson

Transformation Board Update For Information n/a Monthly Finance Report Standing Item


Quality & Performance Report 2017/18 Q2 Monitoring GB 26-01 CCG Fwd Plan Quality & Performance Report 2017/18 Q2

Transformation Board Update For Information n/a Monthly Finance Report Standing Item


Integrated Commissioning Risk Register For discussion Standing Item Integrated Commissioning Risk Register Standing Item

Transformation Board Update For Information n/a Monthly Finance Report Standing ItemMonthly Finance Report For discussion Standing Item Transformation Board Update Standing Item

31-Jan

28-Feb

13-Dec

31-Jan

28-Feb

Joint Session with CoLC ICB Joint Session with LBH ICB

13-Dec

City ICB Page 41

Assurance Review Point 4 - Assure Transformation Capability & Capacity

For approval Devora Wolfson Assurance Review Point 4 - Assure Transformation Capability & Capacity

Devira Wolfson

Transformation Board Update For Information Standing Item Monthly Finance Report Standing Item


Title Reporting Lead Workstream SourceWinter Planning Tracey Fletcher Unplanned Care PH Email 25/07

Unscheduled Items

Joint Session with LBH ICBJoint Session with CoLC ICB

21-Mar 21-Mar

City ICB Page 42

integrated commissioning board - city and hackney … us...meeting-in-common of the city &...

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