FINAL MINUTES. Commissioning, Finance & Performance Committee. Boardroom, 3rd Floor Dominion House, Woodbridge Road, Guildford, Surrey

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1 FINAL MINUTES Name of meeting Date and time Venue Commissioning, Finance & Performance Committee 16 January 2018, pm Boardroom, 3rd Floor Dominion House, Woodbridge Road, Guildford, Surrey Chairman In Attendance Name Darren Watts (DW) Phelim Brady (PB) Karen McDowell (KMc) Jacqui Burke (JB) Vicky Stobbart (VS) Sian Jones (SJ) Justine Hall (JH) David Eyre-Brook (DEB) Vicki Taylor (VT) (Item 7 only) Jane Chalmers (JC) Annette Keen (AK) (Items 9 & 13 only) Jane Williams (JW) David Howell (DH) (Item 5 only) Adam Binnie (AB) (Item 5 only) Julie George (JG) Katie Thomas (KT) Harriet Keen (HK) (Item 12 only) Kristina Clegg (KC) Title Vice Chair (Clinical/GP Member Lay Member Patient and Public Engagement (Deputy Chair) Chief Finance Officer Surrey Heartlands CCGs Lay Member for Finance, Audit & Corporate Governance Managing Director, G&WCCG GP Member GP Member Chair GWCCG Deputy Chief Finance Officer Interim Deputy Director Clinical Commissioning GWCCG Senior Strategic Transformation & Commissioning Lead Head of Clinical Commissioning Unplanned Care Head of Performance & Information, Senior Quality & Performance Analyst Senior Information Analyst Public Health Consultant, SCC Head of Clinical Commissioning Contracts Manager PA & Note Taker Freedom of Information: Those present at the meeting should be aware that their name will be listed in the agenda and action notes of this meeting which may be released to members of the public on request under Freedom of Information requirements

2 Apologies Members Apologies in Attendance Matthew Tait (MT) Niki Baier (NB) Clare Stone (CS) Sumona Chatterjee (SC) Joint Accountable Officer, Surrey Heartlands CCGs Director of Contracts Executive Director of Quality, Surrey Heartlands CCGs Executive Director of Strategic Commissioning, Surrey Heartlands CCGs 1 Apologies for absence Declaration of Conflicts of Interest 2 Chair asked those present if there were any new declarations none were declared. Chair confirmed that there were no conflicts around any agenda items. Action Log Actions from meeting Action 4 JC noted that next meeting of Surrey Priorities Committee is which both JC and KMc will attend. Work has been undertaken at Heartlands level to evaluate new benchmarking produced by South Central West CSU (SCW CSU) to identify possible opportunities this paper will be presented to Priorities Committee and also shared with East Surrey and Surrey Heath. 3 Committee asked if Botox therapies were being discussed. An issue has been identified that there are many indications for its use, some of which have good guidance supporting and some which do not. DH confirmed that Information Team are carrying out work on Botox data and will imminently share with Medicines Management Leads. This work is being undertaken by and for GWCCG, but also across the Surrey Heartlands CCGs. Action1: JC to circulate paper from SCW CSU, JC to provide update at February meeting & KC to add to February agenda JC/KC Action 6 Escalation has taken place, however agreement has not been reached on the requirement to progress and resolve this issue. 2

3 KMc confirmed that she was meeting with all Finance Directors on and that payment models would be discussed which would include this item. There is a meeting with the national team on (Surrey Heartlands system wide efficiency workshop) which will discuss system working and payment models and DOFs will all be present at that meeting. DEB asked if there could be a bilateral meeting including Accountable Officer, Director of Finance and Chief Executive of RSCH as soon as possible following the meeting. On the basis of the timetable above the CCG would not meet the deadline to agree contracts. There was a discussion as to whether feedback also needed to be provided to Practice Council. Actions from meeting Action 2 DH confirmed that this been reflected in the current Performance Report. Item 3 as neither NB, nor MT were present to provide an update, this action is to be held over to February meeting. Draft Minutes of November 2017 meeting Part I 4 The further reviewed and amended November Minutes were approved. Committee is asked to approve the Minutes Committee approved the Minutes Draft Minutes of December 2017 meeting Parts I 5 The December Minutes were not available for the Committee due to late submissions and these will be taken to the February meeting for approval. Action 2: KC to add December Part I Minutes to the February agenda KC

4 Performance Report M8 MRSA Bacteraemia 6 The CCG now have 6 cases of MRSA year to date. Currently there are 3 cases apportioned to an acute trust and 3 community acquired cases. Following Post Infection Reviews (PIR s) for these cases the CCG has requested that RSCH re-open the July case for this to be apportioned to the trust. The outcome of the PIR process for the November case was attributed to Frimley Park Hospital they have disputed this outcome and commenced the arbitration process. A&E 4 Hour Target RSCH did not achieve the national 4 hour standard in November. With the exception of this month and August 2017 the Trust has consistently achieved the standard in this financial year and is still rated green year to date. Although the Trust delivered a performance of 93.2% they are still in the upper quartile nationally in terms of performance. Diagnostics within 6 weeks In November both the RSCH and the CCG moved back to amber under the constitutional standards. The change in performance is related primarily to an increase in echocardiography breaches at RSCH which has in turn impacted the CCG s performance. Senior Information Analyst has sought assurance from the Interim Head of Performance at RSCH and is awaiting the reasons for the increase breaches. JB noted that ambulance delays are not split out between 30 minute and 60 minute delays in the RSCH report as they are in the CCG report and asked whether the two reports could be conformed. JW noted that the current flu outbreak was impacting on RSCH performance and that this would be considered in the Winter review. At the NHSE Assurance Meeting regarding GP Forward View implementation last week it was noted that GWCCG resillience was a good news story. Flu vaccines and the media campaigns were discussed by the Committee and local availability of stock was raised. Childrens vaccines have a short expiry date and it isvery difficult to obtain additional supplies. 4

5 JG asked for a brief summary of the issues to be provided by the GPs so that feedback can be provided to Helen Atkinson, Director of Adult Social Care and Public Health and Rachel Gill, Public Health Consultant. Action 3: On Page 6 of the report AB to remove wording AD of Contracts under person responsible for delivery AB Committee is asked to note the areas of adverse performance and the actions identified to rectify. Committee noted the areas of adverse performance and the actions identified to rectify. Finance Report M9 including Contract Management Update 7 Month 9 Year to date position is a deficit of 9.1m against the plan of 6.3m resulting in an adverse variance of 2.8m Forecast position is a deficit of 8.4m in line with the plan Level of risk has been maintained in line with NHSE expectations however there continues to be a high level of risk to be managed in order to deliver planned year end position Main driver of over spending is acute over performance and prescribing pressures in relation to No Cheaper Stock Obtainable (NCSO) Risk reserve is in place with main acute provider and benefit fully accounted for in CCG position QIPP delivery is forecast to be 70% for the year delivering 6.0m of the 8.6m plan Negotiations are ongoing with the Trust regarding the financial gap between CCG expenditure and Trust income assumptions. Committee noted the new style report produced to align across the three CCGs. KMc and MT attending regular NHSE review meetings. Committee is asked to review and note the financial position for Month 9 and the assumptions and risks as noted. Committee noted the financial position for Month 9 and the assumptions and risks as noted. 2.20pm Rachel Mackay joined the meeting 5

6 Financial Planning CCG awaiting formal planning guidance expected in January 2018 Financial model refreshed based on Month 8 outturn with a number of significant assumptions made which are subject to change CCG must work to a planned deficit of 1.807m Significant number of unknowns at this stage which require formal guidance and confirmation Regular updates will be brought to CFP over planning period 7 cont Discussions are on-going with regard to the CCG s deficit plan for next year. Committee is asked to review and note the draft financial plan for 2018/19 Month 9 and the assumptions and risks reported Committee reviewed and noted the draft financial plan for 2018/19 Month 9 and the assumptions and risks reported 2.25pm David Howell left the meeting & re-joined at 2.30pm STP Report M9 7 cont STP finance update brought to Committee for information and noting. Paper provides an update on the Month 8 financial position across the STP STP programme costs reported on for 17/18 Update on Transformation funds and approved projects Committee agreed that this was a useful paper and they would like it to continue to come to this meeting on a monthly basis. Mental Health bids are currently showing as paused but in the next report they will move to actual. Committee is asked to note the report Committee noted the report 2.30pm Annette Keen joined the meeting Service Transformation Report M9 & PMO Dashboard 8 JC presented the previously circulated M9 Service Transformation report. Highlights were: improved forecast of 70% achievement of plan and that some schemes i.e. Critical Care Co-ordinator, 6

7 Very High Intensity Users and Advice and Guidance may well perform above plan in Q4; however, there was still uncertainty about the amount of transactional savings which could be achieved; therefore, the achievement of 75% (or better) of savings remains a challenge It was noted that at this point in time there had been no agreement to a block contract for non-elective work. Fewer patients are attending A&E which indicates that conversion rates are the issue and analysis has identified that there is considerable variation across the areas. (1) CFP is asked to note progress to date in the delivery of the QIPP plan (2) CFP is asked to note that the year-end forecast has improved from 5.83M (68%) to 6.02M (70%) (3) CFP is asked to note the top 2 risks to achievement of the QIPP plan Committee noted (1),(2) and (3) as above 2.38 Vicky Stobbart left the meeting & returned at 2.45pm Critical Care co-ordinator 4 month pilot review JW spoke to the previously circulated paper providing an update on the work of the Critical Care Co-ordinator to date. The post holder is now being utilised in new work streams including CHC high cost review, head and neck patients and complex discharges in both acute and community. CFP noted the report and it was agreed that an evaluation of the Return on Investment (ROI) for the post would be presented in to CFP March or April as part of a business case to secure recurring funding for it. A question was asked regarding the reduction of the number of patients going through ITU and whether it was a consequence of the changes to the stroke pathway.confirmation was provided that these changes had had no impact. Action 4: KC to add Critical Care Co-ordinator review to April CFP Agenda KC Update on STP Work Committee agreed this should become a standing agenda item. Action 5: Paper from Transformation Board to be circulated KC

8 2018/19 Operational Planning & QIPP 9 AK clarified the update covered the QIPP plan as per the action from last CFP. This was being developed against the expectation that the target would be circa 5% of the CCGs allocation ( 12.6m). The deputy CFO would provide an updated target as the financial elements for Operational Planning progressed. An additional paper was tabled. This brought together the previously circulated excel based QIPP plan (finance and activity information) with the narrative paper identifying the total opportunity value and then mitigated value. JB enquired about the rationale in using Opportunity and mitigated values. AK reported that mitigation was based on historical indicators of in year delivery values and whether QIPP was transactional or transformational recognising the timelines required for implementation. JG enquired about links to STP Work streams. JC gave a summary of the progress towards identifying STP and collaborative QIPP; STP contributions to system saving / QIPP plans are expected form MSK and CVD; collaborative QIPP priority areas are CHC, POLCE, community equipment and supported decision making; KMc asked about the additional schemes bringing QIPP to 7.4m AK reported these were identified in the spreadsheet as: Medicines Mangement STP Collaborative QIPP PB and JB welcomed the approach taken to clarify areas of focus and opportunities. KMc confirmed she was still expecting to see a breakdown by HRGs and incorporation into the CCGs modelling tool. Action 6: KC to add QIPP Plan Update to be added to February CFP Agenda. KC Committee is asked to review and note: (1) Priorities for collaborative reduction of system costs will be discussed with the Trust within the next week. (2) Work will continue in order to ensure a fully identified QIPP plan. (3) Work steams will follow the internal assurance process (4) The updated QIPP plan will be reviewed by CFP at the next meeting. Committee reviewed and noted (1)-(4) as above 8

9 3.05pm Adam Binnie, David Howell, Vicki Taylor and Annette Keen left the meeting Management/Validation of High Cost Drugs Update 10 The CCG has very clear criteria for funding high cost drugs (HCDs), as agreed at the Prescribing Clinical Network (PCN), and the criteria clearly expressed in the Blueteq forms. There is also a clear process for managing HCDs which the medicines management team is concerned is not being fully followed, which could result in the incorrect payment of high cost drugs. Between M1-M8 2017/18 this was indentified as a possible 209,383. KMc indicated that a number of challenges are not taking place with regard to risk share, but would pick this up with NB to see if included or excluded, there is currently an impact of not challenging on patient safety due to the lack of incentive for RSCH to improve their HCD processes. Committee discussed the possibility of using contingency days for an internal aduit if available. Action 7: KMc to follow up with NB re applying challenges on HCDs attached to individual patients and to consider asking Internal audit to review HCD process KMc Committee is asked to support the adoption of the Process for the validation of Medicines Related SLAM for Guildford and Waverley CCG highlighted in appendix 1 of the briefing. The Committee wishes to ensure appropriate challenges are in place and actioned. 3.15pm Justine Hall left the meeting & returned at 3.18pm 3.20pm Rachel Mackay left the meeting 3.20pm Hariet Keen joined the meeting Macmillan s proposed Primary Care Transformation Programme 11 SJ presented this item to the Committee. The CCG has been approached by Macmillan with a proposal for the CCG to host a two-year funded Primary Care Transformation Programme for Surrey. The main aim of the programme will be to improve the primarysecondary-community care interface for cancer care. This is intended to be a flagship programme, bringing together many initiatives already successful elsewhere, which Macmillan ultimately wish to promote as best practice across the country. Macmillan is proposing to fund the following resources: 9

10 Band 8a Primary Care Transformation Manager Band 7 Primary Care Nurse Facilitator Primary Care Nurse Course Education Events GP Practice Staff Training Band 4 Community Navigators; specifically, for North East Hants & Farnham and Surrey Heath CCGs Macmillan GP community of practice Primary & Community Care community of practice Evaluation Committee asked when a full business case could be expected as Finance sign off would be required. Committee also expressed a concern with regard to any contractual implications associated with the project For assurance purposes, Chair agreed that this item would be further discussed outside of CFP and that a Chairs action could be enacted if necessary. Action 8: SJ, AG, JB and DW to discuss with VT re finance sign off & SJ to check with NB re contractual obligations for staff Committee is asked to note the proposal and agree, in principle, to Guildford & Waverley CCG hosting the programme for Surrey. Committee noted the proposal and agreed, in principle, to Guildford & Waverley CCG hosting the programme for Surrey, subject to the action noted above. Procurement Board SJ SJ Adult Community Contract CFP notified of the commencement of the formal assurance process of the Adult Community Contract. Sub groups have been agreed for internal CCG assurance with designated leads for key areas including Contracts, IG/IT, Medicine Management, Workforce, Communication and Engagement and Governance and Quality. The assurance review includes weekly meetings with RSCH and agreed exit and mobilisation meetings with Virgin Care Services Limited and RSCH. A lead has been agreed internally with some additional external provision. RSCH will formally present to Practice Council with the Federation this week and a weekly update is presented to The Surrey Haertlands Joint Executive. RSCH have requested early mobilisation and we have formally requested a paper to state the rationale for this. 10

11 A paper will be presented to Governing Body in January or March subject to assurance levels, for formal recommendation of signature of contract. Chair asked for a specific report on the ACHS procurement to be brought back to February CFP meeting. Action 9: KC to add ACHS Update to February agenda KC CSU mobilisation complete for corporate IT, small number of issues addressed quickly, lessons learned document to come to next meeting and then close for any further Procurement Board action 111/OOH - final suite of documents going to Part II GB for approval. Procurement on track. Wheelchairs - noted in early stages and currently on track; engagement events being set up. GP Extended Hours paper to Part II Governing Body meeting Procurement Board - Minutes of December 2017 meeting Due to staff absence the Procurement Board Minutes were for December were unavailable for the meeting today. Action 10: NB to circulate the Minutes to CFP members/attendees NB pm Harriet Keen left the meeting 3.50pm Annette Keen re-joined the meeting BCF Update 13 The month 8 finance report reported a 300K FYE under-spend. Under the S75 agreement under-spends can be carried forward or returned to the CCG and LA AS 50:50 split. The agreement requires all schemes to have regular and annual reviews; these should be completed at the January meeting. Q3 BCF metrics not yet available but an assurance return for an NHSE deep dive on DToC performance had been completed with the GWCCG performance recovery plan. The process had highlighted inconsistency in the approach for setting the plan and measuring actual DToC which the BCF metrics group were working to resolve. JG noted differences in methodology between CCGs also existed with some including community DToC in their actuals and others (including GWCCG), not. 11

12 The LJCG had received a verbal update on the progress with the urgent care high-impact changes plan; a written update was due to be received. LJCG is focusing on improving risk logs; all scheme leads in the CCG and LA had been asked to review and then submit any risks. A potential patient risk had been highlighted for a scheme where the contract was due to expire at the end of the financial year. The bid for the enhanced hospice services, previously presented to CFP had been received by the LJCG. The group sought further assurance relating the placement of patients and to understand why any homes where patients would be placed should not be able to access the existing end-of-life contract for support. Resubmission had been advised. Action 11: AK to liaise with Sam Farr re speaking at a PPE meeting re Delayed Transfers of Care (DTOC) AK Committee is asked to note the vernal update provided Committee noted the vernal update provided 4pm Annette Keen left the meeting MOG Minutes December 2017 JB noted an issue regarding Minutes from other Committees coming to this Committee which cannot be easily understood. JB noted that MOG is not included in Committee Effectiveness review and that she would need to review the governance around such issues. Action 12: JB to review governance around Minutes from other committees coming to CFP as noted above Committee is asked to note the Minutes Committee noted the Minutes GPFV Programme Board Draft Minutes December 2017 KMc noted that unconfirmed Minutes should not be brought to this Committee. Action 13: KC to add this item to agenda for February meeting. Committee is asked to note the Minutes Committee were unable to note the Minutes for the reason noted above. JB KC

13 Top 5 Risks Dermatology 2. Finances 3. Adult Community Health Services Procurement Operational Planning 5. Phased Restructure - Committee discussed risk to delivery if staff is distracted mitigation of risk needs to be examined. Action 14: VS to consider whether any additional interim resource would be helpful during the period of the re-structure to help ensure 18/19 planning was taken forward at the right pace. VS AOB 17 The bankruptcy of Carillion was discussed briefly and it was agreed that VS would follow up with Director of Finance at RSCH on any potential impacts for the CCG. Action: VS to follow up with Director of Finance at RSCH VS Signed and agreed by Darren Watts, Chair Minutes agreed for publication by Karen McDowell, Chief Finance Officer Date of next Meeting 20 February 2018, pm *QUORUM AND VOTING Non clinical members may not exceed clinical members when decisions are being taken. A quorum shall comprise of half the membership (5/10), and include the following: Committee Chair (clinical) or Deputy Chair (lay) Lay member (may be covered by Deputy Chair) either the Chief Finance Officer or the Chief Officer (Accountable Officer). Three Clinical Representatives clinical (may include Committee Chair) Non clinical members should not exceed clinical members 1, either as part of the quorum or the wider membership where decisions are being taken. All members, as specified in Section 4 above, have voting rights and any decisions put to a vote at a Committee meeting shall be determined by a majority of the votes of members present assuming quoracy is met. In the case of an equal vote, the Committee Chair shall have a second and casting vote. 1 Clinical membership comprises Medical Director (Commissioning), GP Clinical Representatives and Executive Director, Nursing, Quality and Safeguarding 13