1.1.1 Apologies were received from Dr Dina Dhorajiwala, David Graham, Tony Hoolaghan, and Rachel Lissauer.

Transcription

1 Minutes Meeting of the Haringey Clinical Commissioning Group Finance and Performance Committee 14 December 2017 at 1.00pm Room 7, Level 4, River Park House Present: Dr John Rohan JR GP Governing Body Member, North East Lead and Chair of the Finance and Performance Committee, Haringey CCG Simon Goodwin SG Chief Finance Officer, Barnet, Camden, Enfield, Haringey and Islington CCGs Adam Sharples AS Governing Body Lay Member In attendance: Mark Bridgeford MB Provider Performance and Improvement Manager, NEL CSU Anthony Browne AB Deputy Chief Finance Officer, Haringey and Islington CCGs Ernie Gartrell EG Associate Director of Contracting NEL CSU Clare Henderson CH Director of Commissioning, Haringey and Islington CCGs Seonaid Henderson SH Head of Strategy and Performance, Haringey CCG Alex Smith AS Director of Planning and Performance, Haringey and Islington CCGs Linda Roast LR Minutes 1. INTRODUCTION Action 1.1 Apologies for Absence Apologies were received from Dr Dina Dhorajiwala, David Graham, Tony Hoolaghan, and Rachel Lissauer. 1.2 Declarations of Interest Simon Goodwin noted that he was named in the spreadsheet listing NCL management costs. There were no other declarations of interest. 1.3 Chair s Introduction and Opening Remarks Dr John Rohan welcomed all present. 1.4 Minutes of the Previous Meeting The Committee agreed the minutes of the meeting held on 1 November 2017 as an accurate record. 1.5 Matters Arising and Action Log

2 1.5.1 Action 01/11/17 01 It had been previously discussed that, in addition to financial detail, QIPP reporting should cover impact on patients and that this would be included on a six monthly basis. This was yet to be discussed by Clare Henderson and Adam Sharples and this action point would therefore remain open Action 01/11/17-02 It was noted that NCL STP/PMO expenditure was included on the agenda for today s meeting Action 01/11/17 03 Seonaid Henderson confirmed that the Brent CCG briefing and associated documentation on the new LAS standards had been circulated following the previous meeting. Plans by NMUH to clear elective waits as part of winter resilience were still being finalised and had been delayed due to pressures experience in the current week. Alex Smith advised that pro-active planning was in hand and it had been agreed to pay on plan for elective and outpatients activity. It was however acknowledged that details of confirmed plans were required in order to be clear on impact for each acute Trust and this was being followed up Action 01/11/17 04 It was noted that a report on community services performance was included on the agenda for today s meeting Action 01/11/17 05 It was noted that a report on NCL running costs was included on the agenda for today s meeting. 2. Community Health Services Performance Reporting 2.1 Alex Smith noted long standing concerns regarding the performance of WH community health services and the associated waiting times for these services. A paper outlining the Joint Strategy for Improvement had been presented to the CCG Governing Body in November together with feedback from the problem solving session held between WH and Haringey and Islington CCGs to openly discuss the issues involved. There had been sharing of financial information and views on the challenges faced. The paper now presented provided an update on progress made in relation to the reporting and management of community services. 2.2 Mark Bridgeford explained that service performance against a blanket standard of 95% of patients being seen within six weeks of referral had been part of 2016/2017 contracting arrangements. However, it had been recognised that this did not reflect the complexity of services involved or the clinical priorities of each service. A joint Task and Finish Group had been established to review performance and service specifications and at the same time central reporting requirements had changed, moving away from the six week standard and aimed at greater simplification. To date four service specifications had been reviewed and agreed with revised quality and performance indicators. At the last meeting of the Task and Finish Group it had been agreed to establish a Community Service Improvement Group to direct a programme focussed on the quality and performance of services. The draft Terms of Reference for this group were provided as an appendix to the report presented today and the group would be jointly chaired by Rachel Lissauer, Director of the Haringey and Islington Health and Wellbeing Partnership, and Carol Gillen, Chief Operating Officer WH. A new reporting format was being agreed to incorporate the new national reporting requirements and also service specification measures. In adapting to the new requirements reporting had not been made available in September but Alex Smith had confirmed that this was not acceptable and reporting in the existing format would be reinstated during the interim period. 2

3 2.3 Dr John Rohan noted that there should not be waiting times in excess of six weeks for any of the services concerned. He queried the decision making process for categorising referrrals as routine or urgent, as per the new central reporting requirements. He also highlighted associated issues such as a three months waiting time for incontinence supplies which was clearly unacceptable. Mark Bridgeford gave an example in relation to Bladder and Bowel services where initial intervention might require specialist advice and necessitate longer waiting times. Alex Smith noted that the review of service specifications would reflect appropriate target times. 2.4 Dr John Rohan noted the wider issues of staffing and management that had been previously raised as key to the performance of services. Simon Goodwin observed that staffing issues were probably as similarly experienced elsewhere across London. Dr John Rohan emphasised that this did not address that the CCGs were paying for staffing to deliver services they were not receiving. It had also been discussed that a recruitment freeze in acute services at WH had been mistakenly applied to community services. Anthony Browne reported that he had pursued the issue of a recruitment freeze and had been assured this was not the case. Anthony Browne noted that the Trust favoured a focus on outcomes but outcomes were poor as evidenced by performance monitoring to date. He cautioned that out-of-sector over-performance would be exacerbated if patients opted to go elsewhere due to issues such as waiting times and the Trust would not want to see income diverted. Clare Henderson provided assurance that all factors such as funding and workforce would be reviewed as part of the improvement work. Alex Smith advised that the issue of outcomes not being proportionate to investment had been raised with Siobhan Harrington and Carol Gillen. Whilst the improvement work would include a wider, transformational focus the CCGs, as commissioners, would continue to hold WH to account for performance and the increased sharing of financial information was helpful. Siobhan Harrington had offered to attend a session with the Governing Body in January and Clare Henderson advised that she was due to meet with her in preparation for this. It was agreed details would also need to be discussed with Tony Hoolaghan. Mark Bridgeford confirmed that the Committee would receive the workplan of the Community Services Improvement Group and he noted that the Group planned to undertake benchmarking against other community providers 2.5 Adam Sharples welcomed the focus on service improvement and noted that he would be willing to help with preparation for the Governing Body session. However, he expressed concern if new reporting potentially relaxed the standards applied and also that there could need to be care in revising service specifications that might not have originally been fit for purpose. He recommended that the Committee receive details of the new specifications and that changes should be made clear in reporting to the Governing Body. Clare Henderson advised that Rachel Lissauer had asked for a Governing Body member to join the Improvement Group which it was agreed would be helpful. Mark Bridgeford gave assurance that new specifications would be more robust in relation to standards, would be subject to rigorous review and with quality indicators discussed with commissioning leads. Changes to services would be in accordance with current requirements such as NICE guidance and Clare Henderson emphasised that new specifications would also be about working differently, not just reducing waiting times. 3

4 2.6 In noting that WH was the provider of community services to both Haringey and Islington, and that commissioners were working jointly on the Community Service Improvement Group, Adam Sharples suggested that it would be helpful for the Committee to have sight of the equivalent performance dashboard for Islington. Clare Henderson agreed that this would be provided and the Committee requested a further progress report on community services improvement at the next meeting. 2.7 ACTION 14/12/17 01 To receive a further progress report on community services improvement at the Committee s next meeting in February together with the Community Improvement Group workplan and details of the performance dashboard for Islington. MB/ CH 2.8 The Committee NOTED the update on progress regarding the reporting and management of community services. The Committee AGREED to receive a further report at the Committee s next meeting in February together with the Community Improvement Group workplan and details of the performance dashboard for Islington. 3. Financial Report Month Anthony Browne presented a report on the CCG s financial position as at the end of November 2017 (month 8) and apologised for late circulation of details. He noted the efforts of finance colleagues in providing the report two weeks in advance of the usual deadline, due to earlier scheduling of the Committee s meeting. As at month 8 the CCG was reporting an in-year deficit of 0.8m against the target of 0.1m surplus but remained on target to deliver the cumulative planned surplus of 3.6m, subject to delivery of the recovery plan of 8.8m. The table provided in the covering summary demonstrated the position in relation to acute providers as adjusted for challenges, seasonality, STP/QIPP and marginal rates. Section 2 of the report included a table of overall financial performance. 3.2 Anthony Browne highlighted that over performance at UCLH ( 1.0m) and RFL ( 0.5m) was partially offset by underperformance at NMUH ( 0.3m), Moorfields ( 0.2m) and RNOH ( 0.2m). There were further material variances outside of the CCG s main acute providers showing a pressure of 1.8m and it was highlighted that marginal rates did not apply to contracts with out-of-area providers. Month 8 reporting had seen an overall adverse swing of 0.5m in acute services from the previous month. Section 3 of the report included a PoD variance analysis with main areas of cost pressure shown to be within A&E, Outpatients and Drugs and Devices. An underspend on Critical Care at WH was offset by over performance elsewhere. 3.3 Non-acute services were forecasting a 3.7m overspend at year end. The key areas of pressure related to Continuing Healthcare ( 3.2m) and Prescribing ( 0.6m). Recovery actions in relation to Continuing Healthcare were detailed in a separate report included for today s meeting. Anthony Browne advised that pressures on prescribing could increase due to the potential loss of price concessions on further drugs. This was a national issue and 0.5m of further risk was reported in the event that these problems were not resolved in year. 4

5 3.4 At month 8 the CCG was reporting on plan to deliver the cumulative surplus target of 3.7m and the in-year target of 0.2m surplus. This was subject to the delivery of a recovery plan of approximately 8.8m and section 6 of the report set out details of 4.3m identified to date. This included some reliance on Islington CCG Risk Share ( 1.0m); QIPP stretch and elements of the Primary Care Investment Slippage, Primary Care Headroom and Primary Care Contingency as part of Primary Care risk arrangements. Other areas included review of investments, the CHC recovery actions and activity challenges. There would be further work in relation to the remaining 4.5m yet to be identified. Plans included the assumption of risk share arrangements between Haringey and Islington being used to balance the CCG position but it was acknowledged that negotiation could be challenging. There were also further risks to delivery of the control total as set out in the report. These related to further over performance by acute providers during the latter part of the year, under delivery of STP interventions, increased non-acute activity and expenditure and the inability to identify further recovery plans. As previously discussed by the Committee, should these risks materialise the CCG had no significant mitigations and recovery actions would need to be further stretched. The focus was now on further financial recovery planning. The financial position was challenging and review at month 9 would include a deep dive on STP and QIPP areas. 3.5 Simon Goodwin noted the wider context across NCL with Islington reporting on plan to achieve breakeven and with potential reserves in the region of 4m- 6m. Enfield and Camden were both forecasting to achieve breakeven but there were significant risks associated to Enfield s position and Camden would face greater challenges in the forthcoming financial year. Barnet was reporting a deficit of 4.6m. He confirmed that the NCL approach would be for the Islington underspend to balance overspends elsewhere and NHSE acknowledged that the joint management of Haringey and Islington would be reflected in a risk share to balance the position across the two CCGs. However, this had not yet been agreed and would be discussed with Islington following the Christmas period. Anthony Browne explained the reasons for the position in Islington which included some surplus contingency/reserves, an over allocation for overseas visitors associated to C&I MHT plus an element of freeze applied regarding primary care allocations. Some of this surplus had been used for local pressures in areas such as Continuing Healthcare, out-of-sector overspend and QIPP slippage. He noted that Islington had already contributed to NCL funding. At Governing Body level the wider NCL view could be less acceptable and further commitment to Haringey would require careful handling. Dr John Rohan noted the issue of weighted capitation and that there appeared to have historically been significant differences between CCGs in this respect. 3.6 Adam Sharples noted that the support of Islington would be very helpful but this was presumably a short term solution and would not address the problems to be faced in the forthcoming financial year. Simon Goodwin agreed that the factors for Islington s surplus would not apply next year and Adam Sharples therefore emphasised the need to plan for 2018/2019. Anthony Browne noted that there had also been previous discussion that the target for QIPP in 2018/2019 could be as high as 15m. 5

6 3.7 Adam Sharples queried the area categorised as other in the Acute PoD variance analysis. Ernie Gartrell explained that this mainly related to claims, adjustments and various technical issues. Adam Sharples noted that for WH this totalled over 2m. Simon Goodwin agreed that this appeared a very considerable sum and questioned whether this could include activity that should appear elsewhere. Ernie Gartrell advised that claims were allocated to PoD lines where possible but cited the example of ambulatory care being a significant factor for Haringey but with no PoD line to specifically reflect this. The data involved was quite complex and Trusts used different formulas for what was included. Anthony Browne suggested that the presentation of this information could be improved and Ernie Gartrell offered to provide a breakdown together with explanatory narrative outside of the meeting. 3.8 ACTION 14/12/17 02 To provide a breakdown and accompanying narrative to explain the figures categorised as other in the Acute PoD variance analysis. EG/ AB 3.9 In response to Adam Sharples Anthony Browne and Simon Goodwin explained that the overseas visitors issue in Islington related to funding from the DoH that was held by Islington. This partly related to mental health where there had been capacity issues and an additional ward had been funded and there was also a high percentage of overseas visitors in relation to Moorfields. The agreement of a cap on the allocation meant that Islington had benefitted from a surplus and it was noted that overseas visitors were much less of a factor for Haringey Dr John Rohan highlighted the need to apprise the Governing Body of the seriousness of the underlying issues in relation to the financial position. Anthony Browne noted that assumptions had not changed but acknowledged that there was a lot of work to be done in ensuring a focus on options for recovery. He agreed that an update for the next Governing Body meeting in January should include a wider focus than QIPP. Simon Goodwin noted that the financial gap for 2018/2019 was the most important factor and Clare Henderson agreed that there needed to be more work in relation to the longer term strategy and STP achievability The Committee NOTED the financial position as at month / Acute Contract Update 4.1 Ernie Gartrelll advised that today s update would be a brief verbal report but accompanying papers would be provided for the next meeting. Work on reconciliations for quarter 1 was progressing well locally with most now agreed but there were some delays in relation to out-of-sector providers. Work on quarter two reconciliations would commence next week and the position would be reported to the Committee in February. Contract variations for 2018/2019 (on the two year contracts in place) would need to be agreed for signature by 31 March but few such variations were envisaged. 5. Performance and Quality Summary Report 6

7 5.1 Seonaid Henderson presented a summary report providing an overview of the performance of the CCG and its main providers in relation to key performance and quality indicators. Key points to highlight included that the 18 week RTT standard had not been achieved CCG-wide in September and this was in common with Camden and Barnet. NCL commissioners were working on improvement plans with providers including RFL and UCLH. In September the CCG had had two patients treated who had exceeded 52 week waits. The CCG reviewed information on all patients waiting in excess of 38 weeks and liaised directly with the Trusts concerned to confirm treatment plans and to seek assurance that such patients were given options for treatment elsewhere. The CCG-wide diagnostic wait standard had been achieved in September with performance improved from the previous month. October data demonstrated encouraging improvement with NMUH meeting all cancer standards and achievement of all standards CCG wide. Plans were underway to mitigate for any possible delays during the forthcoming holiday period. A&E performance at NMUH had deteriorated. NHSE and the CCG were focussing additional work on improving DToC rates and publicity to encourage the direction of patients via primary care hubs. There was sector wide work aimed at reducing delays with ambulance handovers. Haringey and Enfield CCGs and system partners were working closely with the A&E Delivery Board on improvement plans and contingency measures to meet any increase in winter pressures. Regular briefing calls were in place with NHSE. The LAS Red 1 standard had been achieved in October but not the Red 2 standard. NHSE and DoH were focussed on the improvements required. As of November LAS performance would be measured against the new Ambulance Response Performance (ARP) prioritisation system, replacing the former Red 1 and 2 standards. Questions and comments were invited. 5.2 Anthony Browne queried whether handover delays were related to any specific patient group. Seonaid Henderson advised that there had been some previously successful work regarding attendances of patients with mental health problems. Work on Discharge to Assess was discussed and Seonaid Henderson suggested that reductions in social care were a possible factor for delays and Marco Inzani would be able to provide further information. LB Haringey had undertaken significant work in this respect and Alex Smith confirmed that DToC figures for NMUH demonstrated that partnership work had been very successful. However, most Haringey delays did relate to waits for residential beds. Maintaining a focus on earlier and more pro-active discharge processes by the Trust was essential and the CCG was providing additional support, particularly given the approaching holiday period. 7

8 5.3 Adam Sharples noted that, despite what had seemed at the time an encouraging presentation to the Governing Body by LAS, there continued to be a lack of service improvement and again Haringey appeared to receive the lowest standard of performance. He noted that performance reporting to the LAS Board did not include a breakdown by borough. Alex Smith advised that this could be raised by the NCL lead who attended the Board, together with discussion of the specific performance issues experienced by Haringey and also Enfield. He also noted that Tony Hoolaghan was inviting Peter Rhodes, LAS Assistant Director of Operations, to attend Haringey s Governing Body seminar in February to provide an update. As previously discussed the pilot tethering of ambulances across NCL had been halted in early autumn due to significant delays in handover times resulting in capacity challenges. NHSE and NHSI had written to each A&E Care Delivery Board in November to reinforce that ambulance handover improvement plans were system priorities. A strengthened plan for Haringey and Enfield was due to be submitted to regulators in mid December. 5.4 Adam Sharples observed that data in the performance and quality report demonstrated many red rated areas for mental health and he cited the example of the psychiatric liaison dashboard. It was agreed that Clare Henderson and Seonaid Henderson would liaise with Tim Miller, Lead Commissioner for Mental Health, and report back to the Committee in February. 5.5 ACTION 14/12/17 03 To liaise with Tim Miller, Lead Commissioner for Mental Health, for further information of red rated areas of mental health performance and to report back to the Committee in February. CH/ SH/ TM 5.6 The Committee NOTED the Performance and Quality Summary Report /2018 QIPP Plan Update Month Alex Smith outlined the current position in relation to QIPP plans for the financial year 2017/2018. The gross QIPP value for the year was 9.6m. As previously discussed, 6.6m related to STP acute QIPP schemes agreed in contracts for 2017/2018 with the CCG s main providers, plus a further 3m of non-acute QIPP and 2m set aside as investment in order to deliver the plans. The position at month 8 was virtually unchanged from month 7, with slippage of just over 1m in the Haringey STP/QIPP schemes and it was forecast that this would translate into a year-end under achievement of just below 1m against plan. Alex Smith noted that in approaching the last three months of the year there was a risk related to back-ended schemes now due to start in full. Although mitigated by marginal rate arrangements, this remained a critical period for the achievement of QIPP. The ers/can project in relation to e-referrals, clinical advice and navigation would be a key development. Haringey and Islington were implementing the new scheme ahead of the workstream as part of the fastest first approach and NMUH had been a pioneer. There were associated QIPP savings and the date to go live was 1 January. Communication with Practices was currently underway. Alex Smith advised that close scrutiny of schemes was being maintained. Over the last two months the frequency of QIPP business meetings had been increased to a fortnightly basis. This had been successful in promptly identifying any problems in delivery. Alex Smith cited the example of T-Quest not being implemented at NMUH due to IT issues which had now been addressed. 6.2 The Committee NOTED the QIPP position as at month /

9 /2019 QIPP Planning 7.1 Alex Smith reported that a process was fully in place for the development and finalisation of QIPP plans for 2018/2019 across NCL. A table of schemes was provided for the Committee detailing values, the stage of development and start dates. The plans were a combination of new schemes plus a large number of schemes rolled over. Alex Smith emphasised that, as previously discussed, the QIPP target for 2018/2019 would be challenging and the timescales associated to achievement of transformational change presented risks. Ideas of additional schemes for development were encouraged. 7.2 Simon Goodwin noted that the table of schemes provided required a covering report to include the target and the current position against target. 8. Continuing Healthcare (CHC) update 8.1 Clare Henderson noted that the Committee had previously received a report from Shelley Shenker to explain the month 7 forecast of an overspend of 3.8m for Continuing Healthcare in 2017/2018. At month 8 the forecast overspend was 3.6m and the paper now presented provided an update and summarised the action plan in place to address the overspend both for the current year and in the longer term. Mitigating action had been taken to address in year pressures and once existing and planned mitigations for 2017/2018 were applied to the unmitigated forecast the final outturn to be reported for month 8 would be an overspend of 3.2m. This excluded potential impact in relation to the Edward s Drive respite facility and of clinical reviews. The mitigations only partially addressed the overspend and the Committee was asked to note the current financial risks and worsening risk should the 493k of mitigations not be achieved. 8.2 Clare Henderson noted that, given the challenges of increasing pressure and associated costs, there was a need to consider future commissioning and that resources needed to follow patients and be redirected from acute funding. Section 4 of the report set out details of the pressures experienced in 2017/2018 and these included increased complexity of cases and also that the focus on Discharge to Assess and on reducing DTOCs had a knock-on effect with nursing home beds or home care packages required within short timescales. Limited availability of beds led to more expensive specialist/out of borough placements or large domiciliary packages of care. There had been an increase in demand for LD beds plus less than anticipated/planned discharges. There had been a number of large packages of care deemed as eligible for CHC inherited by the CCG from the Council. To date four people with LD had been accepted as eligible adding a total of 306k to the budget commitment in 2017/2018. There had been pressure on the review of packages of care due to a shortage of CHC Nurse Assessors. Increased activity in mental health acute beds had resulted in more requests for female PICU placements. An additional issue was that savings of 1.0m had been applied to the 2017/2018 CHC budget with no associated plan at the point of budget setting. 9

10 8.3 Clare Henderson explained that mitigations included the Joint Savings Plan with the Council and savings planned from reviews of jointly funded packages. Establishing parity of provider rates was essential and joint working would be key. The Local Authority s expertise and experience in brokerage would be maximised alongside NCLwide work on market management. There would be savings from the temporary closure of the Edward s Drive unit but a longer term plan was needed for re-provision and similarly in relation to OGNH. The CHC clinical team had experienced staff shortages but was now fully staffed. This would enable the backlog of reviews to be addressed but it was acknowledged that it could be very difficult to withdraw services due to changed needs. A new provider to support people with direct payments would enable better management of invoicing and the management of direct payment expenditure via Personal Health Budgets. A great deal of work was underway but Clare Henderson noted that, in common with most services, there were further risks associated to demographics and the increased number of patients living longer with complex health needs. The CCG was behind others in NCL as regards transforming care targets and specialist support was to be provided in the New Year. Interviews had been held for a lead commissioner for LD but the outcome was yet to be confirmed. There had been recruitment to a continuing care commissioner who as part of their role would focus on an improved response to children with complex needs and their families. Clare Henderson advised that a further update, including future management proposals, would be provided at the Committee s next meeting in February. Questions and comments were invited. 8.4 Dr John Rohan questioned whether there was a requirement for more residential beds. Clare Henderson responded that local work on DToC was ahead of many other areas. With availability limited, increased demand for CHC funded nursing beds led to providers increasing prices and this underlined the need for better brokerage. Seonaid Henderson observed that there was little incentive for private providers to discharge patients. Clare Henderson noted that the private market was very stretched but the work underway by NCL would hopefully strengthen NHS/LA brokerage and bargaining power. She noted that Haringey would be able to purchase beds at the female PICU now opened at St Pancras Hospital which would save costs on other more expensive options. 8.5 It was noted that CHC was managed in different ways and Haringey differed to Islington. The Haringey CHC team had been under pressure due to staff shortages and investment in the team would be essential in order to achieve savings in areas such as the review of care packages. Barnet CCG had commissioned a lead to review future management of CHC, including potential at scale options and the Committee would be advised of the resulting recommendations. In response to Adam Sharples, Clare Henderson confirmed that the Haringey CHC budget included both adults and children. The number of children involved was quite small but a breakdown could be provided. The categories and levels of funding contributions were discussed and it was noted that some individual packages could be very expensive. In response to Adam Sharples suggestion, Anthony Browne agreed that it could be informative to review and compare costs per head over the past two years. Clare Henderson noted however that it could prove quite difficult to differentiate issues of acuity and the cost efficiency of care packages. 8.6 The Committee NOTED the report and AGREED to receive an update at the next meeting in February. 10

11 9. Risk Register Review 9.1 Anthony Browne presented an extract of the Risk Register containing the risks for which the Finance and Performance Committee had lead responsibility of oversight. The report included details of the mitigations and assurances in place as well as progress against the planned actions. Changes were highlighted for ease of reference. The Committee was asked to note that the score for Risk 10 had been increased and that the score for Risk 37 had been reduced. 9.2 Alex Smith advised that the increase in the score for Risk 10 reflected concerns regarding A&E services at NMUH over the last three to four weeks, with breaches of performance standards and also issues of support to junior medical staff. The Trust s Medical Director was leading on the implementation of improvement plans which would include increased senior level support. Helen Pettersen and Paul Sinden had addressed concerns to David Sloman as Accountable Officer. 9.3 The Committee NOTED the extract of the Risk Register, the mitigations and assurances in place for each risk, progress against the planned actions and current risk ratings. 10. NCL STP/PMO Expenditure 10.1 Anthony Browne apologised that the report on NCL/PMO expenditure had not been included with the papers circulated due to the earlier scheduling of today s meeting. It was agreed that the report would be subsequently circulated via ACTION 14/12/17 04 To circulate the latest report on NCL/PMO expenditure via to Committee members. AB 11. NCL Management Costs and STP Ernie Gartrell declared a conflict of interest in relation to discussion of contracts with the CSU Anthony Browne presented an update on the latest financial position for the NCL shared management and STP teams respectively. It was noted that Islington was the host CCG for both teams. The STP team remained within budget. In a worse case scenario the management team budget was forecast to overspend due to interim employee costs but this would be partly mitigated if possible to recruit by the end of the financial year. The overall costs for each team were included as an appendix to the report. A further report would be provided to the Committee in February Adam Sharples noted that he had previously raised the potential for savings as a result of reviewing administrative costs on an NCL-wide basis and that such savings be redirected into health care budgets. Anthony Browne advised that costs had been combined. No QIPP had been applied to the management teams but working at scale would achieve savings and similarly the re-negotiation of contracts with the CSU. Simon Goodwin advised of plans for the CSU contracting element to be commissioned in-house. He also reported that expenditure on London Partnerships was to be reviewed for reduction as of next year The Committee NOTED the update and NOTED assurance in relation to accounting arrangements. 12. Any Other Business 12.1 Financial Management Plan 11

12 Anthony Browne presented a paper providing an analysis of the risks facing the CCG as at the month 7 reported position. The paper listed mitigations to reduce key risks identified and the action required to ensure the CCG met its financial control total. Details of the impact on 2018/2019 budget planning were also outlined. The financial report as presented earlier in the meeting had included the more recently reported position at month 8 but the forecast outturn was broadly the same and consistent as regards key risks. Anthony Browne emphasised that the input and ownership of the financial management plan would require the full support of all commissioning colleagues across the CCG and it would be essential to maintain close monitoring of progress. The recovery plan was a live document and would be reviewed and amended on a monthly basis. The plan would be subject to discussion at monthly meetings of the SMT and at the two monthly meetings of the Finance and Performance Committee The Committee NOTED the financial recovery plan, the on-going work required to ensure its delivery and the assurance provided that financial pressures were being addressed within this work There were no other items of business. 13. DATE OF NEXT MEETING 13.1 Wednesday 21 February pm 3.00pm 12