NHS England CCG Authorisation Post Authorisation December 2013 Review Conditions Report CCG name: Vale of York CCG Wave: 3 Regional Operations Director Jon Develing Date report generated: 22/01/2014 Vale of York CCG:Post Authorisation December 2013 Review Conditions Report page 1
Dashboard summary assessment post review Summary Domain Dashboard Assessment threshold outcomes No. of reds No. of greens Criteria changed following review 1. A strong clinical and multi-professional focus 0 17 which brings real added value 2. Meaningful engagement with patients, carers 0 15 and their communities 3. Clear and credible plans which continue to deliver the QIPP (quality, innovation, productivity and prevention) challenge within financial resources, in line with national requirements (including excellent outcomes) and local joint health and wellbeing strategies 0 22 3.1.1 - B (R -> G) 3.1.1 - C (R -> G) 3.1.1 - D (R -> G) 4. Proper constitutional and governance arrangements, with the capacity and capability to 0 32 4.3.1 - C (R -> G) deliver all their duties and responsibilities including financial control, as well as effectively commissioning all the services for which they are responsible 5. Collaborative arrangements for commissioning 0 17 with other CCGs, local authorities and the NHSCB as well as the appropriate commissioning support 6. Great leaders who individually and collectively 0 16 can make a real difference Total 119 authorisation sub-criteria 0 119 4 total Overall Summary The CCG has four remaining conditions. Three of which are linked to its plan, financial plan and QIPP: 3.1.1.B, 3.1.1.C and 3.1.1.D. The fourth condition, 4.3.1.C relates to its capacity and capability to deliver its full range of responsibilities. The CCG has made considerable progress since authorisation and the development of a balanced financial plan is a significant achievement. The support offered by NHS England, principally through the area team, has played a substantial role in enabling the CCG to address its outstanding conditions and to achieve the necessary thresholds for the criteria linked to its plan and financial plan: 3.1.1.B and 3.1.1.C. The CCG has now completed its structuring and has a dedicated CFO, supported by a finance and contracting team, and so has addressed the outstanding issue linked to 4.3.1.C. The CCG still faces significant financial challenges, including the resolution to its underlying deficit position. The change in year to the QIPP plan and the forecast shortfall in delivery of the reduced QIPP plan are indications of the fragility of the financial position in-year. The panel concluded that the threshold for authorisation linked to 3.1.1.D had been reached but that the changes to the plan in year needed to be followed up with the CCG by NHS England. The transition from conditions, with Directions, to a fully authorised CCG will mean that NHS England will need to continue to support the CCG as part of its ongoing assurance role. Vale of York CCG:Post Authorisation December 2013 Review Conditions Report page 2
In respect of authorisation, the evidence submitted has been cross referenced against the outstanding conditions and the ROD panel concluded that the thresholds for all four remaining criteria had now been met. Hence it is the ROD's recommendation that all outstanding conditions and consequently directions be removed. Vale of York CCG:Post Authorisation December 2013 Review Conditions Report page 3
(3.1.1 - B) Clear and CCG must have a credible plans that set out clear and credible how CCGs will take integrated plan that responsibility for service meets authorisation transformation that will requirements improve quality within available resources. CCG has a clear and credible integrated plan, which includes an operating plan for 2012-13, draft commissioning intentions for 2013-14 and a high-level strategic plan until 2014-15. E IV The outstanding issue was that further evidence is required to show how the CCG has developed commissioning plans consistent with the need to address its underlying financial deficit. At site visit the CCG declared that they did not have fully formed QIPP plans for 2013/14 or high level plans for 2014/15. The financial plan at that time did not support the ability to invest in services. The CCG has submitted the following evidence demonstrating significant progress towards meeting this criterion: - Integrated Operating Plan (IOP) 2013-14 - Area Team financial report and action plan - Financial Plan August 2013 - QIPP Dashboard and Profile Chart The CCG has developed a commissioning plan that with its supporting financial plan achieves balance with a planned 1% surplus. The CCG has developed a QIPP plan as evidenced by the QIPP dashboard and profile chart. The CCG has provided evidence that the initial QIPP plan of 10.9m for 2013/14 has now been reduced to 6.8m that would generate a planned surplus of 0.57%. The panel was advised that the projected year end surplus might now be closer to 0.25% and that QIPP was forecast to achieve 4.5m. The CCG s evidence does not demonstrate whether or not the underlying financial position has been addressed, which was one of the outstanding issues raised at moderation. It was noted that balance this year is proposed to be achieved in part due to significant non-recurrent funding including a 1.7m transfer from the CCG s running costs, or 20% of the total allowance. On balance the panel considered that this issue, that of the underlying deficit, needed to be followed up as part of the ongoing assurance of the CCG by NHS England and should not be a bar on its own to the achievement of the threshold. The panel noted that although there is sufficient evidence for the condition to be released, ongoing support is required due to the vulnerability of the CCG s financial position, which requires ongoing inyear intensive support and monitoring, particularly on the progress in achieving its QIPP plan. Vale of York CCG:Post Authorisation December 2013 Review Conditions Report page 4
The evidence submitted by the CCG for 3.1.1.B demonstrates that the threshold for this criterion has now been met. Vale of York CCG:Post Authorisation December 2013 Review Conditions Report page 5
(3.1.1 - C) Clear and CCG must have credible plans that set out detailed financial plan how CCGs will take that delivers financial responsibility for service balance, sets out how transformation that will it will manage within improve quality within its management available resources. CCG allowance, and is has detailed financial plan integrated with the that delivers financial commissioning plan balance, sets out how it will manage within its management allowance, and any other requirements set by the NHSCB and is integrated with the... E IV The outstanding issue at site visit was that the CCG stated that the CCG s plan assumes that the 2% non-recurrent funds of 6.7m in 2013/14 were to be used to repay the 2012/13 forecast deficit of 5.4m. This resulted in residual non recurrent funding of 1.3m supporting the underlying position and contributing to the delivery of a 0.3m surplus. Further, no non recurrent funding was therefore available to pump prime service redesign of reconfiguration arising from the acute services review thereby impairing the credibility of the financial plan. QIPP schemes for 2013/14 and beyond were not yet fully developed. The CCG has submitted the following evidence demonstrating significant progress towards meeting this criterion: - Month 7 Dashboard & commentary - Deep dive action plan - Deep dive task schedule - Operational Financial Plan 2013/14 - Planning template for 2014/15 - Risk Share Agreement The CCG has developed a financial plan that the area team has assured, including through a financial Deep Dive conducted in November 2013. The area team has advised that the CCG has made significant progress in building an assessment of its financial position with robust monitoring and governance arrangements to enable the recognition of risks and mitigating actions to support delivery of targets in 2013/14. As noted in the comments on 3.1.1.B, the underlying financial position has still to be resolved and the CCG has reduced its QIPP target in year from 10.5 to 6.8m with the resulting gap, and underlying issue, covered through the use of non-recurrent funding. The panel concluded that although the production of a balanced financial plan meant that the threshold for authorisation had been achieved that the re-profiling of the QIPP plan, the shortfall against the QIPP trajectory and the need to still address the underlying position meant that these issues would need to be followed up by NHS England as part of its ongoing assurance of the CCG. The panel noted that although there is sufficient evidence for the condition to be released, ongoing support is required due to the vulnerability of the CCG s financial position, which requires ongoing inyear intensive support and monitoring, particularly on the progress in Vale of York CCG:Post Authorisation December 2013 Review Conditions Report page 6
achieving its QIPP plan. The evidence submitted by the CCG for 3.1.1.C demonstrates that the threshold for this criterion has now been met. Vale of York CCG:Post Authorisation December 2013 Review Conditions Report page 7
(3.1.1 - D) Clear and Demonstrate that credible plans that set out QIPP is integrated how CCGs will take within all plans and responsibility for service clearly explain any transformation that will changes to existing improve quality within QIPP plans available resources. QIPP is integrated within all plans. Clear explanation of any changes to existing QIPP plans. E IV At site visit there was a lack of detail about how the CCG's QIPP plan specifically related to its financial strategy and plan. The CCG was using non-recurrent funds to close the financial gap. There was still a need to demonstrate that QIPP was integrated within all plans. The CCG has submitted the following evidence demonstrating significant progress towards meeting this criterion: - Integrated Operating Plan 2013-14 - Area Team financial report and action plan - Financial Plan August 2013 - QIPP Dashboard and Profile Chart - Month 7 dashboard and commentary - Risk Share Agreement The CCG has provided evidence that its QIPP plan relates to its financial strategy and plan and is integrated with them. The CCG s original plan assumed a delivery of a 10.9m programme in 2013/14. In year this has been reduced to 6.8m. The CCG s evidence indicates that 4.5m will actually be achieved by year end. The area team reports that the CCG has identified contingency plans against high risk schemes to mitigate against possible non-delivery in 2013/14. The reduction in the contribution of QIPP to achieving financial balance has been covered through the use of non-recurrent funding. The panel discussed this condition at some length and concluded that the threshold had been met. However given the current forecast for delivery of QIPP and the underlying financial position it was felt that this issue exposed the CCG to a high level of vulnerability and that there would need to be ongoing support from NHS England as part of its assurance of the CCG. The panel noted that although there is sufficient evidence for the condition to be released, ongoing support is required due to the vulnerability of the CCG s financial position, which requires ongoing inyear intensive support and monitoring, particularly on the progress in achieving its QIPP plan. The evidence submitted by the CCG for 3.1.1.D demonstrates that the threshold for this criterion has now been met. Vale of York CCG:Post Authorisation December 2013 Review Conditions Report page 8
(4.3.1 - C) Capacity and Demonstrate how capability to commission key proposed staff areas of care for which they resource and any are responsible. CCG can contracted demonstrate how its commissioning proposed staff resource and support will provide any contracted capacity and commissioning support will capability to deliver its provide capacity and full range of capability to deliver its full responsibilities. range of responsibilities. A, E IV Following the site visit, this criterion was moderated to red by the national moderation panel as it was not clear whether the CCG had adequately addressed the issue around the capacity of joint appointments to support its work and shown how the proposed staff resource and any contracted commissioning support will provide capacity and capability to deliver its full range of responsibilities. The CCG has submitted the following evidence demonstrating significant progress towards meeting this criterion: - Staffing structure - Narrative - Committee Review The CCG has addressed the issue raised at moderation and at the September Conditions Review with the appointment of its full time CFO, supported by an in house finance and contracting team of 14 wte. There is also a full time Chief Nurse and the CCG has described the support that it is obtaining from the CSU, including 13 staff embedded in the CCG. The evidence submitted by the CCG for 4.3.1.C demonstrates that the threshold for this criterion has now been met. Vale of York CCG:Post Authorisation December 2013 Review Conditions Report page 9