FINANCE PERFORMANCE AND COMMISSIONING COMMITTEE Meeting held on 10 th December 2015, 2.00pm Conference Room A, 1829 Building

Transcription

1 AGENDA ITEM: a PRESENT: FINANCE PERFORMANCE AND COMMISSIONING COMMITTEE Meeting held on 10 th December 2015, 2.00pm Conference Room A, 1829 Building Hannah, Chris (CH) (Chair) Lay Member, NHS West Cheshire Clinical Commissioning Group Dr Charles-Jones, Huw (HCJ) GP Chair, NHS West Cheshire Clinical Commissioning Group Dooley, Clare (CD) Head of Governance, NHS West Cheshire Clinical Commissioning Group Gilburt, David (DG) Lay Member, NHS West Cheshire Clinical Commissioning Group James, Gareth (GJ) Chief Finance Officer, NHS West Cheshire Clinical Commissioning Group Hawksworth, Lee (LH) Director of Operations, NHS West Cheshire Clinical Commissioning Group Dr Jones, Annabel (AJ) City Network Representative, NHS West Cheshire Clinical Commissioning Group Lee, Alison (AL) Chief Executive Officer, NHS West Cheshire Clinical Commissioning Group Marsh, Laura (LM) Director of Commissioning, NHS West Cheshire Clinical Commissioning Group Dr McAlavey, Andy (AMcA) Medical Director, NHS West Cheshire Clinical Commissioning Group Palethorpe, Mark (MP) Strategic Director, Cheshire West and Chester Council Dr Perkins, Jeremy (JP) Ellesmere Port & Neston Network Representative, West Cheshire Clinical Commissioning Group Dr Pomfret, Steve (SP) Rural Network Representative, NHS West Cheshire Clinical Commissioning Group Robinson, Philippa (PR) Turnaround Director, NHS West Cheshire Clinical Commissioning Group In Attendance: Britt, Jim Senior County-wide Commissioner for Paramedic Emergency Services and NHS 111 Moore, Ashley Accounts Manager, NHS England Jones, Clare Governing Body and Committees Co-ordinator Welcome and Apologies The Chair welcomed Lee Hawksworth, Director of Operations, and Ashley Moore, Accounts Manager from NHS England, to the meeting and introductions were made. Apologies were noted on behalf of Glenn Coleman, Head of Primary Care, NHS England (Cheshire and Mersey) Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

2 AGENDA ITEM: a Declarations of Interest David Gilburt declared that he currently holds the position of Interim Chief Finance Officer for South rfolk Clinical Commissioning Group and has accepted a position as n-execute Lay Member at Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust. The GP Chair declared her interest as the Chair of a learning disabilities charity against agenda item All GPs declared an interest in agenda item Any Other Business Multi-Protocol Label Switching (MPLS) for all GP practices and recurring financial commitment, in relation to the Prime Minister s Challenge Fund a. Minutes of the meeting held on 5 th vember 2015 The minutes of the meeting held on 5 th vember were agreed as an accurate record, with the following amendments: Page 1 Declarations of Interest item number to be inserted against JP s declaration Page Finance and Contracting, 3 rd bullet point The paragraph relating to the secondary care budget is to be re-worded to provide greater clarity GJ b. Matters Arising not on Plan There were no matters arising to be discussed. c. Tracker The updated action tracker was agreed as accurate and it was noted that all items are included upon the agenda, have been completed, or are updated as follows: Patient Transport Service Procurement This item is on the agenda, although it was noted that discussion has taken place earlier in the year in relation to the reduction in the number of patient journeys, and to consider other available options. It was agreed that, as the service has now been re-procured from July 2016, this issue will be monitored for value for money b Age-Related Macular Degeneration - A gain share arrangement will be proposed to CoCH, but re-procurement of the service may be required if cost savings are not reviewed. Negotiations are ongoing in relation to risk sharing and this item can now be removed from the action tracker. Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

3 AGENDA ITEM: a c QIPP savings contingency plans are to be developed in case alternative plans are required to achieve financial targets. Further discussions are required in relation to alternative plans for achieving financial targets and a meeting has been arranged between Chief Finance Officer, Turnaround Director, Head of Finance, and Head of Contracting and Performance to discuss financial performance in Month 9. An update will be provided to the informal governing body meeting on the 17 th December 2015, and time for discussion of this issue will be included upon the agenda. GJ b.iii CHC, FNC and Complex Care confirmation to be sought as to whether actions identified at Quality Surveillance Group are being monitored by QIC. It has been confirmed that the Quality Surveillance Group monitoring is being undertaken by the quality improvement committee b Performance i. Formal notes of meeting with NHSE re. Dementia and IAPT to be requested. The formal notes of this meeting are not yet available. ii. MH and LD commissioning manager to be asked to produce MH and LD summary report for December 2015 meeting. Two separate reports have been provided for the December 2015 meeting. However, the Chair reflected that the MH report does not provide the information sought following the last meeting of this committee, and this was discussed. The MH programme update does not identify the specific nature of the discussions between NHS England and the MH and LD commissioning manager, nor does it identify any specific issues of concern, and this issue will be followed up by GJ. It was noted that the volume of work in relation to mental health is significant and recruitment of additional support will be undertaken early in GJ iii. MH and LD issues to be raised at next quality and performance meeting with CWP. SP confirmed that the issues identified were discussed at the quality and performance meeting on 12 th vember It has been identified that data around the IAPT service referrals was inaccurate and this issue has been addressed. It was also noted that Cheshire and Wirral Partnership NHS Foundation Trust are currently recruiting additional staff for the IAPT service b Transformation i. Future dashboards to include a financial tracking element. Tracking at programme level is in place, although this has not currently being achieved across all projects. Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

4 AGENDA ITEM: a ii. Detailed information re. investment, in-year and to be carried forward, to be included in future reports. Work is ongoing to build vanguard costs and efficiencies in to future contracts and this will be reported through the Transformation update Risk Register Work is ongoing in relation to the risk registers and the registers will be discussed further at the February 2016 meeting of this committee. CD It was noted that work is being undertaken with the programme management office to review current work plans, the organisation of dashboards, and the creation of templates to ensure a consistent level of reporting across projects and programmes. The senior management team will discuss the most appropriate way to progress this issue at the senior management team meeting on the 14 th December Finance, Contracting and Performance Report The following points from the report were highlighted: Following review of the financial position at the end of quarter 1 the forecast was revised to a break-even position. The clinical commissioning group is now part of the NHS local turnaround process and a revised financial recovery plan has been submitted to NHS England. However, there remains a significant amount of risk within the reported financial position, with the continuing increase in the cost of secondary care contracts and high cost complex packages of care as particular areas of concern. It was noted that following challenges by NHS England and the committee a detailed financial forecast of anticipated expenditure between month 6 and the end of the year has been provided to identify the trajectory of how the clinical commissioning group will achieve financial balance. It was noted that the trajectory to achieve financial balance is reliant on a number of assumptions: Delivery of approximately 900,000 prescribing QIPP savings The current forecast against secondary care contracts does not deteriorate further Delivery of 917,000 QIPP savings before the end of the financial year Receipt of anticipated quality premium funding Receipt of 1.3 million additional funding in respect of specialised respiratory critical care activity. NHS England has been requested to clarify the issue of critical care activity, although no response has been received to date. Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

5 AGENDA ITEM: a Discussions took place and the following points were noted: Prescribing Concern has been noted in relation to the increasing cost of lower priced drugs, which are also becoming more difficult to obtain, and this has been attributed to the way drugs are negotiated centrally by the NHS. This is a known issue and is discussed at the Prescribing Leads meeting and communications are circulated to GPs, outlining which drugs have rising or falling costs. There remains the need for balance between maintaining quality and reducing the cost of prescribing and more difficult decisions may be required in the future if drug costs continue to increase. This issue will continue to be monitored through the Prescribing Leads meeting and it was agreed that the impact of the increasing cost and difficulty in obtaining low cost drugs will be raised centrally and nationally. Hospital at Home Although the service is being used more effectively, there is a concern that planned savings will not be achieved due to the continuing rise in the number of emergency admissions. Consideration has been given to whether any additional support can be provided to care homes and it was noted that a winter commissioning plan has been agreed and this will be circulated to care homes within the next few days, which may start to mitigate this issue, and details of the commissioning plan were provided. Admissions to Countess of Chester Hospital NHS Foundation Trust from care homes appear to be reducing, although the growth in the cost of unplanned care activity continues to outperform planned mitigations. Details were provided of work that will be undertaken in relation to step-up and step-down services, managing care in the community, and ensuring that the patient length of stay in secondary care is appropriate. It was also noted that, even though there may be a reduction of patient admissions, this may not necessarily equate to a reduction in costs. The anticipated expenditure for Month 8 will take the financial position further from the intended target and further discussions are required to identify possible next steps, should the financial position deteriorate further. Discussions took place and it was noted that the review of services of limited clinical value may depend on the contract arrangements in place and the timescales required to complete an audit of in-year activity. It would also be necessary to consider the impact that this may have on provider partners, as their financial position may deteriorate following this review. It was agreed that indepth financial discussions to identify possible cost savings will take place at the informal governing body meeting scheduled to be held on the 17 th December LH LH PR GJ Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

6 AGENDA ITEM: a Performance against secondary care contracts as a percentage, the overspend in relation to value of the Mental Health and Community Services contract with Cheshire and Wirral Partnership NHS Foundation Trust value is significant. The majority of this contract is on block contract and a breakdown of the block contract costs will be provided within the finance report for the February 2016 meeting. GJ Discussions are ongoing with Countess of Chester Hospital NHS Foundation Trust in relation to the increase of incidents recorded, in an attempt to determine whether there are any additional coding practices and resulting financial values. The significant financial pressure reported in vember 2015 against the Wirral University Teaching Hospital NHS Foundation Trust has subsequently been identified as a result of a change in how the Trust reported anticipated commissioning for quality and innovation scheme income. This is no longer being reported as a financial pressure. Performance The following performance measures breaching target were highlighted and discussed: Accident and Emergency Waiting Times this target was achieved for quarter 2, although performance has deteriorated over recent weeks with 93.8% of patients being seen within 4 hours, breaching the target of 95%. Referral to Treatment 18 weeks due to a change in the way Countess of Chester Hospital NHS Foundation Trust records data, the Trust will not deliver the 18-week target and has also identified a number of patients that will have waited in excess of 52 weeks for their care, and further details were provided. A formal contract query has been issued to the Trust and a meeting was scheduled for the 3 rd December 2015, to agree an action plan to progress the issue, and an update report has subsequently been provided to NHS England. There is a contractual penalty for each patient waiting in excess of 52 weeks for treatment and, therefore, there is a financial risk in relation to the possible increase in activity as the Trust works to treat those patients, which would have an impact on costs. The contractual penalty monies are retained by the Trust and the clinical commissioning group will request that a plan is provided on how those monies will be reinvested. Diagnostic Tests this target has not been achieved, with 97.7% of patients waiting less than 6 weeks for tests against a target of 99%. It has been agreed to issue a contract query in relation to this target. An action plan has been agreed and updates will be provided within future performance reports. Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

7 AGENDA ITEM: a Cancer this issue is mainly due to hospital to hospital patient referrals, and has been discussed in detail with NHS England. This issue has also been raised with the Cancer Network, for progression on behalf of the clinical commissioning group. The finance, performance and commissioning committee noted financial and contracting performance (including QIPP delivery) at the end of October 2015 and performance against agreed performance measures as at September Stabilisation and Transformation Delivery Report Stabilisation PR tabled the stabilisation report, noting that this report is intended to provide a broader base of information rather than simply covering details from previous stabilisation reports and includes details of the operational and functionality work being undertaken by the clinical commissioning group. The following points were highlighted and discussed: A Better Care Fund joint review meeting between involved clinical commissioning groups and Cheshire West and Chester Council has been scheduled for the 23 rd December This meeting will progress the review of the better care fund and future intentions. The clinical commissioning group will also ensure that there is appropriate evaluation and monitoring of the better care fund, as this will provide a clearer assessment of the current position. Cheshire West and Chester Council have requested that the clinical commissioning group completes a template covering a number of areas, and further details were provided. MP noted that concern has been expressed that the national guidance for planning is not scheduled to be issued until week commencing 14 th December 2015, which is expected to confirm the minimum pooling requirements. Going forward, a wider client pool is estimated, particularly in relation to integrated personal commissioning, and there are a number of key requirements that will need to be determined quickly to reflect the change in priorities from 2015/16. A draft NHS 111 Mobilisation Plan for the implementation of the NHS 111 service across West Cheshire was provided. Work is being undertaken with Cheshire and Wirral Partnership NHS Foundation Trust for transfer of the service by April The changes to the service will reduce costs for the clinical commissioning group, although a surcharge will still be applicable. A formal letter to NHS Blackpool Clinical Commissioning group, to outline West Cheshire Clinical Commissioning Group s intensions, will be drafted on behalf of AL. LH/JB Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

8 AGENDA ITEM: a Details were provided of the Alamac daily reporting of metrics from the West Cheshire health economy collected over the last 12 months. The report has now started to deliver accurate monitoring of key performance indicators and work is ongoing to refine the processes. A copy of the information is also provided to NHS England. HCJ noted that, in relation to Partners4Health, the number of patients admitted to the service on weekends is extremely low compared to the rest of the week and queried whether this was due to a lack of referrals from the Out of Hours Service, or whether patients are more likely to simply telephone for an ambulance at the weekend. It was noted that this issue has been highlighted and further investigations are being undertaken to identify where there may be issues to be addressed. The system resilience group is now fully functional in its new format, and there is excellent partnership working within the group. The group meets on a weekly basis to discuss a number of issues, and the current focus is in relation to winter planning and pressures. Emergency Care Intensive Support Team Review (ECIST) details were provided on the progress of the review, which has been combined with the acute Trust s report, and is provided for information. AL noted that, at the Senior Leadership Group meeting on the 9 th December 2015, discussions took place in relation to the whether the discharge to assess model has been fully implemented, as the view from Countess of Chester Hospital NHS Foundation Trust is that this is not the case. PR confirmed that the model was implemented on the 5 th July 2015, and further details were provided. Discussions took place as to the possible reasoning behind the Trust s viewpoint, which may include the issue of the discharge of medically optimised patients not working as effectively as originally intended, or the decision by Sutton Beeches to undertake a voluntary suspension of new patient admissions. MP noted that, although the model has been implemented, an evaluation of the model has not yet been undertaken due to the short period of time it has been running. It was agreed that PR and LH will work with the Trust to audit the service to gain assurance the service is functioning appropriately. As the Trust indicated at the Senior Leadership Group meeting that the service requires significant improvement, AL will write to the Tony Chambers, Chief Executive, requesting dialogue around this issue. PR/LH AL Transformation The following points from the report were highlighted and discussed: Following the receipt of part of the New Care Model funding from NHS England, work has been undertaken with Countess of Chester Hospital NHS Foundation Trust and Cheshire and Wirral Partnership NHS Foundation to agree the process for the transfer and investment of the Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

9 AGENDA ITEM: a funding. It has been proposed that a 'business case justification' is collated for each scheme, which will set out the detail required before funding is transferred. Progress on the evaluation of the West Cheshire Way is continuing with Dr Julia Reynolds, rth West Coast Academic Health Science Network, and Chester University. As there is a West Cheshire focus on self-care, there is an opportunity to develop innovative measures to understand the changes the clinical commissioning group will be making to levels of self-care and empowerment. The West Cheshire Way was launched week commencing 16th vember 2015, which was also national self-care week, and provided the opportunity to talk to the public about the West Cheshire Way. A communication and engagement plan is being created to ensure that the West Cheshire Way message continues to shared and updated. The first formal quarterly review meeting is scheduled with NHS England for the 6 th January 2016, to review current progress on spend against the investment funding and to identify whether there are any additional areas of support required. A refreshed value proposition will be submitted in early January 2016 for 2016/17. It is expected that the clinical commissioning group will be requesting approximately 10million. A Webex is schedule for week commencing 14 th December 2015 with Bain & Co, who is funded by NHS England to provide support with this process, to assess how the clinical commissioning group s value proposition is described from a business viewpoint. The programme highlight reports continue to be reviewed and refined, and it is intended to create a standardised reporting template, utilising an online reporting tool, and which is expected to reduce the number of meetings and s and allow managers to view the most up to date information. The committee noted the updates within the report in terms of progress against the commissioning plan within stabilisation and transformation, and noted the change of direction in aligning stabilisation information to the West Cheshire Way Continuing Health Care, Funded Nursing Care and Complex Care Programme Update The following points from the report were highlighted and discussed: Previously Unassessed Periods of Care the clinical commissioning group remains on trajectory to deliver the expected target. The backlog cases for continuing health care reviews continue to be an area of concern. The NHS Continuing Health Care Commissioning Policy Policy was approved by the vember 2015 governing body meeting and is now in operation for all new cases. Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

10 AGENDA ITEM: a Winter pressures Details were provided on a number of historically fully funded health respite beds for people requiring care related to a physical or mental illness. This issue was discussed and it was agreed that the first recommendation within this paper, for consideration and agreement to be given for medical cover to be provided to utilise the respite beds, will be withdrawn. The committee: a. Acknowledged that the recommendation to consider and agree whether medical cover can be sourced or the beds to be released back for Respite provision has now been withdrawn. b. ted the continued position of the service and the risks associated to any exceptions identified Being Well Programme Update The following points from the report were highlighted and discussed: Identification of Risk to Improve Safety (IRIS) An IRIS advocate educator has now been appointed and will work in partnership with the local clinical lead to provide IRIS training to general practice. Enhanced risk stratification has been developed to assist with the earlier identification of patients that may need proactive support. Work is being progressed through Vanguard to work with an external partner to consider tools used in other countries that may identify more risk than that around admissions, and to develop a more appropriate local risk stratification tool. It was noted that it will be important to ensure that there is appropriate clinical input in to this work, possibly utilising one of the local GP Networks, and LM will progress this once development work commences. The Mediscan Intermediate Eye Health Service triaged 397 patients in October 2015, with 120 patients treated. It is expected that the number of referrals will increase as the service is utilised more fully. A review of the service and its impacts is scheduled for January 2016 and an update will be provided to the February 2015 meeting of this committee. LM The Deep Vein Thrombosis Service has been under review due to a number of operational issues and will be re-launched in January 2016 with revised clarity in the protocols for spoke sites. The December 2015 rolling half day will also be used to remind clinicians of the correct protocols for suspected pulmonary embolism patients. The service currently requires an amount of management input that outweighs the cost efficiencies achieved and future consideration may be required as to the effectiveness of this service. Long Term Conditions dashboard it was noted that there appears to be a discrepancy in the non-elective figures for Countess of Chester Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

11 AGENDA ITEM: a Hospital NHS Foundation Trust and Wirral University Teaching Hospital NHS Foundation Trust and it was agreed that LM will review these figures. The Podiatry redesign has now commenced following the outcomes of the public consultation. The implementation of the new criteria, and the review off the 6,500 patients on the podiatry waiting list, is expected to take 18 months. Current waiting times for routine follow-up patients in some areas remains in excess of 52 weeks and Cheshire and Wirral Partnership NHS Foundation Trust report, by exception, to the scheduled quality and performance meetings. It was agreed that an update on the current position will be requested for the next quality and performance meeting and a further report is also to be requested for six months after that report. The committee: a. Received the programme update b. ted the progress made, and c. Supported the programme s priorities moving forwards LM LM Mental Health Programme Update It was agreed that the mental health programme update will not be discussed at this meeting. It was agreed that an update will be provided to the February 2016 meeting which will outline the current position of the programme, why targets are not being achieved, what work is being undertaken to achieve targets going forward, and a timescale of when targets will be expected to improve. GJ/LM Learning Disabilities: Transforming Care Partnerships The Chair declared her interest as the Chair of a learning disabilities charity against this item. The background to this item was provided and it was noted that NHS England and the clinical commissioning group are required to have a Transforming Care partnership in place by December Details were provided of the scrutiny around this issue and the work being undertaken to ensure that people with a learning disability and/or autism have the right to the same opportunities to live satisfying valued lives and to be treated with dignity and respect. The reduction of hospital beds and hospital admissions is a key target, which will require commissioners to provide alternative care and support to inpatient care, and to improve discharge rates for patients in hospital to ensure that stays are no longer than necessary, and significant work is being undertaken with local partners to achieve these outcomes. AL has agreed to Chair the Transformation Board, and has accepted the role of Senior Responsible Officer for this work. The first board meeting has been scheduled for the end of January Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

12 AGENDA ITEM: a The report was discussed and the following points were noted: Increased media attention around learning disability issues is expected once NHS England publishes its review of the deaths of people with a learning disability or mental health problem at Southern Health NHS Foundation Trust. People living in their own home will be funded through point of care rather than means tested. During the existence of Primary Care Trusts funding was managed jointly with the local authority and this position will be recreated to produce a combined learning disabilities budget. The committee noted the requirement of the clinical commissioning group to form a Hub within the Transforming Care Partnership and the work that is expected to be delivered Patient Transport Service Jim Britt provided details of the current position in relation to the patient transport service and the procurement of a new provider, noting that the current contract for the service has been extended by three months, to the end of June 2016, to ensure that a full scale public sector procurement exercise took place, and the new provider contract will commence 1 st July Contract mobilisation will commence on the 1 st January 2016, and there will be a risk to the clinical commissioning group during the mobilisation period. The following points from the briefing papers were highlighted: The result of the procurement process and the successful bidder will be announced on the 15 th December 2015, although it has been acknowledged that the successful bidder is not rth West Ambulance. A revised service specification has been agreed and costs are based on activity and projected activity. The change in provider will require the TUPE of staff, transfer of vehicles, estates, call centres, etcetera, to the new provider, which will be a significant piece of work. This work will be undertaken as a part of the mobilisation process. The eligibility criteria for the service are managed nationally and there are no immediate plans to alter the criteria. In response to questions raised, the following points were noted: The overall summary of activity is based on projected activity and shows an expected increase to costs of approximately 5,500. Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

13 AGENDA ITEM: a However, as costs are based on activity and expected growth within the service is expected to increase, costs are likely to increase. The blended price within the summary refers to whether a patient can travel unattended or, for example, requires to attendants and a specialist vehicle. Post Meeting te: Typical monthly cost c. 56,000, per year 792,000. Projected marginal increase from July c. 27,000, depending on usage. The current tariff costs, by type of patient transport service journey, are available here. There is no decision to be made by the committee, as the clinical commissioning group has previously agreed to endorse the successful bidder. Cheshire has been identified as an above average user of the service and work will be undertaken with Blackpool Clinical Commissioning Group to consider this issue further. Once more detail is available, and update paper will be provided to this committee. The finance, performance and commissioning committee members noted the contents of the procurement briefing paper and acknowledged and supported West Cheshire Clinical Commissioning Group s endorsement of both the procurement process and the recommended successful bid result. LH/JB Primary Care Strategy This item was deferred to the February 2016 meeting Co-commissioning of Primary Care Business from 1 st January 2016 The clinical commissioning group has submitted the required application documentation, to NHS England Cheshire and Mersey, to undertake the co-commissioning of primary care with NHS England, commencing on the 1 st January The documentation has subsequently been submitted to NHS England rth, and feedback on the submission is currently awaited. The first co-commissioning meeting will take place on the 4 th February 2016, and this and future meetings will be undertaken as a Part 2 agenda to the finance, performance and commissioning committee. It was noted that a meeting will be scheduled as a priority between Clare Dooley, Glenn Coleman and Dr Huw Charles-Jones to agree business for future meetings.. CD Items for reporting to governing body including escalation of risks Finance, Contracting and Performance Transformation / stabilisation Key highlights from programme updates Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

14 AGENDA ITEM: a Any Other Business Multi-Protocol Label Switching (MPLS) All GPs declared an interest in this agenda item. Details were provided on the clinical commissioning group s planned spend for the implementation of MPLS for all GP practices, from the Prime Minister s Challenge Fund and the need to establish arrangements for the funding of recurring costs. It is proposed to split set up costs across two financial years in order to achieve the most appropriate system for mobile working. There will be resultant recurrent costs, due to the nature of the system required, and further details were provided. The mobile working system will generate savings for GPs, although the recurrent costs will create a financial pressure for the clinical commissioning group, as the budget for GP practice IT will be unable to meet this cost. It was noted that services other primary care services, and not just GP practices, will utilise the mobile working system. The non-gp members of committee discussed the recommendations and approved the funding, noting that the recurrent costs are to be funded from the primary care budget. The finance, performance and commissioning committee noted the planned spend for implementation of MPLS across all GP practices and approved funding associated with the recurring financial revenue costs associated with maintaining the BT connection and firewall from within the primary care budget. Date and Time of the next meeting Thursday, 4 th February 2016, Boardroom, Redesmere Building, Countess of Chester Health Park Minutes of Finance Performance and Commissioning Committee 10 th December NHS West Cheshire Clinical Commissioning Group Finance, Performance and Commissioning Committee 4 th February 2015

15 AGENDA ITEM: a FINANCE PERFORMANCE AND COMMISSIONING COMMITTEE Meeting held on 4 th February 2016, 2.00pm Boardroom, Redesmere Cheshire and Wirral Partnership NHS Foundation Trust PRESENT: Hannah, Chris (CH) (Chair) Lay Member, NHS West Cheshire Clinical Commissioning Group Dr Charles-Jones, Huw (HCJ) GP Chair, NHS West Cheshire Clinical Commissioning Group Dooley, Clare (CD) Head of Governance, NHS West Cheshire Clinical Commissioning Group James, Gareth (GJ) Chief Finance Officer, NHS West Cheshire Clinical Commissioning Group Hawksworth, Lee (LH) Director of Operations, NHS West Cheshire Clinical Commissioning Group Dr Jones, Annabel (AJ) City Network Representative, NHS West Cheshire Clinical Commissioning Group Lee, Alison (AL) Chief Executive Officer, NHS West Cheshire Clinical Commissioning Group Marsh, Laura (LM) Director of Commissioning, NHS West Cheshire Clinical Commissioning Group Dr McAlavey, Andy (AMcA) Medical Director, NHS West Cheshire Clinical Commissioning Group Dr Perkins, Jeremy (JP) Ellesmere Port & Neston Network Representative, West Cheshire Clinical Commissioning Group Dr Pomfret, Steve (SP) Rural Network Representative, NHS West Cheshire Clinical Commissioning Group Robinson, Philippa (PR) Turnaround Director, NHS West Cheshire Clinical Commissioning Group In Attendance: For Smith, Sarah (SS) Dementia Lead, Boughton Health Centre Walsh, Cathy (CW) Programme Manager for Mental Health, Learning Disabilities and Dementia Murray, Sarah (SM) Primary Care Programme Manager Ashcroft, Helen (HA) Head of Commissioning Regler, Tina Administrator (minutes) Welcome and Apologies The Chair welcomed everyone to the meeting and noted that apologies have been received on behalf of David Gilburt, Mark Palethorpe, Fiona Reynolds and Councillor Paul Dolan. Discussion took place in relation to the late submission of papers for the committee meeting, i.e. Turnaround, Stabilisation and Transformation and Continuing Healthcare, and concerns were also expressed in relation to the quality and content of a number of papers. Minutes of Finance Performance and Commissioning Committee 4 th February NHS West Cheshire Clinical Commissioning Group 3 rd March 2016

16 AGENDA ITEM: a It was agreed that, as identified at the NHS England Assurance Meeting, there is a need for the clinical commissioning group to undertake a capacity and capability review to clearly identify what actions are required to address these concerns and to ensure that those actions are undertaken. It was noted that the programme management office will be functioning effectively and transformation and stabilisation committee reports will now be fed in to the finance, performance and commissioning committee. It was agreed that a meeting will be arranged between the committee Chair, Director of Operations and Head of Governance to discuss and agree the length, style, quality of papers, action tracker format and frequency of committee meetings for 2016/17 Discussions will include Identifying measures needed to ensure the committee can effectively perform its function of providing assurance to the Governing Body on Finance, Performance and Commissioning, AL/CD CD Declarations of Interest Declarations were noted from GPs present in relation to the matter arising from the meeting on 21 January concerning primary care CQUIN payments a. Minutes of the meeting held on 10 th December 2015 The minutes of the meeting held on 10 th December were agreed as an accurate record, with the following amendments: Page Stabilisation last paragraph wording to be amended to reflect the wording within the letter to Countess of Chester Hospital NHS Foundation Trust. Page Transformation 5 th bullet, 3 rd line, web-ex to be amended to Webex Page Transformation - the last paragraph on the page is to be removed. Page Recommendation a. - considered to be amended to consider b. Minutes of the meeting held on 21 st January 2016 The minutes of the meeting held on the 21 st January 2016 were agreed as an accurate record. c. Matters Arising 10 th December 2015 Page Mediscan Intermediate Eye Health Service An action is to be added to the tracker for a one line update to be provided at the next committee meeting. LM 21 st January 2016 Laura Marsh advised that, as requested at the meeting on 21 st January 2016, a thorough review of the three GP clusters that did not achieve the agreed milestones at the end of quarter 3, as set out in the Minutes of Finance Performance and Commissioning Committee 4 th February NHS West Cheshire Clinical Commissioning Group 3 rd March 2016

17 AGENDA ITEM: a commissioning for quality and innovation scheme, has been undertaken. It is recommended for payment to be made to two of the three clusters, and further details were provided. This decision was ratified by the nonclinical members of the committee. d. Tracker The updated action tracker was agreed as accurate and it was noted that all items are included upon the agenda or within update reports, have been completed, or are updated as follows: Risk Register A risk register position update will be brought to the May 2016 meeting of this committee a. Nursing Homes (step up and step down services) the position in relation to this issue continues to deteriorate and an urgent care recovery week is scheduled to take place, from 8 th 15 th February 2016, to address the pressures being experienced. GP clinical leads have been attending the Countess of Chester Hospital NHS Foundation Trust in recent days to consider their own patients and to facilitate discharge processes with the Trust. The clinical commissioning group Medical Director will request that the GP clinical leads provide a bullet point summary of their experiences to inform how the clinical commissioning group can test/improve the system further. The clinical commissioning group s GP Chair and Chief Executive Officer will provide the Strategic Leadership Group with feedback in relation to interventions identified/provided throughout the urgent care recovery week b. Procedures of limited clinical value the audit/review of services of limited clinical value has been escalated due to information governance issues between the clinical commissioning group and Countess of Chester Hospital NHS Foundation Trust in relation to accessing records for an audit of in-year activity. A response in relation to providing administrative support for redacting records at the Trust has not yet been received from the Trust s Medical Director. It was agreed to progress this issue through a formal letter to the Trust, in-line with current clinical commissioning group policy. CD AMc HCJ /AL GJ Finance, Contracting and Performance Report The following points from the report were highlighted by the Chief Finance Officer: Finance The clinical commissioning has previously reported a risk within the forecast of between 2 million and 3 million, which would need to be mitigated to deliver financial balance as at 31 March The governing body met in December 2015 to discuss options for mitigation and a clear mandate was given to enforce all contractual levers and penalties, where appropriate, and details were provided of the estimated possible financial benefit. Minutes of Finance Performance and Commissioning Committee 4 th February NHS West Cheshire Clinical Commissioning Group 3 rd March 2016

18 AGENDA ITEM: a The clinical commissioning group has been notified that the level of nonrecurrent funding in relation to charging exempt overseas visitors will be approximately 600,000 less than anticipated. This is currently being challenged with NHS England and the impact that this reduction in payment would have on the clinical commissioning group s forecast position has been escalated. The total reported over performance against the Countess of Chester Hospital NHS Foundation Trust contract has risen to million, which is in line with the previously reported trajectory. The main areas of over performance are non-elective payments-by results and critical care activity. Planned care activity is expected to increase in the fourth quarter as the Trust implements the action plan to recover the 18-week referral to treatment and 52-week wait performance targets and this situation will be closely monitored The forecast assumes that specialised critical care activity will be funded in full by NHS England, with full year estimated cost of 1.3 million, and all contracting reserves have been utilised to support the year-end forecast. The forecast also assumes that contractual penalties of 300,000 will be applied and that commissioning for quality and innovation scheme milestones will not be achieved. Both of these issues will be discussed with the Trust to agree a year-end contract settlement in advance of the end of the financial year. Mental health and community services contract budgets are reflecting an overspend of approximately 0.5 million, and this mainly relates to developments that have been agreed over and above the contract with Cheshire and Wirral Partnership NHS Foundation Trust in relation to the acute visiting service and end of life service. Discussion took place by committee members and the following points were noted: During 2014/15 outpatient activity at the Countess of Chester Hospital NHS Foundation Trust grew by 14.5%. This level of activity was consolidated in the 2015/16 finance and activity plan. An additional 7% growth has been provided for in the 2016/17 plan. For 2015/16, it is expected that the clinical commissioning group will achieve its target, although there is expected to be an impact in 2016/17, due to non-recurrent issues, and the turnaround plan will have a significant impact on this issue. Planning guidance states that the clinical commissioning group is required to provide a system wide financial plan by June There are currently two models in development; internal, which affects the clinical commissioning group budgets, and external, which is local health economy wide. The intention is for all involved Directors of Finance to attend a meeting arranged by Countess of Chester Hospital NHS Foundation Trust, to agree the assumptions set out in the local health Minutes of Finance Performance and Commissioning Committee 4 th February NHS West Cheshire Clinical Commissioning Group 3 rd March 2016

19 AGENDA ITEM: a economy model. The Strategic Leaders Group will then be asked to receive and endorse the requirement for this plan. It was noted that the West Cheshire health economy is currently ahead of other health economies in this regard, having a system wide long term financial model. It was noted that the strategic transformation plan will describe our ambitions for the urgent care system and Better Care Fund allocation and performance. The specialised commissioning for acute care funding of 1.3M for 2016/17 will need to be factored into our financial plan as it will not be received from NHS England. Performance to the end of October 2015 The Chief Finance Officer highlighted the following performance issues from the report: There are now 11 performance measures failing to achieve target and are currently rated as red. The deterioration of many of the performance measures can be linked to the significant level of pressure in the urgent care system and the resulting bed occupancy levels within the Countess of Chester Hospital NHS Foundation Trust. Further details were provided and it was noted that these measures will continue to be monitored, with a number of these being monitored via the quality and performance meetings. The failure to achieve the 11 performance measures was discussed in detail at the quality and performance meeting with the Trust and it was accepted that the issues were in-line with the increased activity and delays in discharge of patients. The clinical commissioning group has requested that the Trust provides a recovery plan in relation to the 11 performance measures for the next quality and performance meeting at the end of February The health regulator, Monitor, is also aware of this issue. Discussions have previously taken place at the quality and performance meetings with the Trust in relation to the enforcement of contractual penalties around targets and, therefore, the Trust takes the nonachievement of targets very seriously. It has been noted that a number of annual performance measures will not be achieved due to hospital pressures. In relation to comments and questions, the following points were discussed: The clinical commissioning group would rather not invoke financial penalties and prefer that targets are achieved. The objectives for improvement (targets) are within the remit of clinical commissioning group team managers, by utilising metrics already in place. Minutes of Finance Performance and Commissioning Committee 4 th February NHS West Cheshire Clinical Commissioning Group 3 rd March 2016

20 AGENDA ITEM: a The committee agreed that details of the actions to be taken to improve positions are to be brought to the March 2016 meeting, to enable committee members to be involved in the discussions of ideas for improvement. GJ The finance, performance and commissioning committee noted the financial and contracting performance at the end of December 2015 and performance against agreed performance measures as at October 2015 and the mitigating actions which are in place/planned Stabilisation and Transformation Delivery Report The Director of Operations provided an overview of the stabilisation section of the report as follows: Urgent care The delivery of Emergency Care Intensive Support Team (ECIST) will now be a focus of the system resilience group. Details were provided of the urgent care recovery week initiative being led by the clinical commissioning group, which will give commitment, focus, resources and an on-site presence at the Trust from across all providers and commissioners in West Cheshire. The aim of the initiative is to support the Trust to alleviate current pressures. Once potential financial implications are identified, further discussions will be required in relation to risk sharing by providers and commissioners. The Hospital@Home service specification review is scheduled to take place, and will include contractual negotiations. This is an 18 bed service which provides flexibility across step-up and step-down bed capacity, and is supporting the current high level of acute demand. On a longer term basis, the clinical commissioning group would prefer for all 18 beds to be on a step-up basis, in order to support prevention of unnecessary admissions into hospital, although the current flexibility for step-down capacity is still required. The implementation of NHS 111 across West Cheshire, from 1 st April 2016, has been agreed and confirmed and an agreed draft mobilisation plan has been produced to support the implementation process (which was circulated to committee members with the papers for this committee meeting). The Director of Transformation provided an overview of the transformation section of the report as follows: The Value Proposition for 2016/17 funding will be submitted to NHS England New Models of Care Team on the 8 th February The clinical commissioning group s Chair and executive directors have been involved in this work and have helped to shape the revised document. The document will now need to be shared with primary care and consideration will be given as to how to effectively implement the work outlined. The Value Proposition has also been shared with partners and Minutes of Finance Performance and Commissioning Committee 4 th February NHS West Cheshire Clinical Commissioning Group 3 rd March 2016 LM