Airedale, Wharfedale & Craven CCG X Bradford City CCG X Bradford Districts CCG X Minutes of the Joint Finance and Performance Committee Meeting Thursday 7 th June 2018, 11 1, Millennium Business Park Present: Neil Fell (Chair) Lay Member for Governance AWC CCG Liz Allen Director of Accountable Care BC CCG & Clinical Board Representative BC CCG Julie Lawreniuk Chief Finance Officer 3 CCGs Bryan Millar Lay Member for Finance 3 CCGs Sue Pitkethly Director of Accountable Care AWC CCG Dr Colin Renwick Clinical Executive Representative AWC CCG Dr Dave Tatham Clinical Board Representative BD CCG Apologies: Sarah Dick Head of Governance 3 CCGs In Attendance: Robert Maden Deputy Chief Finance Officer 3 CCGs Alison Needham Deputy Director of Financial Strategy 3 CCGs Richard Wall Deputy Director of Contracting 3 CCGs Kerry Weir Deputy Director, Planning, Performance & Assurance 3 CCGs Sharon Wood (minutes) PA to Chief Finance Officer 3 CCGs 1. Apologies Apologies had been received as noted above. 2. Declarations of Interest There were no declarations of interest relating to the items on the agenda. The register of interests records all interests declared and is available at: http://www.airedalewharfedalecravenccg.nhs.uk/ for Airedale, Wharfedale and Craven CCG http://www.bradfordcityccg.nhs.uk/ for Bradford City CCG http://www.bradforddistrictsccg.nhs.uk/ for Bradford Districts CCG 3. Minutes of the Meeting held on 3 rd May 2018 The minutes of the Joint Finance and Performance Committee meeting held on the 3 rd May 2018 were agreed to be an accurate record. 4. Action Log Specific items which other Committees should have oversight or take actions on are now highlighted within the individual agenda item. Presentation on Aligned incentive contracts to be shared with Committee Members - Julie confirmed this was shared and was discussed at Airedale Accountable Care Development session and is still work in progress.
RAG Activity Reporting - Julie confirmed a meeting was held to discuss and it was agreed that the reporting will flow through the Finance and Performance report through the continuing care section of the finance report. Clare Smart has done some work around authorisation limits which the finance team need to have a look at. Robert confirmed CCGs are looking to identifying weekly approval amounts as opposed to total value of contract. The suggestion is to put them into bands and assign budget holder responsibility to those bands and then anything with a high cost will come through as an exceptional item in the finance report. 5. Performance Report Kerry Weir gave an update Key points to note are: 18 week performance continues to be delivered by Airedale at an overall level but there are still pressures. CCGs are seeing a deteriorating position at Bradford with an increase in the validated 14 plus waiting list, there are 2 issues relating to the 18 weeks which are capacity issues relating to EPR implementation and also a data quality issue. As part of their recovery plan they are looking clearly at patient safety and clinical harm and clearing the back log and have secured some funding to support the validation process. Reporting issues continue following implementation of the new EPR system at BTHFT and the latest CCG scorecard position is therefore not a true reflection of performance; Performance at BTHFT against the RTT and Cancer wait time targets also remains a significant concern, Trust recovery plans in place. All recovery plans will be monitored via the contract management meetings; Airedale Hospital Foundation Trust (AHFT) continues to fail the diagnostic 6 week wait target as a result of the service pressures for Ultrasound. Although BTHFT s reported position for April continues to indicate less than 1% of patients are waiting over 6 weeks, the data still excludes Endoscopy and Neurophysiology, which are still undergoing testing and data validation by Cerner. The Trust is predicting a breach position and a recovery plan is being developed. Cancer - Airedale achieved the 62 day target but did have some breaches with the 2 weeks breast cancer target, they are expecting to correct this by May (this was due to some capacity issues). Cancer performance at Bradford remains poor, failures in 2 weeks, 62 day treatment and 62 day screening targets. A&E targets both Trusts failed to deliver the A&E target for April. Issues at Airedale Trust are around delayed first assessment due to staffing capacity and bed holds. Bradford Hospitals are showing deterioration in performance although activity levels are remaining the same. CCGs need to know the issues and this will be picked up within the Urgent Care Programme Board. Venous Thromboembolism - Both AHFT and BTHFT performance was above the 95% threshold in April. This is the first time BTHFT has achieved the target since June 2016. End of year performance against the national CQUIN scheme has in general been positive, with the three main providers performing significantly better than earlier forecasts; BDCFT was named the top performing Mental Health Trust in England for its flu campaign, 83% Both acute Trusts failed to deliver the totality of the sepsis CQUIN, and this is likely to become more challenging 2018/19; CQUINS 4 & 8: These schemes encourage partnership working between mental health, community and secondary care providers. Delivery of the two CQUINS in 2017/18 has seen a circa 25% reduction in A&E attendances from the cohort of identified frequent attenders with mental health issues and an increase in patients discharged back to their usual place of residence following an acute admission. Poor performance against constitutional standards continues to impact upon CCGs IAF assessment; AWCs appeal in regards to the CCG IAF baseline compliance assessment against the standards of public and patient participation was unsuccessful. Confirmation has recently been received that the ratings for the CCGs are AWC (amber), City (Green) and Districts (Green). The letter received with the results did state this was the final decision and Helen Hirst is keen to feed back to NHSE the inconsistency CCGs have seen in the ratings across
all 3 CCGs which is a bit disappointing given the shared functions that CCGs have. Julie confirmed this is detailed in the Assurance Letter CCGs received from NHSE. Bryan asked for an update on the EPR position as the CCGs were expecting to know by the first week in June if everything was operational. Kerry confirmed CCGs are receiving data and Richard will update on his item. Julie confirmed Q4 finance ratings for the IAF, AWC and Bradford City will be rated as green and Bradford Districts will be rated as amber, this is because if you don t deliver 95% of your QIPP you are amber. Bradford Districts had a high QIPP target in 2017/18. Julie confirmed when the Joint Quality Committee met with BTHFT s Quality Committee they looked at what BTHFT s processes were for internally escalating areas of concern and how they managed those areas of concern. The CCGs confirmed after the meeting they could only be assured once they start to see an improvement in performance. Julie and Michelle had a phone call with CQC and fed those concerns into the discussion. Recommendations; Noted the update on performance against the constitutional targets; Noted the end of year CQUIN performance; Noted the Q3 IAF position; and Highlighted AWCs appeal in regards to the CCG IAF baseline compliance assessment against the standards of public and patient participation been unsuccessful. Highlighted a number of concerns and the actions being taken. The committee noted that even at this early stage in the year a number of recovery plans were required to be in place. 6. Contracting Report Richard Wall gave an update. All main provider contracts have been issued and signed as part of the NHSE planning guidance deadlines for 2018/19. In the case of both Airedale FT and BTHFT attempts were made to agree either the whole or a portion of the contract as a block. Although Airedale FT were close to agreeing, BTHFT were some distance from agreement. Work will be ongoing throughout 2018/19 with both Trusts to try and reach a resolution and move towards an aligned incentive contract. Moving forward into 2018/19 processes are being established with Airedale FT to explore the move towards an aligned incentive contract. BTHFT have been explicit in their desire for a full PbR based contract, and although CCGs will be working with them to move towards a block CCGs fully expect to apply exacting rules to how PbR activity is monitored, challenged when necessary and utilised for payment. This is dependent on BTHFTs insistence that the new EPR monitoring system will resume reporting from 21st May 2018, when month 12 outturn is expected to be uploaded into SUS. BTHFT did make a month 12 submission by the due date. The data provides activity from month 6 to month 12 which they had previously been unable to report. Data was received by the CCG in early June and a period of analysis and clarifications is underway. Bryan asked if there was a financial implication and Julie confirmed for last year 17/18 there is no financial implication. The Contracting team is undertaking an internal review of contracts which has highlighted the volume and duplication in of contracts and agreements currently held, with the intention of trying to rationalise and reduce the total number. For example some organisations hold multiple
contracts as opposed to one contract holding specifications and a more detailed finance schedule. Recommendations; Noted the contents of the report 7. QIPP Report Alison Needham gave an update. What is included within the report is the high level QIPP numbers for 2018/19. CCGs agreed a QIPP value at the start of the year and charts changes as the year progresses. Airedale CCG has reduced 838k out of the 3.4m unidentified gap. Going forward there will be a detailed dashboard with trajectories and what CCGs will do in the report is provide information around where CCGs have not achieved, what actions are being taken and where they are doing well. Bryan confirmed that the personalised commissioning target for Bradford City appears to have more identified QIPP than originally, Alison confirmed they did a QIPP target aligned to them all and work has progressed on splitting that down between the 3 CCGS. There are a number of areas that don t fall under a programme banner and Alison would like to align all schemes to a programme so they have a home and ownership. The challenge for AWC is a gap of 2.6m, and at the moment there is not enough contingency to manage that gap. Neil highlighted a couple of queries relating to Castleberg and Bradford Districts figure. 300k castleberg figure - Sue confirmed this is the part year impact of the 650k revenue costs. Districts figure is less than last year - Alison confirmed the QIPP target for Bradford Districts last year was 13m. This year the target isn t as high, Bradford Districts underlying position is stronger and this can be seen through a reduced QIPP Plan. If AWC deliver the 18/19 QIPP plan the challenge the year after is not as high. The Autumn Budget (2017) and the extra resources that came in from that has helped to stabilise CCG financial positions, resulting in more realistic QIPP targets, particularly for Bradford Districts CCG. Recommendations: The Finance and Performance Committee Noted the contents of the report Highlighted the challenge for AWC is a gap of 2.6m, and at the moment the CCG doesn t have enough contingency to manage that gap, but work is ongoing. 8. Finance Report Robert Maden gave a verbal update on the areas that were flagged up as requiring further work when the plans were signed off. There are 5 main areas the finance team are working through: 1. Care Home fee uplift is the most significant ones where CCGs have gone with the LA figure that they have put out in their consultation process which finishes in 2/3 weeks time. There is a follow up meeting arranged to talk about the implications of the response to that consultation which could result in an increase to care home costs.
2. CCGs are working with Primary Care contract implementation guidance in terms of understanding the costs that have come out of the national agreement, and in particular, the indemnity cost contribution change and whether that gives us an additional pressure or not. In 17/18, nationally the contribution was 30m split across all CCGs, but this has now increased to 60m as part of the GMS contract agreement for 2018/19. 3. Use of improved Better Care Fund monies CCGs met with the LA to talk about their improved Better Care Fund allocation which goes direct to them which has gone up from 12m in 17/18 to 16m in 18/19. A lot of that is around keeping the care home market stable and they have used a lot of this money to support their fee increase. CCGs were talking to them about particular risks that still remained around certain contracts like Turning Point and also the potential for a higher increase in fee rates for 2018/19. A further meeting is planned with the LA. 4. NHSE wrote out to CCGs saying they would be picking up the costs of what is referred to as Primary Care Enabling Services, which covers things like registration authority support, Information Governance support for practices and NHS mail admin support. Simon Wilson is picking this up through the Chief Information Officer network to understand what the implications of this are. 5. Impact of the Agenda for Change Pay Award and funding for it - Trusts will be fully funded for the impact of the new pay award, there remains a risk about whether CCGs will also receive additional funding for this. Bryan raised a couple of queries: Care Home Fees - are you saying that changes the council make payments for residential care will have a knock on effect for us in terms of nursing care costs? Robert confirmed CCGs have jointly negotiated those fee uplifts and have always taken a fairly consistent approach to uplifts just so they can present a united front to the market, and be seen to treating everyone fairly. That s not to say you need to do the same thing but if you do something different there needs to be a reasonable explanation as to why. The Council have responsibility for commissioning school nurses and Health Visitors. They are currently going through an exercise to re-procure these services with a reduced budget. This is currently reported on the CCG risk register as a purple risk. The wording of this risk is currently under review. 9. Terms of Reference The Joint Finance & Performance Committee was established as a joint committee across the 3CCGs last year and its terms of reference were approved by the respective Councils of Members / Representatives in June 2017. The TOR document states that it will be reviewed at least annually. Whilst the role of JFPC is to advise and support the Governing Bodies through oversight of key financial and performance indicators / targets, its legal form (as is the case for all joint committees) is as a committee of the CCG and it is thus directly accountable to member practices. There were a small number of suggested amendments and comments arising from work recently undertaken by Internal Audit which generated a number of queries. It was agreed that Julie would have a conversation with Sarah to address these and bring an update to the next meeting. Recommendations; Reviewed the attached terms of reference; and Recommended that ToR be brought back to the next meeting of the committee with further information to answer the queries that had been raised.
10, Risk Register Julie gave an update on behalf of Sarah Dick There are currently a total of 24 open JFPC risks. Of these: No JFPC risks are classed as critical (scoring 20 to 25). There are five JFPC risks classed as serious (scoring 15 or 16) this is compared to eight such risks at the last risk cycle. Seven new JFPC risks have been added to the Risk Register during the current risk cycle. These include the 2018/19 financial position risks and 2018/19 QIPP identification and delivery risks for each CCG. No JFPC risks have increased in score during the current risk cycle. Four JFPC risks have decreased in score during the current risk cycle. Three JFPC risks have been marked for closure. The QIPP risk 1179 and a question about whether the red rating was too high, given the fact that all the plan is identified and at this stage in the year is not showing under delivery The BMDC budget risk 1104 and a question on whether or not it was still static and red, given 18/19 council budgets have been published. Risk 930 and 1040, do we still need 1040? Recommendations: Reviewed and approved the JFPC Risk Log for reporting to Clinical Boards / Executive and Governing Bodies, subject to any amendments requested. Identified whether there are any particular risks or related issues to highlight to the Clinical Boards / Executive for their consideration and / or request additional assurance on behalf of the Governing Bodies. 11 Issues to highlight to CB, CE & GB Performance Highlighted AWCs appeal in regards to the CCG IAF baseline compliance assessment against the standards of public and patient participation been unsuccessful. QIPP Highlighted a number of concerns and the actions been taken. Recovery plans in place. Highlighted the challenge for AWC is a gap of 2.6m, and at the moment the CCG doesn t have enough contingency to manage that gap, but work is ongoing. 12 Any Other business No items. 13 Date and Time of Next Meeting The next meeting will be held on Thursday 5 th July 2018, 11am 1pm, Douglas Mill, Boardroom 1 st floor. Apologies from Julie Lawreniuk & Liz Allen.