1.2.1 The minutes from the last meeting were agreed and recorded as accurate.

Transcription

1 Minutes Meeting of the Haringey CCG Finance and Performance Committee Thursday 17 December 2015, 13:00 15:00 Room 7, 4 th Floor, River Park House, 225 High Road, N22 8HQ Present: Name Initials Title John Rohan (Chair) JR North East Lead, Haringey CCG Sherry Tang ST Chair, Haringey CCG Sarah Price SP Chief Officer, Haringey CCG David Maloney DM Chief Finance Officer, Haringey CCG Jill Shattock JS Director of Commissioning, Haringey CCG Adam Sharples AS Lay Member, Haringey CCG Dina Dhorajiwala DD West GP Member, Haringey CCG Aisling Bowman AB Assistant Director for Acute Contracts and QIPP, Haringey CCG Ernie Gartrell EG Associate Director of Contracting, NEL CSU In Attendance Steve Beeho SB Head of Integrated Governance, Haringey CCG Louisa Dearman (minutes) LD Primary Care Administrator, Haringey CCG 1. INTRODUCTION Action 1.1 Apologies for absence Apologies were received from Eileen Fiori and Seonaid Henderson. 1.2 Minutes from last meeting/ matters arising The minutes from the last meeting were agreed and recorded as accurate. 1.3 Matters Arising and Action Log Action 19/11/15 01: complete. Seonaid Henderson circulated information about LAS performance on 2 nd and 9 th December Action 19/11/15 02: complete. Cassie Williams had confirmed that the Primary Care dashboards will be available in January 2016 and on alternate months from then on Action 19/11/15 03: AB noted that she will create a more in depth dashboard detailing the Community Health Services performance information. This is currently in progress Action 19/11/15 04: JS noted that emerging cancer target issues will be included as a specific target risk on the risk register until the CCG has assurance. In response to a query, JS noted that performance risks are left on the log until there is assurance that issues have been rectified. 2. Month 8 Finance Report 2.1 DM noted that the report contains information up to the end of November There is an overall over spend of 400,000. DM noted that an area of focus during the month was the run rate on acute contracts where it stabilised in line with the average following a high run rate from month 5. Where there are risks, these largely sit outside local contracts where Haringey CCG has greater control; for example Barnet & Chase Farm, Royal Free and Barts Healthcare. Non acute budgets were overspent by 200k. This reflects a worsening in the Continuing Healthcare position but as DM noted, takes into account the Better Care

2 Fund (BCF) contingency of 300,000 for the first quarter. Overall, DM noted that he is able to forecast achieving a balanced position at the year end, but this carries a degree of risk. DM explained that the CCG would be submitting a bid to the NCL Risk-Share in light of the increase in critical care expenditure of 2.5million compared to last year. 2.2 Regarding North Middlesex University Hospital (NMUH), DM noted that there is a particular financial pressure relating to unplanned paediatric admissions and the intention is to include this in a year-end deal to close off the 2015/16 position with the Trust. Regarding this point, DM advised that a deal would also look to include agreements for key CCG issues also for 2016/17. All agreed this point. SP noted that she has been in contact with Julie Lowe in order to make plans for the next financial year so that ongoing issues are sorted. With regards to high levels of admissions, SP noted that the issue cannot solely be an issue of money; there needs to be assurance about clinical safety too. All agreed this point. 2.3 DM noted that with regards to the Royal Free Hospital, the contract continues to overspend; in month 8 there has been an over spend of 300,000. This over spend includes 200,000 for critical care of two patients; it is understood that the remainder related to planned care. 2.4 With regards to Whittington Health, DM noted that there are concerns over the accuracy of activity and information provided. DM noted that any risk is covered by the cap and collar and the CCG is reporting its financial position in line with the cap. The Trust is wishing to agree a year-end position with its local CCGs. DM noted that in terms of the palliative care service transfer, Whittington Health has not completely signed this off. This is to be resolved. It is likely that the CCG will need to invoice Whittington Health. 2.5 DM explained that the CCG was continuing to forecast a break-even position by the end of the year, albeit a position that included a degree of risk. DM noted that the CCG had limited room for manoeuvre if there was an increase in the run-rate for the rest of the year. DM explained that Chief Finance Officers of CCGs in NCL would agree the use of the NCL Risk Share and then make a recommendation to Chief Officers. It was planned that this would be closed off by the end of January. JR queried the risks across NCL. DM explained that in particular Enfield CCG had a tight financial position and had limited scope to cover any worsening in their position. 2.6 Regarding risk, AS asked to clarify to what extent additional risks and mitigations were played into the CCG s financial position. DM explained that the risks/mitigations table included in the Finance Report was additional to the numbers reported in the financial position. He explained that the CCG would be looking to finalise year-end positions with providers to mitigate against the possibility of future risks and cost pressures. DM also noted that the BCF contingency for the whole year is not played into the CCG and the CCG has taken a prudent position on claims and challenges. 3. Integrated Contract Monitoring Report 3.1 EG noted that the UCLH contract was signed last week and contract query notices were raised for UCLH as well as for NMUH and Royal Free for cancer diagnoses. EG noted that the impact of the cardiac transfer from UCLH to Bart s Health is being monitored carefully. 3.2 SP noted that, regarding diagnostics at NMUH, pressures on cancer have increased, but Eileen Fiori is working with the Trust on agreeing a recovery position. NMUH had 2

3 a reduced capacity and wanted to push its trajectory to March, however this was rejected by NHS England. NMUH is looking to buy private capacity; however it was noted that many Trusts are struggling with their cancer pathways. 3.3 In terms of A&E attendance, SP noted that rates at NMUH are still high and the Trust is looking at additional clinical capacity. SP noted that NHS England required Haringey CCG to enlist the use of McKinsey consultants to evaluate the flow of patients, protocols, and front desk triaging and to make recommendations to Haringey CCG and the Trust for ways that the system can improve. SP noted that the feedback highlighted the slow pace of discharge management that is not improving. SP noted that this is something herself and Julie Lowe will focus on from January SP noted that the temporary Medical Director is having a positive impact, and there will be an Assistant Director for Nursing in post from January. 4. QIPP Update 4.1 AB noted that QIPP performance in month 8 is in a similar position to that in month AB noted that in terms of QIPP schemes, they are delivering but with ongoing pressures. The QIPP Delivery Group had noted that the community gynaecology service at Whittington Health is not performing as planned. Islington CCG has similar concerns. The service also has high rates of DNAs. JR noted that if the service is not delivering, it is a case for re-procurement. AB noted that due to the performance criteria, it wouldn t be necessary for the CCGs to have to go through the whole procurement process. 5. NCL Financial Base Case - Update 5.1 DM noted that there was a discussion at the Governing Body seminar on 10 December 2015 about what should be done to reduce the financial gap. DM noted that it was expected that more work will need to be done from January 2016 by the CCGs in conjunction with the local councils and providers. He explained that the latest estimate of the do nothing gap for the NCL health and social care economy was 1.6bn. 5.2 AS noted that any savings on a large scale need to be developed in a cooperative way. SP agreed and noted that NHS England is arguing for there to be more collective responsibility. Therefore, SP noted that the CCG will be meeting with providers and the local authority on 26 January 2016 to discuss future collaborative working across the borough and to clarify responsibilities. 5.3 Regarding the 2016/17 allocation, DM noted that there was an NHS England board meeting today with a follow up phone call on Friday 18 th or Monday 21 st December 2015 which will clarify the implications for Haringey. DM noted that he can send the headlines from this meeting to Committee members next week, ahead of receiving the full picture in January. DM noted that it was likely that there would be a tariff inflator in 2016/17 which would add a financial cost to CCG positions. ACTION 17/12/15 01: Circulate the headlines from the NHS England board meeting concerning the 2016/17 budget allocation affecting Haringey to the Committee. DM /17 QIPP Plan 6.1 AB noted that the plan outlines the future challenges and lessons learned from 2015/16 such as contract negotiations and ensuring robust PIDs etc. AB noted that currently the draft QIPP plan for 2016/17 was 7 million. AB explained that it was important for CCG QIPP plans to be worked up early in the planning cycle so that 3

4 early conversations with providers could commence. 6.2 For 2015/16, AB noted that largely providers has accepted CCG QIPP areas, but suggested that the CCG could push projects further in 2016/17 and negotiate into contracts for next year. The Committee noted the plan for next year s QIPP schemes including various urgent/unscheduled schemes, provider efficiency schemes, and primary care-led schemes. 6.3 Regarding pathology test results, AB noted that there is an opportunity to reduce test usage. This model has been tested in Barnet where savings have been made. AB noted that this model could be applied in Haringey and Barnet is happy to share their work. All agreed this would be useful. ACTION 17/12/15 02: AB to gather the work of Barnet CCG on a pathology testing model for potential use in Haringey. AB 6.4 ST highlighted the medicines management prescribing figure of 800,000 and queried the figure. AB noted that Pauline Taylor had provided this figure based on various schemes led by the Medicines Management team, and acknowledged it was an optimistic but achievable figure. 6.5 DD queried the utilisation of the UCCs. AB noted that 40% of attendees are channelled at NMUH, and this is similar at Whittington Health. SP noted that LAS is agreeing a process with the Trust to stream patients due to the pressures in the department. 6.6 ST queried the figure set for Mental Health Continuing Healthcare. AB noted that more funding has been requested in the Continuing Healthcare budget in order to deliver the QIPP. AB noted that Shelly Shenker also has ideas of mental health QIPP schemes in the pipeline and first steps will be taken now to ensure efficient delivery. 6.7 In terms of the profile for the next two years, AB noted that urgent care will be a focus, in both paediatric and adult care. DM noted that working with other CCGs, providers, and the local authority will be essential and the required level of savings is dependent on whole-system changes to ensure effectiveness. 6.8 All agreed that the QIPP plan will need to be taken to Clinical Cabinet soon. JS noted that it can be taken to the meeting on 7 January 2016 which will focus discussion on the QIPP plan and the plans for the PMS review. All agreed this. ACTION 17/12/15 03: Present the 2016/17 QIPP Plan at the next Clinical Cabinet meeting in January JS 7. Integrated Contract Monitoring Report (Performance) 7.1 All noted the Integrated Contract Monitoring Report provided in the papers for the meeting. JS noted that LAS attended the pan-12 CCG group meeting where attendees agreed to meet more regularly. LAS proposed a year end trajectory achievement of 73.4%. JS suggested that LAS is supported to handle calls better at a larger scale. The LAS CQRG is being rejuvenated because there were many actions that were not being scrutinised. In terms of recovery, JS noted that information is not available yet as it is to be confirmed and clarified. All noted this. 8. Impact of Investment on GP Access 8.1 All noted the report and agreed on its clarity. 8.2 JS asked whether this information rang true with GPs with what they see on the 4

5 ground. JR noted that there are ongoing issues with telephone access and patients not getting through, despite the fact that many patients problems can be solved over the phone. The majority of the missed calls are between 08:30 09:00 with the longest waiting times as well. SP noted that this is much to do with learned behaviour that patients can only get an appointment if they call early. All agreed this point and agreed that an area to focus initial attention is initial access and addressing a change of habit. 8.3 AS noted that despite high demand at the beginning and end of the day, the uptake of out of hours services seemed to be small. JS noted that there was greater uptake in the west than the east of the borough. JR noted that more hubs are needed in the east. SP noted that the issue is the lack of larger practices in the east with capacity to become an out of hours hub, particularly in the Green Lanes area. 8.4 The Committee agreed with the report s conclusion that a systematic solution across the borough is needed to improve overall access. 9. Review of Finance & Performance Committee s Effectiveness 9.1 SB attended the meeting to present the feedback from the self-assessment of the Finance & Performance Committee. SB noted this review was part of the rolling programme for overall assessment of the effectiveness of the CCG s committees. SB noted that overall there were favourable responses from members. SB asked the Committee for any feedback before he consolidated the outcome of the review for the Audit Committee. 9.2 SP noted that the Committee s meetings usually run well, however timing is an ongoing issue and improvements could be made. SP noted that reports which come to the Committee could be presented in a more concise way and the Committee could be stricter on time allocated for each item in order to get through business efficiently. All agreed this point. All agreed with SP that the finance aspect usually takes precedence over the performance aspect of the meeting, but all appreciated the challenge in balancing the discussion. 9.3 AS noted the high quality of the reports which come to the Committee and that the meetings usually get through the business efficiently. AS queried if providers could attend meetings. JR noted that provider representatives used to attend meetings, but this was seen as not very constructive. All agreed that representatives could be invited on an ad hoc basis for certain items. 9.4 JR noted that it may be useful for him and DM to have an initial phone conversation about the agenda items and pick out key issues for the Committee to focus on at each meeting. DM agreed that a phone conversation prior to each meeting would be useful. 9.5 Regarding membership, ST noted that the Terms of Reference should clarify that membership is made up of 3 GPs including the Chair. All agreed this point. 9.6 All agreed that the feedback is encouraging. SB noted that the next step of this review process will be for him to alter the Committee review paper for the next Audit Committee following this discussion. 10 Risk Register Review 5

6 10.1 The Committee noted the Risk Register. 11. Any other business 11.1 JS noted that the task and finish group to create the operating plan for next year would shortly commence. JS flagged that teleconferences may be needed in order that the Committee had oversight over the CCG s submission. All noted this. DATE OF NEXT MEETING Thursday 28 January 2016, 13:00-15:00 Room 7, Level 4 River Park House, 225 High Road, N22 8HQ 6