PRESENT NHS Barnet Clinical Commissioning Group Governing Body Meeting held in Public Thursday 26 January 2017 09:30 to 12:00 Committee Room One, Hendon Town Hall Debbie Frost DF NHS Barnet CCG Chair (West Locality) Cathy Gritzner CG Accountable Officer Roger Hammond RH Chief Finance Officer Bernadette Conroy BC Lay Member Governing Body Ahmer Farooqi AF GP Board Member (North Locality) Barry Subel BS GP Board Member (South Locality) Charlotte Benjamin CB GP Board Member (South Locality) John Bentley JB GP Board Member (South Locality) Michelle Newman MN GP Board Member (West Locality) Swati Dholakia SD GP and Governing Body Member (West Locality) Helen Donovan HD Registered Nurse Governing Body Member Clare Stephens CS GP Board Member (North Locality) IN ATTENDANCE Neil Snee NS Interim Director of Commissioning David Holden DH Interim Director of Governance and Corporate Affairs Emma Savage ES Interim Associate Director of Quality Dawn Wakeling DW Director of Adult Services, London Borough of Barnet Julie Pal JP Chief Executive Officer, Community Barnet Robyn Sandler RS Communications and Engagement Lead Marian Tobin MT Trauma Therapist / PTSD Lead, BEH Andrew Howe AH Director of Public Health, London Borough of Barnet APOLIGIES Jonathan Lubin JL GP Board Member (North Locality) Michael Rich MR Head of Healthwatch Barnet Leigh Griffin LG Interim Director of Strategy and Primary Care SECRETARIAT Michael Weaver MW Interim Governing Body Secretary OPENING ADMINISTRATION GB/045 Introductions and apologies for absence Introductions were made and apologies were received from Jonathan Lubin and Michael Rich. 1
PATIENT STORY GB/046 Patient Story Debbie Frost, NHS Barnet CCG Chair welcomed Marian Tobin, Trauma Therapist / Post Traumatic Stress Disorder (PTSD) Lead, Barnet Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust and Faizaneh Tahajodi to the meeting. Faizaneh had come to the United Kingdom in 2009 as a refugee. Faizaneh spoke of her life in Iran where she attended University and had been active in promoting the rights of women. As a consequence of her participation in protests Faizaneh had spent time in prison prior to her seeking asylum in the UK. Her treatment in prison had left her psychologically and physically traumatised. Marian spoke her work as a Trauma Therapist and the support provided by the PTSD Team that had helped Faizaneh to first stabilize and then understand and normalise her experiences. A range of interventions offered by the Complex Care Team had helped Faizaneh to develop coping strategies and lead a more independent life. The Chair thanked Marian and in particular Faizaneh for showing great courage and attending the meeting today to talk about her experiences. It was especially pleasing to see how the service had helped Faizaneh to progress and through her own endeavours recently pass a qualification in Dental Nursing. Members of the Governing Body thanked Marian and Faizaneh. OPENING ADMINISTRATION GB/047 Minutes of the meeting held 24 November 2016 The Governing Body accepted the minutes of the meeting held on 29 September 2016 as a true and accurate record of the meeting subject to an amendment on page 12, Item GB/035, to be corrected as follows BC reported on a meeting to of the Primary Care Co-Commissioning Joint Committee attended by AF, BC and LG where there had been discussion of the process of due diligence. GB/048 GB/049 Action Tracker The following was noted in relation to the action log: GB.16/09. 360 Degree Survey At its meeting on the 28 July 2016 the Governing Body agreed a worked up action plan based on the results of the 360 degree survey would be reported to a future meeting of the Governing Body. An update would be reported at today s meeting. The Governing Body noted closure of action GB.16/09. Action Tracker The following was noted in relation to the action log: GB/006 Options appraisal for future accommodation of NHS Barnet CCG Headquarters At its meeting on the 29 September 2016 the Governing Body requested to receive an options appraisal paper for future accommodation of the NHS Barnet CCG Headquarters. An update would be reported today at the Governing Body meeting held in Private. The Governing Body noted closure of action GB.006 2
OPENING ADMINISTRATION GB/027 Patient Story At its meeting on the 24 November 2016 the Governing Body agreed it would discuss suggestions / ideas for patient stories at a future Informal Governing Body Meeting. The Governing Body noted closure of action GB/027 GB/030 North Central London Sustainability and Transformation Plan (STP) At its meeting on the 24 November 2016 the Governing Body agreed to hold a future Informal Governing Body meeting to discuss estates management. Members of the Governing Body noted Estates Management would be the subject of a future Informal Governing Body meeting on 23 February 2017. The Governing Body noted closure of action GB/030. GB/032 Overarching Section 75 Agreement At its meeting on the 24 November 2016 the Governing Body asked to see an update on section 75 that included an update on action to move from aligned budgets to pooled budgets. The Chief Finance Officer and London Borough of Barnet (LBB) Finance team were undertaking work to move from aligned budgets to pooled budgets. NS confirmed the finance teams of the CCG and LBB were working to create pooled budgets from April 2017, however this work was taking longer than originally expected. BC stated the need for a report on pooled budgets to be reported to the CCGs Audit Committee. NS noted the request for a report on pooled budgets to be taken to a future Audit Committee Meeting. The Governing Body noted the action to move from aligned budgets to pooled budgets under Section 75 arrangements and that a report on pooled budgets would be taken to a future Audit Committee Meeting. NS GB/050 Declarations of Interest Debbie Frost asked the Governing Body to note that GP Governing Members were conflicted in relation to Item 8.0, North Central London NHS 11 Integrated Urgent Care Services Mobilisation Assurance, Item 12.0 Primary care Co-Commissioning and Item 13.0 Procurement of Extended Access in Primary Care. Any discussion regarding commercially sensitive information in relation to financial information or analytical i.e. activity data would require the exclusion of GP Board Members. All members of the committee noted the requirement for GP GB members not to be present during discussion of matters in relation to Item 8.0, North Central London NHS 11 Integrated Urgent Care Services Mobilisation Assurance, Item 12.0 Primary care Co-Commissioning and Item 13.0 Procurement of Extended Access in Primary Care where there was consideration of commercially sensitive or analytical i.e. activity data that would therefore require them to be excluded from the meeting for the duration of discussion of those particular items 3
GOVERNANCE AND CORPORATE BUSINESS GB/051 GB/052 Chair s Report The CCG would soon be holding an election process to fill a number of positions on the Governing Body that included one GP representative for the North Locality, two GP representatives for the West Locality and two GP representatives for the South Locality. These positions had arisen as five of the current GP Governing Body members term of office was set to conclude on the 31 April, 2017. The CCG had received 14 applications for the positon of Lay Member for Audit and Conflicts of Interest and the interviews would be held in February 2017. Interviews for the position of Patient and Public Involvement (PPI) and Secondary Care Doctor would be held on 8 February 2017. The Health Service Journal had announced its shortlist for the Value in Healthcare Awards 2017 and the Chair was delighted to announce that Barnet CCG has been shortlisted for two awards. Nominations related to the following entries Medication optimisation for respiratory conditions at Barnet CCG, which has been shortlisted in the Pharmacy and Medicines Optimisation category and Reimagining Mental Health, which has been shortlisted in the Improving The Value Of Primary Care Services category. The Chair offered her congratulations to everyone involved, particularly Darush Attar- Zadeh, Dr Charlotte Benjamin, Paula Arnell and Ray Baird. The five clinical commissioning groups in North Central London (NCL) (Barnet, Camden, Enfield, Haringey and Islington) had appointed Helen Pettersen as chief officer, accountable officer designate across north central London and the sustainability and transformation plan (STP) convenor. A start date for Helen to begin her role had still to be agreed. The Governing Body noted the report. Chief Officer s Report The CCG was reporting achievement of the 2016-17 finance plan but at some risk. The current status should be seen in the context of the wider NCL CCG financial control total and the 12m - 15m unfunded CCG pressures. Further detail would be reported in today s Finance Report. The CCG was working with Camden CCG to adopt their existing system that would allow the sharing of digitised patient records across different local providers in Barnet. The Care Integrated Digital Record (CIDR) would be implemented with an opt-out mechanism for Barnet residents and an engagement programme was being launched in Spring 2017 to raise awareness of the programme and provide Barnet residents with an opportunity to opt-out. Barnet GPs would be provided with more information over the coming months before the public engagement launches in Spring 2017. NHS contracts for 2017-18 and 2018-19 had been agreed, the draft STP would be refreshed to reflect the progress made since October. This would be ready by the end of January. Delivery plans for each of the STP work streams were being developed to be ready for implementation from April 2017 onwards. Opportunities to further deliver efficiencies to reduce the remaining financial deficit were being sought. The CCG had launched a project entitled Reimagining Finchley Memorial Hospital (FMH) and were working with NHS England (NHSE) and Community Health Partnerships (CHP) to look at how to reduce the price of the space to make FMH attractive for innovative services. A working group had been established to set out a programme of work on FMH and the template of this could be used for reimagining other buildings in Barnet that could be used to enhance primary care delivery The Governing Body noted the report. 4
GOVERNANCE AND CORPORATE BUSINESS GB/053 North Central London NHS 111 Integrated Urgent Care Service Mobilisation Assurance Dr Barry Subel presented a report that provided a further update on progress made on quality, performance and service developments within the North Central London (NCL) NHS 111 Integrated Urgent Care (IUC) Service. BS reported positive monthly contract-monitoring meetings. No Serious Incidents had been reported and Business Intelligence demonstrated an effective service. BC thanked BS for his report. BC felt assured by the verbal report in addition to the written report circulated in advance that had contained technical language. CB asked whether an unintended consequence of the success of the mobilisation would create more stress in the system. JL asked to know if the 111 service had considered the greater use of technology e.g., video links and whether interventions such as Rapid Care Nurses changing catheters in the care home had been considered. HD welcomed the success of the service and asked to know if there was monitoring of unnecessary admissions. Could the CCG be assured that patients were receiving individual care? There were monthly Clinical Quality Review Group (CQRG) meetings to review a number of Key Performance Indicators (KPIs) including the number of answered phone calls. It was reported that 95% of calls were answered within the stated time. A catheter change and rapid care process was in place. The use of technology such as video links was being considered in the next phase of mobilisation. BC asked to see the KPIs as it would be interesting to know the number that were input related and those that were output related. The Governing Body noted the report and asked for the CCG to report the minutes of monthly Clinical Quality Review Group (CQRG) meetings at future Board meetings. NS GB/054 NHS Barnet CCG: Strengthening Engagement with Members and Local Stakeholders Dr Ahmer Farooqi, expressed his thanks to Leigh Griffin, Interim Director of Strategy and Primary Care for producing the report but who wasn t able to be at today s meeting. The report and recommendations sought to address the issue of engagement and communications between the CCG and its member practices and stakeholders. This included the outcome of a 360* assessment undertaken in early 2016 and subsequent developments, including a review undertaken jointly with the Good Governance Institute (GGI). A number of recommendations were presented with a view to further strengthen CCG engagement and communications. BC suggested the Governing Body should see a workplan that included Financial and Human Resource Implications. Whilst circumstances had been difficult in 2016 this was unlikely to change in 2017. CB asked to know if the CCG had decided at what level it should engage with member practices i.e. the level of engagement that would represent value for money and benefit member practices. BC suggested the CCG needed to consider its relationship and engagement as a CCG and how it would run Primary Care Commissioning should it receive delegation. With regard to engagement with member practices DW asked to know the CCGs strategic priority. There was an opportunity for the CCG to work with the Local Authority (LA) and third sector organisations where there was resources and experience that would benefit the CCG. 5
GOVERNANCE AND CORPORATE BUSINESS AF welcomed the opportunity to work with the LA. The CCG needed to develop some form of ongoing evaluation of its engagement activities and not just rely on the annual 360 degree evaluation. Engagement should be a core activity for the CCG. DH asked the Governing Body to note there was resource to support communications and engagement activity in the new CCG management structure. JP stated the need to develop a more coherent plan for engagement in the CCG. The Governing Body noted the report, noted the need for the CCG to appoint a Patient and Public Involvement (PPI) Lay Member supported by a communications and engagement resource and asked to see a workplan presented at a future Informal Governing Body meeting. AF / LG GB/055 Report on North Central London Cancer Services Clare Stephens, GP Board Member, (North Locality) gave a presentation entitled Using integrated commissioning to improve Cancer Outcomes that included contributions from Elizabeth Babatunde, Victoria Bradburn, Teresa Callum, Rajeshtree, Yasmin Faroouqui, Emma Savage, Neil Snee and Charlotte Stone. The Independent Cancer Taskforce had Published a five year strategy for cancer in July 2015 with aim to improve cancer services across the entire patient pathway by 2020. 16 Cancer Alliance footprints had been confirmed in addition to three Vanguard sites. Alliances would explore potential to put in place models for hardwiring clinical and pathway change across whole systems learning from the Vanguard. CS reported on interventions to improve the uptake of bowel cancer screening within Barnet CCG, local pathway improvements and Quality assurance for patients on 62 day cancer pathways at Royal Free London NHS Foundation Trust (RFL). JL queried RFL Cancer Performance. JL expressed concern over GP capacity to follow up prostate patients. There was pressure on GPs with the two week referral rule. AF queried pathway diagnostic changes. CS stated there needed to be improvements in early diagnosis and diagnosis with better referral rates. CS reported an update on Barnet Prostate Cancer Stratified Follow Up Service that had included the support of CCG leads with help from the Local Medical Committee. DF expressed the need for all patients to be involved. The Governing Body noted the report. GB/056 Developing the commissioning arrangements in North Central London report relating to issues and clarifications raised in November governing body meetings The Chair updated the Governing Body on matters discussed at the meeting held on 24 November 2016 that included a review of proposals made in a set of three papers relating to proposed NCL commissioning arrangements that had also been presented to the governing bodies of all five CCGs. These papers had set out 21 proposals for each governing body to resolve (14 relating to governance, and seven relating to management). Against these proposals each CCG had areas that required further work, clarification, or prioritised next steps. Members of the Governing Body were asked to review proposals in relation to the establishment of a Joint Committee of North Central London CCGs to commission some services and proposals related to the establishment of a joint management team to work across the five North Central London (NCL) Clinical Commissioning Groups (CCGs) 6
GOVERNANCE AND CORPORATE BUSINESS GB/056 Developing the commissioning arrangements in North Central London report relating to issues and clarifications raised in November governing body meetings The Governing body were asked to approve an increase in the number of independent clinical members of the joint committee from 2 to 3, of whom at least one would be a secondary care clinician and one would be a nurse. This differed from what had been put forward in proposals 3 and 9 of the paper discussed at the Governing Body meeting on 24 November. It was expected that, in the first instance, these members would be drawn from the current membership of governing bodies. HD asked the Governing Body to note discussion at the Remuneration meeting in Common had considered wording that stated at least one nurse. The at least should refer to the secondary care clinician and the nurse role. BC noted the need to improve clinical representation with as wider pool as possible. DF noted the need to agree a process for finding the independent members. With reference to Appendix 2, section 1.1, DH advised the Governing Body to note the NCL Joint Commissioning Committee would not have standing orders. The Governing Body noted CG would speak to the Accountable Officer (AO) designate to discuss agreement of an appointment process for independent members of the proposed joint committee. CG Developing the commissioning arrangements in North Central London: Proposal to establish a joint committee of North Central London CCGs 3. The Governing Body approved the membership of the proposed joint committee as 14 Voting members that included the Chair from each CCG (x5), a Lay member from each CCG (x5) Two independent clinical advisors (x2) the NCL Accountable Officer and NCL Chief Financial Officer and 8 Non-voting members that included an Independent Chair, One representative from each local authority (to be nominated by each local authority) (x5) Director of Public Health (to be nominated by the Directors of Public Health) and one representative of Healthwatch (to be nominated by Healthwatch). 4. The Governing Body approved the proposal that the five CCGs delegate the responsibility to the proposed joint committee for the application of their resources for the commissioning of the delegated areas (acute commissioning, the Transforming Care Programme, integrated urgent care and specialised services). 6. The Governing Body did not approve the proposal that the shared CFO develops the financial strategy into a set of policies and procedures which will require endorsements by the joint committee for operation. Members of the Governing Body agreed they could not approve the proposal for a shared CFO to develop the financial strategy into a set of policies and procedures that would require endorsements by the joint committee for operation. It was still the view of the Governing Body that the Joint Committee could not endorse what was proposed. It was for the Governing Body of each NCL CCG to endorse a set of policies and procedures not the joint committee. 7
GOVERNANCE AND CORPORATE BUSINESS GB/056 Developing the commissioning arrangements in North Central London report relating to issues and clarifications raised in November governing body meetings Developing the commissioning arrangements in North Central London: Management arrangements. 3. The Governing Body approved the proposal that all running cost workforce in finance, performance and acute commissioning functions to be line managed by the new shared director roles. At its meeting on 24 November 2016 the Governing Body had not approved the proposal that Islington CCG should act as the host employer for any new appointments that are shared across the NCL CCGs. BC asked the Governing Body to consider approval of the proposal on the basis that there is clarification of what constitutes the host employer. HD advised the Governing Body that Job Descriptions and Job Adverts looked as though they were advertised as an Islington CCG Role. CG agreed to discuss clarification of the proposal with the Human Resources team at NHS England. It was noted that whoever hosted the shared director roles they would only be responsible for their statutory duties. The Governing Body noted CG would discuss clarification of arrangements for the running costs in relation to the proposed shared director roles. CG GB/057 Primary Care Co-Commissioning At its meeting on 24 November 2016 the Governing Body approved the recommendation that Barnet, Enfield, Haringey and Islington CCGs submit an expression of interest to become Primary Care delegated commissioners subject to satisfactory conclusion of due diligence activities in the take on of delegated commissioning responsibilities and a finalised governance arrangement which allows four delegated CCGs (Barnet, Enfield, Haringey and Islington) to meet as Committees-in-Common, alongside one Joint Co-Commissioning CCG (Camden). Following the submission made by four of the five NCL CCGs on 5 December 2016, Camden CCGs Governing Body, in dialogue with its membership and Local Medical Committee (LMC) submitted their expression of interest along with the other four CCGs on 16 December 2016. Subject to a membership ballot in Camden CCG in the spring, all five NCL CCGs would move forward together as delegated commissioners. Since November 2016 the programme governance lead had developed the governance documentation required to mobilise the Committee-in-Common approach agreed by the CCGs in NCL as the preferred governance route for managing delegated commissioning. Outstanding due diligence questions provided by the Islington Chief Finance Officer on behalf of the NCL CCGs had been sent to NHS England (NHSE) and resolved. NCL CCGs had been working closely with NHSE to agree an approach to management of the primary care contracting function and associated staff. With reference to Diagram 1, Aligned organisation structure BC noted the reporting arrangements were unclear. The ability to manage the resources was unclear (finance and staffing). DF noted the papers needed to make explicit reference to Barnet CCG. The document advised that NHSE staff would be hosted at the Islington CCG. 8
GOVERNANCE AND CORPORATE BUSINESS GB/057 Primary Care Co-Commissioning DW asked to know why Islington was always the host. The Chief Officer of Islington was the Senior Responsible Officer (SRO) for Primary Care and that would explain why Islington was currently the host. BS asked the Governing Body to note that he felt that having the NCL clinical lead for Primary care also from Islington was possibly a conflict of interest. The Governing Body did not approve the recommendation that Haringey, Islington, Barnet, Enfield and Camden CCGs mobilise delegated commissioning. The Governing Body asked Ahmer Farooqi and Bernadette Conroy to lead on clarifying matters raised in relation to Primary Care Co- Commissioning and to bring an update to the Governing Body meeting on 30 March 2017. AF / BC GB/058 Procurement of Extended Access in Primary Care Dr Ahmer Farooqi introduced a document that set out the case to formally procure a GP extended access service that would enable 08.00 to 20.00 hrs, seven days per week access to GP appointments for patients registered in Barnet. This procurement would enable Barnet CCG to meet the requirements of the GP Forward View and London Primary Care Strategic Commissioning Framework. The report also set out how the procurement would be led at NCL and local level, in order to secure potential efficiencies and deliver equity of access across the five boroughs. The CCG would receive resource from NHSE to support extended access. The NCL share of the London investment was 6.1m for 2016/2017 of which Barnet would receive 725k and 5.72m for 2017/2018. Members of the Governing Body noted the level of allocation for each NCL CCG. BS queried the accuracy of the reported total funds to be transferred in December, reported as 3.4m in the paper but should be reported as 5.2. DF asked to know why Barnet CCG was only expecting to receive 725k which was lower than all the other NCL CCG allocations. As the largest CCG in NCL it was inequitable that Barnet CCG was receiving less allocated funds than other NCL CCGs. NS agreed the level of reported allocation for Barnet CCG appeared odd as Barnet was the largest CCG in NCL with a challenged urgent care environment and largest residential care sector. It was vital the CCG received investment in a direct referral service. BC suggested the CCG should concentrate its efforts on securing an appropriate level of funding in 2017/2018. BC expressed concern the CCG was being forced into a 08.00 to 20.00 hrs 24/7 service. It was a waste of public funds to put people into practices to provide a service that wasn t used. BS agreed, and suggested there needed to be more innovative GPs at the front door of Accident and Emergency. NS asked the Governing Body to note the allocation of funds for extended access in primary care was a national policy. DW expressed LBB s disquiet at these allocations The Governing Body supported the intention to procure across NCL, extended access services, endorsed the approach set out in the specification that would deliver extended primary care services and delegated the Primary Care Procurement Committee to approve the procurement process. 9
FINANCE, PERFORMANCE AND QUALITY GB/059 Performance and Quality Report Swati Dholakia, GP and Governing Body Member (West Locality) and Neil Snee, Interim Director of Commissioning introduced the Performance and Quality Report. With reference to the executive summary members of the Governing Body were asked to note Barnet CCG (BCCG) was meeting Referral To Treatment (RTT) targets, with the main provider, RFL, continuing to deliver good performance. Royal National Orthopaedic Hospital (RNOH) was consistently failing the RTT target. A Contract Performance Notice (CPN) was issued by the NHSE Specialist commissioning team in August 2016. As a consequence, RNOH had submitted a revised RTT trajectory, agreed with commissioners, which showed compliance by February 2017. However, the trajectory had not been met at this stage and success hinged on successful outsourcing. BCCG did not achieve two out of eight Cancer Waiting Times (CWT) targets in November 2016. The non- compliant CWT targets were the 62 day Cancer Waiting Times and 31 Day standard for subsequent cancer treatments - anti cancer drug regimens. The latter was marginally below the target of 98% at 97.8%. The main providers contributing to this under performance are RFL, University College Hospital (UCLH) and RNOH; all have RAPs in place. BCCG lead on NCL improvement in cancer waits and so oversee all NCL trajectories and improvement actions. BCCG s main provider, RFL, had failed the 62 day standard. RFL experienced problems with their Patient Tracking List, which was now resolved. A number of pathway improvements had been implemented but close monitoring was required as STF remained at risk. BCCG achieved the standard for diagnostic waiting times in November 2016. The RFL continued to perform well and UCLH was progressing on implementing their RAP through the work with McKinsey. BCCG performance for access and recovery rate targets remained unachieved at November 2016. The recovery action plan submitted by Surrey and Borders (SABP), in October 2016 for the IAPT Access and Recovery rate targets, was rejected by BCCG due to a lack of baseline modelling, trajectory details and benchmarking in the plan. SABP were due to submit a revised RAP. The CCG issued a Contract Performance Notice due to a persistent breach of the Operational Standard eight week wait (56 days) for first appointment for routine musculoskeletal referrals as set out in 4.1 of the service specification for the Integrated Musculoskeletal Service and inability to evidence that urgent referrals are seen within 2 weeks. This was being followed up and monitored at the Contract Monitoring Group. The CCG had received CLCH's Remedial Action Plan (RAP) and had asked for further improvements to be made. A refreshed version would be available in late January 2017.There were 6 overdue Serious Incident Reports (SIRs) at the end of November for RFL. The Trust was confident that RFL would achieve their trajectory of zero overdue Serious Incidents SIs by end of January 2017. BC stated she was not assured about the contracts the CCG didn t lead for e.g. SIs at Moorfields Eye Hospital were never reported to the Governing Body. The Governing Body needed to receive assurance of quality and safety of services from other providers that other NCL CCGs were the lead commissioner for. ES reported the Governing Body received a slimmed down version of the report that went to the Clinical Quality and Risk Committee. BC stated the need for the report to Governing Body to pick up associate provider issues. NS noted the Performance and Quality Report should report exceptions from other providers to the Governing Body. 10
FINANCE, PERFORMANCE AND QUALITY GB/059 GB/060 Performance and Quality Report DF noted that mixed sex accommodation breaches were reported to be increasing. ES reported on discussion at Clinical Quality Review Group meetings as to why there had been a rise in mixed sex accommodation breaches. The Governing Body noted the report. Finance Report Roger Hammond, Chief Finance Officer reported the Month 9 (December 2016) Finance Report. The CCG was on plan year to date (YTD) and was forecast to deliver its plan for 2016/17. The CCG had planned to deliver an in-year 2.7m surplus to repay the remaining deficit brought forward from previous years and, as agreed with NHSE, post a 1.1m cumulative surplus. Pressures being seen across CCG expenditure lines, plus unexpected in year pressures (i.e. funded nursing care, London Ambulance Service) required the CCG to identify further opportunities to offset. The Executive Team were identifying and considering opportunities to do so. Overall, acute expenditure was forecast to overspend by 5.9m, a decrease of 2.1m from the M8 reported position. Contracts for 2017/2018 would reflect the level of acute expenditure. Non-Acute expenditure was 1.6m over plan YTD and forecast to over perform by 2.3m for 2016/17, primarily through pressures in continuing healthcare services and slippage on saving plans to year end of 700k. Corporate expenditure was overspent against plan YTD and was forecast to overspend by 0.3m. This was primarily due to external consultancy costs and the high level of interims. The Executive Team would continue to review corporate expenditure and commitment. A number of mitigations and reserves have been identified to cover potential risks although at present risks outweigh mitigations, with a net risk of 0.7m in M9, a decrease from month 8. A number of non-recurrent measures have been identified to offset. In conclusion, the CCG was forecast to achieve its planned position as agreed with NHSE however the risk to delivery of financial plan was assessed as amber as the CCG had little or no reserves left. The CCG had been asked to facilitate the balancing of the Service Transformation Plan (STP) control total for NCL and had, in conjunction with other CCGs, identified additional pressures across NCL that would need to be managed collaboratively to secure all organisations achieving their control totals for 2016/17. Originally these pressures were estimated at 12-15m but increased to circa 26m earlier in the year. At month 9, it was estimated that 5m was still required to achieve overall NCL balance. With reference to page 4 and 5 of the Finance Report BC expressed concern over the position reported with regard to the STP where there was no reported risk pool or governance arrangements. BC asked to know which of the reported QIPP schemes were expected to deliver. JL commented on the potential transfer of money from the CCG to NCL. Over the past few years the CCG had struggled to invest in primary care services. The CCG shouldn t be subsidising other primary care services. BS wanted assurance the CCG had something in the contract that allowed the CCG to dis-invest in acute care and invest in primary care services. RH assured the Governing Body there was no intention to move funds between NCL CCGs. 11
FINANCE, PERFORMANCE AND QUALITY GB/060 Finance Report QIPP schemes were under close scrutiny and were being driven as far as they could be. With regards to the run rate in 2017/2018, the block contract had been reviewed to reflect underlying run rates. The STP was there to manage big shifts in activity across NCL. Investment in Care Closer to Home required a degree of pump priming before services could be moved. The Governing Body noted the Month 9 (December 2016) financial position reflecting a balanced position and forecast to achieve the financial plan agreed with NHSE. REPORTS AND MINUTES OF COMMITTEES OF THE GOVERNING BODY GB/061 Minutes of Committees of the Governing Body The Governing Body noted minutes of Finance, Performance and QIPP meeting held on 17 November 2016, the Audit Committee meeting held on 1 September 2016 and the Clinical Quality and Risk Committee held on 8 September 2016. MINUTES OF THE HEALTH AND WELL BEING BOARD GB/062 GB/063 GB/064 Minutes of the Health and Well Being Board The Governing Body noted minutes of the Barnet Health and Well Being Board held on 10 November 2016. CLOSING ADMINISTRATION Any other business None declared Date and time of the nest meeting Thursday 30 March 2016 09:30 to 12:00, Committee Room One, Hendon Town Hall, The Burroughs, London NW4 4AX. 12