Subject to Ratification at the Next Meeting
Minutes of a Meeting of the Finance and Performance Committee
Held on Tuesday, 24 March 2015 in the Boardroom, Blackpool CCG
Present:
David Edmundson, Lay Member (Chairman)
Roy Fisher, CCG Chairman
David Bonson, Chief Operating Officer
Gary Raphael, Chief Finance Officer
Dr Marie Williams, GP Member
Dr Cruz Augustine, GP Member
In Attendance:
Allan Jude, Director of Ambulance Commissioning
Helen Lammond-Smith, Head of Commissioning
Janet Barnsley, Head of Contract Management Strategic Locality Lead, M&LCSU
Beth Goodman, Contract Management Locality Lead, M&LCSU
Lesley Anderson-Hadley, Interim Quality and Performance Locality Lead, M&LCSU
John Clark, CMT Finance Officer, M&LCSU
Louise Talbot, Secretary to the Governing Body
SUBJECT
DECISION
1. Apologies for
Absence
Apologies for absence had been received from Amanda Doyle, Michelle
Martin and Helen Skerritt.
2. Declarations of
Interest Relating to
the Items on the
Agenda
The Secretary noted the primary care related issues be declared by GP
members as covered in the CCG’s Register of Interests.
3. Minutes of the
Meeting Held on 24
February 2015
RESOLVED: That the minutes of the meeting held on 24 February 2105
be approved as a correct record.
4. Matters Arising
•
•
5. Integrated
Business Reports:
Six Dedicated Beds for Gynaecology – Lesley explained how the
pressure on beds generally had had an adverse impact on the
availability of gynaecological bed availability. She agreed to discuss
with Helen Skerritt how this should be raised with BTH. The issue
would also be discussed at the Quality and Engagement Committee.
Diagnostics – Agreement had been made with Fylde and Wyre CCG
and BTH to undertake a piece of work on capacity including
diagnostics and elective care. Beth explained that cystoscopy was still
an area of concern and operating close to the threshold. Information
was not always forthcoming from the Trust. It had been raised with
the Trust and it needed to be part of the wider urology pathway.
(a) Financial Report – Eleven Months Ending 28 February 2015 – Gary
reported that the financial position had deteriorated further in month
eleven. The CCG was at risk of not achieving the 1% surplus. Gary had
alerted NHS England and discussed the position with them. Gary
1
ACTION
LA-H/HS
Subject to Ratification at the Next Meeting
explained that we are still signalling that we will achieve the 1% based on
the possibility of improvement in March.
Gary explained that there had been a slight improvement in prescribing
expenditure.
It was noted that we will achieve the target only through non-recurrent
adjustments in-year that would have to be addressed in 2015/16. Whilst
prescribing was still high, it had slightly levelled off. Discussion had been
held at the Executive Team regarding some repeat prescription audits
that had taken place. Further discussion would be held at the Practice
Link meeting to agree some proposals around this.
RESOLVED:
That members receive the financial report.
(b) Performance Business Report – Month Ten – January 2015 – Lesley
took members through the report:
•
•
•
•
•
•
•
•
•
•
•
•
Referral to Treatment (RTT) Target – Whilst the RTT had achieved for
the month, it had failed in Q3.
Diagnostics – The target was failed in January.
4 Hour A&E Waiting Time Target – BTH had not achieved the target
in January. There were activity spikes together with bed capacity
which had attributed to patient flow and had influenced the January
waiting time performance. Nevertheless, overall performance in
Blackpool was better than most other places in the north of England.
12 Hour Trolley Waits in A&E - There had been a breach in January.
A root cause analysis had been undertaken and processes put in place
to avoid a repetition of the breach. It was noted however, that a
further 12 hour breach had occurred in February and a root cause
analysis was currently in progress. The penalties for the Trust are
£1,000 per patient and discussion ensued as to whether a penalty
would be applied. It was felt that in this instance a penalty should be
enacted. It was recognised that it was a Never Event. Lesley
informed members that both herself and Helen Skerritt would be
visiting A&E to assess operational processes.
Cancer Waits – Lesley took members through a variety of different
causes where patients had breached the targets. David would be
picking them up with Lesley outside of the meeting.
Category A Ambulance Calls – Non-achievement of red category
target was noted.
Mixed Sex Accommodation Breaches – There were no breaches in
January.
Cancelled Operations – It was pleasing to note that the target was
good in respect of cancelled operations.
Mental Health – The position was noted.
C.Difficile – Discussion ensued regarding screening levels. The
information within the report in respect of cases was noted.
HSMR – The AQuA review work had commenced with other Trusts.
TIA – It was anticipated that the new referral form should improve
the figures. Lesley would check if the TIA targets were the same for
both local CCGs.
RESOLVED:
That members receive the Performance Business Report.
2
LA-H
Subject to Ratification at the Next Meeting
(c) Delivery Dashboard – Q3 2014/15 – David made reference to the
circulated Q3 delivery dashboard for 2014/15. He informed members
that the quarterly meeting with the Area Team would be held on 10 April
2015. Due to the recent restructure and new management at the Area
Team, it was likely that the meetings would have a different focus than
previously. There would be more focus on performance. David explained
that a pre-meeting had been planned with CCG colleagues to go through
the detail of the delivery dashboard. David took members through the
various indicators. In particular, reference was made to delayed transfers
of care activity which was higher than the baseline. Helen L-S would
check the reasons behind this outside of the meeting.
RESOLVED:
That members receive the Delivery Dashboard for Q3.
(d) Contract Business Report – Month Ten – January 2015 – Beth spoke
to a circulated report and in particular, drew members’ attention to the
following:
•
•
•
•
Dermatology, Day Cases and Vascular Surgery – Beth had been
informed by the Trust that they had agreed a change in pathway for
dermatology however, she was unable to locate any documentation
relating to this. It was noted that there are four dermatology beds at
Clifton Hospital and patients are seen as day cases. Clarification was
sought as to why the dermatology beds were still in existence as they
aren’t across other patches. Beth was awaiting further information in
respect of vascular surgery.
Appointment Slot Issues in Choose and Book – The result of the first
audit had been received following which, a second verification
sample was being progressed. Beth reported that the Trust had
responded to her stating that they could not locate some of the
patients however, the CCG’s Booking and Choice Manager could
locate them on the system. We await further feedback.
Other Acute Providers - Beth reported that cumulative significant
cost over performance remained at LTH, WWL and Spire Fylde Coast
although the extent of this over performance had again slightly
reduced during the month at both WWL and LTH. This would be
monitored and would be part of our contract planning for next year.
Psychological Therapies – Helen explained that we have a recovery
plan to meet the access targets for this year. She reported that
commissioners are working on a plan to achieve the 2015/16 waiting
times targets. We are also looking to commission an element from
the voluntary sector.
RESOLVED:
That members receive the Contract Business Report.
(e) Contract Dashboard
RESOLVED:
That members receive the Contract Dashboards for both
BTH and all other providers.
3
HL-S
Subject to Ratification at the Next Meeting
7. Information
Governance Annual
Report 2014/15
The Agenda was taken out of order.
Gary provided some background in respect of the Information
Governance Annual Report 2014/15. He explained that the IG Toolkit
requires approval from the Committee in order to submit the scores
attained throughout the past year to achieve a satisfactory rating. Gary
explained that the CCG had done well in achieving 86% which was edging
into Level 3. This was good news for the CCG. Gary explained that the
Information Governance Officer will continue to undertake audits
throughout the year.
RESOLVED:
5. Integrated
Business Reports:
That members approve the Information Governance
Annual Report 2014/15 for recommendation to the
Governing Body.
(f) Lancashire Ambulance Performance Report – January 2015 - Allan
spoke to a circulated report in respect of Ambulance activity as at January
2015. Since the report was issued, there was further information in
respect of the February position and he updated members as follows:
•
•
•
•
Activity had reduced but not at the level expected.
Category Red Calls were a cause for concern and activity was up by
approximately 12%. He explained that this drives the demand for
extra ambulance resources.
Contract discussions had been held in respect of the PES. There was
a shortfall of £16m between NWAS and the CCG. Allan explained
however, that there was a general understanding between both
organisations but no movement on how we could broker the
difference. Work was taking place in looking at commissioners
putting in an additional £8m however, it was noted that this would
still leave a shortfall of £16m. He explained that this may need to be
referred to arbitration. Amanda had asked for a letter to be sent out
to all Accountable Officers at the CCGs in the North West setting out
the proposals around this.
PTS – Allan explained that this may also go to arbitration and a
request had been put into the current contract to the value of £4.2m.
Allan explained that the contract had been tendered for a fixed term
of three years.
RESOLVED:
That members receive the Lancashire Ambulance
Performance Reports noting the current issues as
outlined above.
(g) NHS 111 Performance Reports – January 2015 – Allan spoke to the
following reports:
•
•
January – FCMS for Coastal Lancashire.
December – NWAS.
Allan reported that NWAS had been awarded the 111 contract. He
explained that this would offer opportunities to modernise the front end
of services so that we have one point of clinical triage. FCMS is a partner
in the bid and will continue to provide the service.
RESOLVED:
That members receive the NHS 111 Performance Reports.
4
GR/LJT
Subject to Ratification at the Next Meeting
6. CCG Budget
Report 2015/16
Gary conveyed his apologies for the lateness in issuing the report
however, he had only received further information on the position with
BTH at the end of the previous week.
Gary explained that the report proposed the budget for the CCG in
2015/16 and ultimately, it would form the basis of the paper seeking
approval from the Governing Body for the budgets recommended within
the report by the Committee. Gary took members through the report
and in particular, he drew their attention to:
•
•
•
•
•
•
•
•
•
•
Issues for Blackpool CCG in relation to the Five Year Forward View
and business rules.
Gary explained that if we only fund to outturn, we are not identifying
any further growth in our Acute Trust contracts.
Cruz commented that we need more open communication in respect
of care plans with the GP practices.
Allen commented that it would be unrealistic that there was to be no
growth. The reality is that with an ageing population, the demand
continued. He felt that that growth should be minimal and that we
should be planning for smaller growth. Gary agreed, but pointed out
that we could not afford any growth, except for ambulance services,
and therefore, savings are required. He explained that nearly all the
extra funding had gone to fund at outturn levels.
Marie commented that we have an ageing population and an
increasingly complex population.
She commented that the
Extensivist, Better Care and Enhanced Primary Care may improve
issues. It was recognised that people have more expectations and
more needs and they are sent into hospitals as GPs cannot do
anymore for them.
Roy commented that we have to recognise these issues.
Gary commented that we need to see the balance of the report,
which looks at activity trends, savings, the need for developments to
change future provision and the need to hit the business rules.
Janet commented that more could be done on audits of activity and
she felt that we should revisit the re-admissions audit which had been
undertaken a number of years ago.
David Edmundson commented that funding the outturn gives us an
increase in previous plans. Any assumptions would give us a
reduction even if it was one patient per practice per week. There
needed to be clear monitoring on how this is delivered.
Gary then made reference to paragraph 15 within the report where
the CCG had proposed to set the contract baseline for non-elective
activity at 2014/15 outturn less 700 (3.5%) which is to give effect to
the Better Care Funds plans. He explained that given the exceptional
increase in non-elective admissions in 2014/15 compared to previous
years, this must be considered a major risk for the CCG. The report
provided information on the plans to deliver the reduction. He
identified broad areas where we would have an impact. David
Edmundson commented that we would need to have the schemes
well identified and monitored monthly to see what is and what isn’t
working. David Bonson made reference to work currently taking
place in respect of the £5 per head schemes at GP practices.
5
Subject to Ratification at the Next Meeting
Gary then drew members’ attention to other financial issues which
provided information on budgets which were forecast to over perform
significantly against budgets:
•
•
•
Continuing Healthcare
Prescribing
Other Acute Providers
It was commented that we may wish to look at the wording around
funding at outturn. We have looked at referral patterns etc. For
continuing healthcare, it was acceptable to fund it at outturn. Roy made
reference to various appeals panels and money set aside for these.
In respect of prescribing, a question was asked as to whether we should
we be funding at outturn. We should be looking at making savings and it
was reiterated that a piece of work was being undertaken in respect of
repeat prescribing and wastage. It was recognised that we may need to
put funding into other areas. We may need to be more focused and we
would need a wider look at the community pharmacists. We could look
at incentivising practices around this.
David Edmundson suggested stating that continuing healthcare and
prescribing are budgeted provisions which is lower than the outturn and
then have some planned action to bring it down.
Gary explained that we have had to reduce the running cost allowance by
£400,000. The CCG cannot retain this as NHS England had assumed all
CCGs had made their savings and the money had gone into the pot to
offer the notified uplifts to CCGs.
Gary then drew members’ attention to the developments and pressures
in 2015/16. Discussion ensued regarding the source and application of
funds for the 2015/16 financial year. The requirement for the additional
savings programme is £2.898m. If we are unable to achieve this, then
Gary would have to deduct various developments from the budget. He
recognised that we would need to have a balance but was mindful of the
CCG’s risks.
David Bonson made reference to the Vanguard scheme and the work
taking place in respect of the Extensivist which would be up and running
shortly. The risk will be with the CCG as the PbR type contracts for the
bulk of our spend is with the Acute Trust and others. It was recognised
that there would not be as much of a risk to the Trust. David Bonson
explained that using the Map of Medicines work will help the elective
activity. Helen LS also commented that some work in respect of
children’s services on the £5 per head could be undertaken and some
deflections could be made around this.
David Edmundson commented that there was a reasonable balance
between all of the issues and funding of contracts would, therefore, need
to be at outturn. He commented that if the Executive Team can identify
savings, then it should be taken forward however, they would need to be
monitored. David also asked whether we could take off £200,000 from
the prescribing outturn and some off the continuing healthcare budget.
6
Subject to Ratification at the Next Meeting
Gary explained that we would need to decide whether we want to
continue to plan for a 1% surplus and it was an option to consider. He
welcomed the comments and would take them into account for further
discussion with the Executive Team prior to recommending a report to
the Governing Body on 31 March 2015. Gary would update the report
reflecting all the comments made and would circulate the updated report
to members of the Committee when he had had further discussion with
the Executive Team.
RESOLVED:
That members:
•
•
•
8. Items for
Inclusion on the
CCG Risk Register
Note the risks around the contract negotiations
which were still being undertaken.
Note the requirement for a savings programme in
2015/16 to enable a minimum level of
developments to be undertaken.
Taking all the discussions into consideration and
following discussion with the Executives, the
Committee would recommend the budget proposals
to the Governing Body.
Louise noted the following items for inclusion:
•
•
LJT
2015/16 CCG Budgets
2015/16 Ambulance Contract – Blackpool CCG risk as lead
commissioner
9. Agenda Items for
the CCG Governing
Body Meetings
– 31 March 2015
and 5 May
•
10. Any Other
Business
There were no issues.
11. Declaration of
Confidentiality
That with the exception of any agreed items to be submitted to the CCG
Governing Body meeting held in public, all other items should be
regarded as confidential.
12. Date, Time and
Venue of Next
Meeting
The next meeting would be held on Tuesday, 28 April 2015 at 1.00 pm in
the Boardroom, Blackpool CCG.
•
GR
31 March 2015 – 2015/16 Budgets
5 May 2015 – Financial Dashboard, Performance Dashboards and
report, Delivery Dashboard and Information Governance annual
report 2014/15
7
LJT