Meeting of NHS Bristol CCG Finance, Performance and Planning Committee

Transcription

1 Meeting of NHS Bristol CCG Finance, Performance and Planning Committee Minutes of the meeting held on Tuesday 18 th August in the CCG Conference Room, South Plaza Minutes Present: Martin Jones Chair of Bristol CCG Jill Shepherd Accountable Officer Patsy Hudson Lay member for Governance Nicola Dunn Chief Financial Officer Uli Freudenstein North and West Locality Representative Jon Hayhurst Head of Medicines Management David Moss Contracts Manager Alison Moon Director of Transformation and Quality Justine Rawlings Head of Strategic Planning Louisa Darlison Senior Performance Analyst Emma Gara Head of Performance and Information Imogen Parnham Work Experience Student Lucy Powell Note taker Jane Schofield Informatics Consultant (Item 6) 1 Apologies Apologies were received from Ewan Cameron, Tara Mistry, Sarah Carr and Steve Davies. Imogen Parnham was introduced as a work experience student and was welcomed to the meeting. 2 Declarations of Interest There were no declarations of interest. 3 Minutes of previous meeting, matters arising and action log Action Action Minutes Page 1 of 8

2 Changes were made to the minutes of the June meeting as outlined below: Alison Moon s apologies were added SLAM and SUS were expanded for clarity to Service Level Agreement Monitoring and Secondary Uses Service respectively. There were amendments to the section regarding the patients waiting over 52 weeks on an epilepsy pathway. There was an action around CQUINs which was unrecognised by the committee. This was removed. With these amendments the minutes were agreed as a correct record. The committee reviewed the action log: 27/04 3(2) There was no update on the OCD clinic business case. The business case had not been presented to the Mental Health and Learning Difficulties Steering Group. The action remained open. 21/07 3(1) The information from the task and finish group had been circulated. Emma Gara explained that that if any further impacts were identified; Adwoa Webber has agreed to report to the committee. This action was closed. 21/07 4(1) David Moss noted that a paper outlining the possible approach to be taken has been sighted by the CFOs of the BNSSG CCGs. A letter has been drafted regarding the 62 day cancer referrals but has not yet been sent. The letter implies that action will be taken soon on this matter. It was agreed to keep this action open. 21/07 4(2) The action relating to penalties and CQUIN was not recognised by the committee. This was removed from the minutes and closed on the action log. 21/07 7(1) The slides from the NHS England QIPP event have been shared. This action was closed. 21/07 8(1) GP IT paper to be presented later in the meeting. This item was closed. 4 Integrated Quality, Performance and Finance Report Emma Gara highlighted part 4 of the paper relating to the new CCG Assurance Framework Operating Manual. The new assurance categories were outlined and the new approach to Action Minutes Page 2 of 8

3 assessment is continuing the regular meetings, informal routes and information reports but with some elements being assessed by self-certification by senior CCG staff and signed off by the Audit Committee. The technical guidance for the assurance framework has not been published yet; the committee will be updated once this has occurred. Emma Gara suggested that the CCG undertake a selfassessment against the new assurances for internal assurance. It was agreed that this would be presented at the next committee meeting. NHS England are hosting an event on the 18 th September to demonstrate how the new Assurance Framework will operate in practice. Several members of the CCG will be attending this, and any useful information from this meeting will be circulated to committee members. EG EG Patsy Hudson asked about the role of the Audit Committee within the new assurance framework specifically around the selfcertification element. Emma Gara surmised that this is the type of information that will be relayed at the NHS England event and would be circulated afterwards. Post meeting note: Guidance published and explanatory notes were circulated by Emma Gara on 19 th August. It was noted that the Assurance Framework made mention to independent participants at the Assurance Meetings. The committee discussed this aspect and it was agreed that once this was clarified, the committee would be updated. Emma Gara noted that she would amend the section regarding assurance ratings for the Governing Body meeting as the CCG had recently been assured with support. The committee agreed to remove the key measures at a glance as the graphs did not contain any date or measurement data. The committee agreed that these were a useful diagrammatic tool for showing the ratings against the measures and this approach would be further developed. Following the previous Quality and Governance meeting, the Quality key messages were being updated for the Governing Body meeting. Alison Moon asked about the MRSA performance section and asked that further clarity was provided around the pre-48 hours/pre-24 hours measurements. It was also asked that a recovery date be added to the paper. LD Action Minutes Page 3 of 8

4 Performance David Moss informed the committee that UHB and NBT achieved the 95% standard for June; however Bristol CCG did not achieve its plan of 95.2% for quarter 1 against UHB only. UHB is working towards delivery of 95% for quarter 2 and is working with commissioners to assess the recent increase in attendances at the children s hospital. The mitigations for A&E 4 hour performance were highlighted as part of the exception reporting section. The committee discussed RTT (Referral to Treatment Time) and noted that with the focus on incomplete pathways, Bristol CCG had reported performance in excess of plan as at the end of June. There were pressures reported in increased outpatient referrals and there is currently an ongoing piece of work within the planned care steering group to identify referrals by specialty. This could possibly lead into the referral management centre alleviating some of the demand. The committee discussed the need for the CCG to receive referral information as soon as it is received into the Referral Service team. This would allow the data to be analysed much earlier and trends picked up on quicker. The committee noted that currently activity not referrals information is fed through various groups from the SUS (Secondary Uses Service) and SLAM (Service Level Agreement Monitoring) data. The Referral Service is currently receiving referrals from South Bristol but it is hoped that 80% of the Bristol CCG area GP practices will be serviced by March The committee agreed that this needed to happen much sooner. It was raised that the data received from the referral service could be biased toward certain trusts dependent on which practices were covered. Data from this route would not represent a total provider position, e.g. data from South Gloucestershire practices to assess NBT total referrals. A local contract data flow is received from providers but it is not currently used due to gaps in quality and completeness. The committee understood the need for data validation but agreed that the raw data would provide the CCG time to analyse issues and trends and react to them to possibly prevent future problems. Emma Gara offered to obtain an update on referral data sources and expedite routine referral reporting. The committee agreed that further work needed to take place on the planned care governance structure and it was agreed that there needed to be a review of groups and some intelligence into EG Directors Action Minutes Page 4 of 8

5 how the SRG (System Resilience Group) work feeds into the CCG. The committee asked that further discussion take place at a Directors meeting to review the CCG structure and the function of the CCG Directorates and posts. It was agreed that Nicola Dunn would meet with CSU and CCG finance and information colleagues to discuss the lack of total CCG activity/cost reporting and report back to FPP with the information. It was noted that Leadership Group had discussed the need to understand the activity levels in order to understand the financial position after month end. ND It was noted that in July the new trajectory for RTT had been received from NBT. This forecasts the backlog increasing from 2759 to 3850 patients waiting over 18 weeks at year end. The committee discussed the new Patient Administration System being implemented at NBT. The CCG is concerned that this will impact on reporting and creates a risk around the RTT investment. The Committee noted the need for clarity around this issue and the CSU informed the committee that they will know the planned activity levels for the rest of the year at the end of August for the CCG to compare back against. The Committee noted the need for evidence of the activity being delivered in line with the RTT investment; the expectation is lower numbers of patients waiting and clinical review of each patient waiting over 18 weeks. The Committee agreed that the CCG needed to be aware of the recovery trajectories before the switch to Lorenzo to ensure that commissioned activity delivers the intended performance improvement. It was noted that there would be a reduction in activity during the implementation. The Committee discussed the mitigations for waiting patients. There is a project in place instigated by the planned care steering group to suggest offering patients choice of another provider where predicted waiting times are over 18 weeks. It was asked if the committee could be updated as to which stage this project was at. When this had been enacted in the past, 6% of patients had changed provider. Uli Freudenstein noted that if the patient chose to move, the waiting time clock would restart and that this was a concern. AN It was clarified that the CSU had sent out letters to the Acute Trusts to remind them of the CCG s expectations in line with NHS England guidelines. It was noted that the AWP annex was not included within the papers. It was agreed that once this was received, it would be sent to the Committee members. LP Action Minutes Page 5 of 8

6 Finance Nicola Dunn informed the committee that Bristol CCG is reporting achievement of the 6.8m surplus at the next Governing Body meeting; however there are significant financial challenges facing the CCG. The committee were informed that all reserves had been utilised and all uncommitted funds had been committed. The significant pressures in the Acute Trusts were highlighted including an increase in non-elective activity and an overspend in planned care. It was noted that there were pressures in Mental Health regarding out of area placements, which was an area where there was a high risk of unachievement of QIPP. It was noted that Medicines Management were achieving their QIPP target, however cost pressures such as changes to category M drugs costs are always a likely pressure. Nicola Dunn told the committee that Neil Kemsley, Director of Finance for NHS England, South West had been informed of the financial pressures to achieving the surplus. 5 Corporate Risk Register and Assurance Framework 6 GP IT The committee were asked to note the amendments to the Risk Register. This would be presented at the next Governing Body on the 25 th August. The committee welcomed Jane Schofield to the meeting for this item. It was explained that there were two areas of spend within the IT budget, capital and revenue. For 2015/16, these budgets had to absorb extra costs. The capital budget had been used to pay for the Windows 7 upgrade and the revenue budget included covering the costs of the SMS text message service. It was noted that the capital budget was fully committed and resubmitted for sign off a fortnight ago. Emma Gara explained that to accommodate practice Windows 7 costs NHS England need to source funds to cover the IT costs of practice mergers. Jane Schofield informed the committee that NHS England had a national pot of 1m which could be bid for to fund practice mergers. The committee discussed the SMS text message service. A national contract has been agreed with EE which commences in October. Costs for the last 6 months of the year have been factored into the revenue budget planning based on current usage. Emma Gara noted that by using current usage data there was a risk that usage could increase causing a cost pressure on Action Minutes Page 6 of 8

7 the budget, if the trend to use more electronic communication continues. The group felt this was a low risk. It was noted that some practices have opened negotiations with other providers rather than remain with the national EE contract. The committee identified this as a risk as other providers may offer additional services but for a higher price. The committee discussed the possible solutions to this. It was agreed that the CCG would fund practices who choose the EE contract. It was clarified that practices have the option to choose their own provider but this will not be funded by the CCG. The committee reviewed the budget plan for the GP IT budgets and noted the risks associated with it. Justine Rawlings informed the committee that an IT strategy was being commissioned jointly with North Somerset and South Gloucestershire. At this point, Jane Schofield left the meeting. 7 Unidentified QIPP Justine Rawlings highlighted schemes which were being strengthened for the 16/17 planning round, as well as a list of potential schemes for 2016/17. There are meetings in place between the steering group managers and Justine Rawlings to discuss planning. Nicola Dunn and Justine Rawlings have recently been to Bexley CCG whose QIPP planning was more aligned with contracting. This was highlighted as possibly the approach that Bristol CCG needed to take. 8 Planning update The planning timetable for 2016/17 was tabled and it was noted that the QIPP, planning and contracting timescales were further aligned and this alignment would need to be extended to provider timescales and other key meetings such as Partnership. The timetable, once finalised, will be sent to the committee for comments and feedback. It was noted that the QIPP plans for 2016/17 were being developed now and would roll into the 2016/17 planning process. ALL 9 Strategic Informatics Group minutes The committee received the minutes of the Strategic Informatics Group. Action Minutes Page 7 of 8

8 10 Key messages The assurance framework operating manual has been published which outlines the assurances that NHS England will be measuring the CCG against. There is an event on the 18 th September, which several CCG staff members will be attending, which will further explain the assurance framework. The committee discussed the risk of NBT not utilising the RTT money which has been allocated by the CCG. The CSU have been asked to monitor activity levels before and after the Lorenzo implementation to mitigate the risk. The significant financial pressures were highlighted to the committee which included unidentified QIPP. The committee agreed that the CCG would fund SMS text messaging at GP Practices, if practices use the agreed EE national contract. The planning timetable will be sent to committee members and finalised soon. There will be sessions set up for staff to learn more about the planning timetable and the timescales involved. 11 Any Other Business A paper regarding community equipment will be presented to the committee in the future. Nicola Dunn was asked to give consideration as to how any money generated from Remedial Action Plans would be used. It was asked if clarification could be received whether the use of these monies needed to be published. Post meeting note: Louisa Darlison has received confirmation from NHS England that the use of the money generated from the Remedial Action Plans does not need to be published. 12 Date of Next Meetings Tuesday 22 nd September 12.00pm Tuesday 20 th October 12.00pm Tuesday 18 th November 12.00pm Administrator Lucy Powell: Action Minutes Page 8 of 8