NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 14. Date of Meeting: 12 th April 2019 TITLE OF REPORT:

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1 NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 14 Date of Meeting: 12 th April 2019 TITLE OF REPORT: AUTHOR: PRESENTED BY: PURPOSE OF PAPER: (Linking to Strategic Objectives) LINKS TO CORPORATE OBJECTIVES (tick relevant boxes): RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) COMMITTEES/GROUPS PREVIOUSLY CONSULTED: REVIEW OF CONFLICTS OF INTEREST: VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT: EQUALITY IMPACT ASSESSMENT (EIA) COMPLETED & OUTCOME OF ASSESSMENT: CCG Finance & QIPP Committee Joanne Taylor, Board Secretary Charles Hendy, Committee Chair For the Board to receive and review the minutes of the Finance & QIPP Committee meetings held on 29 th March Delivery of Year 3 Locality Plan. Joint collaborative working with Bolton FT and the Council. Supporting people in their home and community. Shared health care records across Bolton. Regulatory Requirement Standing Item The Board is asked to approve the Minutes. The key points the Board is asked to note from these minutes are:- To undertake a more detailed review of the Transformation Fund Evaluation outcomes at the next meeting. On behalf of the Board, the Committee s approval of the initial financial plan for 2019/20. Bolton FT s forecast delivery of their financial control total at year end. Finance & QIPP Committee. Conflicts of Interest are reviewed at every meeting. Patient views are not specifically sought as part of this report. EIA and an assessment is not considered necessary for the report. 1

2 MINUTES FINANCE & QIPP COMMITTEE Date: 29 th March 2019 Time: Venue: 12 noon 2.00pm Bevan Room, 2 nd Floor, St Peters House Present: In attendance: Minutes by: Charles Hendy Tony Ward Ian Boyle Kelly Knowles Joanne Taylor GP Board Member/Committee Chair Lay Member, Governance Chief Finance Officer Deputy Chief Finance Officer Board Secretary Minute Topic No. 25/19 Apologies for Absence Apologies for absence were received from:- Alan Stephenson, Lay Member. 26/19 Declarations of Interest The Chair reminded members of their obligation to declare any interest they may have on any issues arising at meetings which might conflict with the business of the CCG Board. It was noted that declarations declared by members of the Board are listed in the CCG s Register of Interest. The Register is available either via the CCG Board Secretary or the CCG s website at the following link: 27/19 Minutes from the last meeting held on 22 nd February and Action Log The minutes were approved as a correct record and the action log noted. The actions discussed were:- TF Evaluation Update as discussed through Board Development, the Committee requested a further report to the next meeting following a realistic assessment being undertaken of the benefits gained from the Transformation Fund, including spend both recurrent and nonrecurrent, highlighting any projects that were ceased and are planned to continue. Introductory Meeting with Bolton FT Finance Committee Chair and Director of Finance the Committee received an update on the main points of discussion held at the recent joint meeting. It has been agreed that regular quarterly meetings will be undertaken. The main discussions focused on Bolton FT s underlying financial position, and the risks to delivery in the 2019/20 financial year. 28/19 Report of the Chief Finance Officer (M11) The CFO Finance Board Report for Month 11, 2018/19, including month 10 contract position and areas of pressure/under spends was presented to the Committee. As at month 11, the CCG is reporting in line with the expected control total of a break even position, which includes the 4m contribution towards the national position. The CCG is

3 forecasting full delivery of all financial duties. In month 11, the CCG received the final quarter s allocations for Transformation Fund and GP Forward View for 2018/19. There were further allocations totaling 36k for pass through funding (TB and Healthwatch). The CCG also received a capital allocation of 330k for the HQ relocation; this is separate to the revenue allocation. The detailed position for month 11 was reported. This included a detailed review on:- Acute Services. Critical Care. Trauma and Orthopaedics. Nephrology. Mental Health Learning Disabilities. Prescribing. Community. Primary Care. Funded Care. Corporate Services. It was noted that the majority of the identified risks have been reduced this month as they have been reported within the financial position. The remaining risks are prescribing, as a result of the volatility of the BAS reported spend and CHC, which again, is due to variability of the reported spend. However, it was noted that as the pressures outlined above have been covered using reserves, financial risks have been have been flagged as amber. Should overspends continue at the same rate and not be mitigated, there is a risk to delivery of a balanced position in-year. The Committee noted the financial position as at month /19 Joint Savings Performance Update (M11) The report provided the Committee with an update on the 2018/19 Joint Savings Performance as at Month 11. The joint savings performance summary as at month 11 variance versus plan is 858k under achievement, with the year to date variance versus plan being 2.8m under achievement as at month 11. The full year forecast at month 11 is to achieve 19.9m versus the 22.6m system wide savings target. The CCG s QIPP performance, progress on QIPP schemes and progress on Bolton FT s icip performance was also reviewed. It was noted that corporate cost schemes have over achieved plan by 201k year to date mainly due to vacancies. Estates and IT schemes remain on plan. BMI pain management is on plan following the implementation of the new pain management model at Bolton FT. Wrightington, Wigan and Leigh Neuro rehabilitation is on plan following agreement of 2018/19 contracts. APMS full year effect has delivered in full and the forecast position for 2018/19 shows delivery of the QIPP plan in full. It was further noted that mental health out of area placements is marginally behind plan ( 58k) year to date due to the delayed opening of Honeysuckle lodge and additional delays with patients transferring into the unit. The risk to delivery of the St Peter s House scheme due to slippage in project timescales has now been reflected in the forecast. The risk to delivery in full of 500k specialist services prescribing in 2018/19 is also now reflected in the forecast. It was also noted that the non-bolton FT contract challenges scheme is slightly behind plan at month 11 following a lower than anticipated confirmation of challenges in month. The Committee noted the QIPP and joint savings performance for 2018/19 at Month 11 and agreed to include bed utilisation in future joint savings discussions. Page 2 of 4

4 30/19 Transformation Fund Update (M11) The report provided the Committee with an update on the Bolton 2018/19 transformation fund financial position as at Month 11. The main highlights noted were the expenditure at month 11 of 9.2m, the management of Transformation Fund slippage through GM system wide senior committee by partners from key organisations, 3.7m slippage re-profiled with GM to be drawn down in 2019/20, that Transformation Fund meetings have taken place with leads for all areas following outcome of the 2017/18 end of year reviews and that transformation fund scheme reviews are now being progressed. The CCG continue to update forecasts and profiling to confirm funding requirement for 2019/20 and recurrent, noting that some schemes are yet to identify ongoing funding streams if required. The next steps were noted as further identification of funding streams for recurrent schemes and a further evaluation of all schemes in progress throughout quarter 4. The Committee noted the transformation fund financial performance for 2018/19 at Month 11 and agreed to review the final evaluation in more detail at the next meeting. 31/19 Health Economy Financial Position:- Bolton FT Finance Committee Report (M11) Members discussed Bolton FT s forecast to deliver its financial control total at year end. The report would be circulated to members once received from Bolton FT. 32/19 Final Financial Plan 2019/20 The report outlined the CCG s 5 year financial allocation and the adjustments already made to the 2019/20 allocation by NHS England. Members were informed of the primary care cocommissioning allocation and the national adjustments that have been made to this allocation in respect of the new GP contract, in particular the receipt of no additional funding and the assumption that funding for the primary care network partnership is already included in the baseline allocation. The risks regarding this were reviewed and noted. The Committee was also informed of the CCG s core allocation reducing to 5.2% and the challenges this will bring to next year s financial position, including the spend on mental health as a national requirement. The QIPP plans for 2019/20 were also presented and reviewed by the Committee. The plan also included an outline of the financial risks and mitigating plans and the process for review of these risks through the CCG Executive. The joint prioritisation process of potential pressures and investments that has been undertaken with all partner organisations was also presented. The Committee was also updated on the contract negotiations recently undertaken with Bolton FT, which has now been signed off with a memorandum of understanding to review the financials on a monthly basis given the very challenging financial year ahead for the Bolton NHS system. On behalf of the Board, the Committee approved the balanced financial plan for 2019/20 for submission to NHS England, acknowledging the risks and additional actions required to focus on the uncommitted financials. It was agreed to receive a further update on the final financial plan 2019/20 at the next meeting. 33/19 Any Other Business:- There was no further business to discuss. Page 3 of 4

5 34/19 Chair reflection on significant decisions/actions/risks that may need reporting to the Board through these minutes The main points highlighted were:- To undertake a more detailed review of the TF Evaluation outcomes at the next meeting. On behalf of the Board, the Committee s approval of the initial financial plan for 2019/20. Bolton FT s forecast delivery of their financial control total at year end. 35/19 Time and Date of Next Meeting It was agreed the next meeting would be held on 26 th April 2019 following the Board Development session in the Bevan Room, 2 nd Floor, St Peters House. It was noted that this was Charles Hendy s last meeting as his term of office was to end on 30 th April His apologies for the April meeting were noted and it was agreed to ask Alan Stephenson to chair the meeting. The Committee thanked Charles for his work as Committee Chair. It was agreed to review the role of Committee Chair with Wirin Bhatiani. Apologies were also noted for the 26 th July meeting from Ian Boyle and Kelly Knowles. It was agreed to re-arrange this meeting to link with another board/committee meeting that month. Page 4 of 4

TITLE OF REPORT: QIPP Programme Update Month 7. Kelly Knowles Head of Strategic Financial Planning. Annette Walker Chief Finance Officer

NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 13 Date of Meeting: 25 th November 2016 TITLE OF REPORT: QIPP Programme Update Month 7 AUTHOR: PRESENTED BY: PURPOSE OF PAPER: