CCG Finance and Performance Committee Minutes of Meeting held on Tuesday 17 th March 2015, 9:00-10:30am Sovereign Court, Hounslow Present In Attendance Prash Gupta (PG) HCCG (Chair) Natasha Malhotra (NM) HCCG Quentin Symington (QS) HCCG James Eaton (JE) CWHHE Ian Robinson (IR) LBH/HCCG Martin Waddington (MW) LBH/HCCG David Thomas (DT) HCCG Paul Shenton (PS) HCCG Trevor Woolley (TW) Lay Member Sue Jeffers (SJ) HCCG Nicola Burbidge (NB) HCCG Apologies Not in Attendance Nigel Howcutt (NH) LBH Agenda Item 1. Welcome, Introductions & Apologies PG welcomed members to the meeting and apologies were noted. 2. Declarations of Interest 2.1 PG asked for any DOI s. Action 2.2 PS and PG declared an interest for Item 10 on the agenda Extended Hours Business Case 3. Notification of AOB 3.1 No AOB s. 4. Minutes of the Finance and Performance Committee meeting held on: Tuesday 3 rd March 2015 4.1 The Minutes were agreed as an accurate record of the meeting held on the 3 rd March 2015. 5. Matters Arising Actions from last meeting 5.1 See Action Log for updated information. 6. Operating Plan and 2015/16 Draft Budgets 6.1 QS presented the Operating Plan Finance section and 2015/16 Draft Budgets. 6.2 6.3 QS said the Operating Plan and budget Paper summarised the recent operating plan submitted to NHSE on the 27 th February 2015 and detailed the budgets underpinning the plan. Due to the timing of the NHS plan submission, the Operating Plan was Page 1 of 8
reviewed by the Governing Body on the 10 th March 2015. PAPER 13 (b) 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 QS highlighted key points from the Operating Plan. QS informed the Committee that the big change for HCCG for 2015/16 was the notified allocation increasing from 292.767m in 2014/15 to 314.185m which was an increase of 7.3%. This increase reduces the distance from fair share allocation from 12% to 9.3%. QS said the requirement of CCG s to invest 2% non-recurrently has been reduced to 1%. The table on page 3 shows The Better Care Fund allocation of 4.58m which replaces the section 256 funds of 3.747m. QS discussed Table 2 and said this shows the non-recurrent income from 2014/15 and how it is being treated in the current planning model for 2015/16. GP IT budgets have not yet been set as NHSE income has not yet been confirmed. QS highlighted the 5.4m SaHF part C funds which is treated as nonrecurrent in the NHSE model and so this income is shown as invoiced under other programme costs in the 2015/16 plan. Page 5 outlined the planning assumptions within the model and shows that there is a risk around the drawdown surplus. A Collaborative Business Case will be submitted to request the drawdown of 3,629k, which is the difference between the 6.929m 2014/15 surplus and the 3.3m 2015/16 planned surplus. QS said the 10% reduction in running costs allowance for 2015/16 has been factored into the QIPP plans. The published tariff for 2015/16 was withdrawn and replaced with the Enhanced Tariff Option. The cost of this option is factored into the risks as per NHSE guidance. The estimated cost is 988k. The summary table of the submission on page 7 tracks the main fund movement from the forecast 2014/15 outturn position of a 6.9m surplus to a 3.3m surplus in 2015/16. QS said that a risk in the plan is that not all the contracts have been signed. The aim is that contracts will be signed by 31 st March 2015 and then it will be clear what level if any, of surplus funds remain to be considered for investment at the May Finance and Performance Page 2 of 8
Committee meeting. PAPER 13 (b) 6.16 6.17 6.18 6.19 6.20 The Table on page 8 shows key movements between the January and February plan submissions. The most significant change is the increase in 2014/15 surplus from 4.2 to 6.9m. Page 9 shows a snapshot of the 7.1m QIPP plans. QS informed the Committee that the next submission is due on the 7 th April 2015. QS reported that there are a number of substantial NHSE mandated investments required by the CCG in 2015/16, these were the BCF, Mental Health and Systems Resilience as stated on page 10 of the plan. QS said the 2015/16 plan has a positive impact on the underlying position. The CCG is moving from an underlying historic deficit position into an underlying surplus position forecast to be 1.65m in 2015/16. 6.21 However the plan still contained a large amount of reserves, such as the acute contract settlement reserve 1.7m. A significant proportion of this it is anticipated will be placed in contracts to support contract sign off. This will affect the underlying position and may reduce the underlying surplus. 7. Section 75 Agreement between HCCG and LBH for Commissioning Health and Social Care Services 7.1 SJ informed the Committee that this is a legal agreement between the Council and the CCG covering the governance around the BCF pooled Fund. 7.2 7.3 7.4 7.5 7.6 SJ reported that the Finance and Performance Committee was given delegated authority by the CCG Governing Body on the 10 th March 2015 to agree the Section 75 agreement on behalf of the CCG prior to being signed off by the JCB. The Finance and Performance Committee were asked to agree to the agreement on behalf of the CCG prior to the JCB agreeing it. MW said the Council, as the Host, will lead on arrangements for financial management of the BCF Pooled Fund. In line with the terms of this agreement, internal procedures and nationally published guidance. The Pooled Fund Manager will work with finance and performance colleagues from the CCG and the Council to ensure that there is monthly financial and performance reporting to the BCF Executive, The CCG Finance and Performance Committee and the Adult Social Care senior leadership team meeting. QS wanted it noted that he thought the better option would be for the CCG Page 3 of 8
to host Section 75 as the CCG has a much tighter NHS reporting regulatory framework and it was not yet clear that LBH as the Pooled fund host would be able to meet these requirements which presented a potential risk in terms of financial governance. Work with LBH Finance was underway to mitigate this risk 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 DT said the Council s finance department have a set of skills which are different to the skills that are required for NHS reporting. QS added that the CCG would need to see what is required for each scheme in detail, the level of reporting and whether the council s systems can be adapted to accommodate this. MW said from December to March the CCG will have finance staff that can help support the Section 75 going forward and the Council will have the correct accounting system in place. The Executive Board and the Finance and Performance Committee will remain monitoring this. Jenny Bartlett or Nigel Howcutt will attend the Finance and Performance Committee for monthly reporting on Section 75. A joint escalation process needs to be put in place to ensure monthly reports are being produced to ensure adequate and consistent reporting. ACTION: Technical accounting process to be developed and put in place. SJ questioned if the CCG have reporting mechanisms in place to allow discharging our responsibilities and are the CCG content with the areas of spend. The first assessment which needs to be made is to see if the CCG is achieving the 4.2% reduction in NEL and if this is the case then the money is not needed to be able to pay for acute care so the pool fund can be drawdown. The second assessment which needs to be made is depending if HCCG have more or less money against the BCF schemes it will have to be reviewed and adjusted scheme by scheme. A process needs to be put in place agreeing what money is spent on the schemes. MW said part of the BCF fund is held back as part of the performance fund which will be used to pay for acute activity if the CCG s targets are not met. If there is under performance and targets are not being met the CCG and LBH will discuss any additional investment needed. DT said the guidance around what to do if activity is not moved away from MW/NH JB Page 4 of 8
the Trust, drawing down from the risk share and the financial flows associated with this are clearly stated. What is not clearly listed in the specification are the budget virement details and these need to be included in the updated specification. 7.19 7.20 7.21 7.22 7.22 MW added the Pooled Fund Manager shall ensure that any such overspend or underspend will be notified, along with all relevant background information in respect of the overspend or underspend, through monthly reporting to the CCG Finance and Performance Committee, BCF Executive and the Joint Commissioning Board for review by partners. SJ said there needs to be clarity in the specification around the governance arrangements with regard to underspends and overspends listing rules and framework. This will allow the BCF Executive group to work within a framework and bring decisions to the Finance and Performance Committee and the JCB. ACTION: IR to electronically circulate track changes made to Section 75 Agreement document to the Finance and Performance Committee for review. SJ said HCCG have asked DAC Beachcroft Solicitors to work on the CCGs behalf on producing a legal view for the CCG prior to signing off the Section 75 Agreement. The Council s solicitor will also be doing the same. IR 7.23 APPROVAL was given by the Finance and Performance Committee to take forward the agreement to an Extraordinary meeting of the JCB for approval before final sign off by the Health and Wellbeing Board on the 31 st March 2015 subject to the above amendments. 8. Community Nursing Business Case 8.1 SJ presented the Adult Nursing Business Case. 8.2 8.3 8.4 The Finance and Performance Committee were asked to re-consider and approve the revised investment mandate for recurrent additional funding for community nursing for 2015/16. Further information was requested regarding the additional activity and value for money that the investment would bring. It was also asked how the current levels of nursing vacancies are managed and how the additional recruitment to new posts would be achieved. This information is included in the revised mandate. HRCH currently have a rolling programme to recruit community nursing staff. The recruitment of staff will be filled using bank and agency staff until recruitment is fully complete. Page 5 of 8
8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 The Trust have put in more detail around the Service Delivery / Patient Outcome benefits from the previous document. The Trust have added delivery milestones and the programme for recruitment. NB asked why there is a reference to developing an OPAT service at WMUH in the Business Case when this was not to be commissioned. ACTION: SJ to discuss the OPAT service at WMUH with GW for more detail. DT informed the Committee that the WMUH OPAT Service Business Case is expected to come to the Finance and Performance meeting on the 5 th May 2015. NB said the outcome measures for 85% of staff appraised was low and Community Matron or Community Nursing presence at all MDT s should not be requested. SJ said MDT s and MSG s are beginning to be separated. A nurse will go to the MDT s in the practice if nursing input is required. NB pointed out that the care plan for over 75 s was now called care plans for the frail and elderly. QS said the CCG should ensure measures were agreed with HRCH to ensure that the investment could be tracked in terms of extra manpower recruited and that any payment should be adjusted to reflect actual increased staffing. SJ said for this year in the contract negotiations the CCG have asked the Trust to break down the block contract into three major service groups which are: 1. Acute care closer to home. 2. Children s care 3. Specialist and Planned care SJ added in order to deliver the model described the Trust has proposed to Expand the Community Nursing Service by increasing the size of the community nursing teams. There will be 4 x Band 4 Senior Administrators to work with the Community Matrons to provide care co-ordination for patients, engage with GPs, supporting the delivery of the patients care plan and support at MDT s, working with nurses in the development of proactive caseload management. SJ/GW Page 6 of 8
8.16 The Finance and Performance Committee APPROVED the revised investment mandate of up to 670k for recurrent additional funding for the HRCH community Nursing for 2015/16. This is based on the actual costs of HRCH increased staffing costs during 2015/16. That is if no extra staff are recruited the CCG will claw back the extra funding. 9. ONWL 111 contract extension 9.1 The Finance and Performance Committee were asked to note the content of the ONWL 111 contract extension report and agree with the Outer NWL NHS 111 contract extension until the 18 th February 2016 with a proposed contract value of 1,821,600 across the four CCGS. 9.2 9.3 SJ informed the Committee last year in the re-negotiation of the contract the CCG reduced the activity schedule as the service was not meeting the planned activity levels. Through 2014/15 the service met the activity levels that the CCG had reduced them to. The financial impact of changing the service model would be a reduction in price per call from 14.81 currently to 12.65 after implementation of the changes. This means there is an overall reduction in the total contract value. 9.4 The Finance and Performance Committee AGREED the contract extension until the 18 th February 2016 with a proposed contract value of 1,821,600 across the four CCGs. 10. Extended Hours (out of Hospital Service) Business Case 10.1 The Finance and Performance Committee were asked to review the Extended Hours (out of Hospital Service) Business Case and agree the financial impact. 10.2 10.3 10.4 SJ informed the Committee that there is a cost pressure for HCCG as the main difference between the current service and the information in the Business Case is that it includes 4 hubs rather than 5. DT added that the Business case includes nurse input where the current service does not include this. The current service includes 10 hours at the weekend with the Business case includes 12 hours at the weekend. ACTION: SJ to provide clarification and feedback from the CWHEE Investment Committee held on the 12 th March 2015. SJ 10.5 Please see Appendix A for Action Answers 11. Update on Investment Prioritisation 11.1 Item not discussed. Date of the next meeting The next CCG Finance and Performance Working Group meeting will be held on: Page 7 of 8
Tuesday 21 st April 2015, Sovereign Court, Hounslow, GS-3 APPENDIX A - Extended Hours (out of Hospital Service) Business Case PAPER 13 (b) The Business Case was AGREED at the Investment Committee on the 12 th March 2015. The Concerns outlined below were raised at the Investment Committee and were responded to as follows. Competed with 14/15, the new schemes will offer about a 1% increase in primary care availability (and of GP availability) across the 5 (in some CCGs it will reduce). At the Investment Committee on the 12 th March 2015 the discussion identified a net increase in clinical hours rather than opening hours, as there will be a nurse and GP available so the clinical hours will double what was previously available. Compared with 14/15, the cost will be about 40% higher. The increased price is related to two receptionists, nurse time and availability and having 5 hubs in Hounslow rather than 4 as was in the original Business Case. The increased price is partly down to the need for two receptionists rather than one in extended hours for reasons of safety (not clear why existing arrangements in this respect are unsafe. Whilst safety is a consideration (e.g. in Hounslow two receptionists are already required to work at the weekend to provide mutual support and safety). The additional reason as expressed at the Investment Committee was in relation to workload. The hub practices are going to provide extended hours for their locality, not just their practice and two receptionists are required to provide an effective reception (e.g. Answering phone calls, managing the waiting room and answering the door). It is also partly due to increased nurse availability. While this is no doubt of value, the driving force behind extended hours is to increase access to GPs, not nurses, and I am not clear whether there is evidence to suggest an unmet demand for extended hours for nurses. How confident are we that there will be full utilisation of the increased availability of nurses? Whilst the driving force behind extended hours is to increase access to GPs, it has long been understood that nurses can provide extra clinical hours in general practice and can carry out care that a doctor does not need to do. An example of this would be wound management. At the moment patients having their wound dressed all week by the practice nurse are sent to A&E at the weekend because the nurse is off duty. In Hounslow when we re-commissioned the PMS contracts we insisted that each practice delivers 17 clinical hours per 1000 patients per week as well as 50 opening hours a week. The critical issue is clinical hours not just opening hours. Page 8 of 8