Strategic Finance Committee. Minutes. Minutes of the meeting held on 30 th January 2018, held in the CCG Conference Room. Present Danielle Neale Chair

Size: px

Start display at page:

Download "Strategic Finance Committee. Minutes. Minutes of the meeting held on 30 th January 2018, held in the CCG Conference Room. Present Danielle Neale Chair"

Meghan Parks
6 years ago
Views:

1 Strategic Finance Committee Minutes of the meeting held on 30 th January 2018, held in the CCG Conference Room Minutes Present Danielle Neale Chair DN Bristol CCG, Audit and Governance Lay Member John Rushforth South Gloucestershire CCG, CCG Lay Governing Board JRu Member Ryan Richards North Somerset CCG, Audit Committee Chair RR Glyn Howells BNSSG Chief Financial Officer (Until 31 st Jan) Lisa Manson BNSSG Director of Commissioning LM Janet Biard South Gloucestershire CCG Governing Body, Practice JB Representative Dr David John North Somerset CCG Governing Body, GP Member DJ Apologies Julia Ross BNSSG Chief Executive Officer Deborah El- BNSSG Transformation Director Sayed Richard Laver Bristol CCG Governing Body, Practice Representative In attendance Sarah Truelove BNSSG Chief Financial Officer (From 1 st Feb) Rob Moors Bristol CCG Deputy Director of Finance RM Steve Rea BNSSG PMO SR Claire BNSSG Delivery Director CT Thompson Jo Underwood Delivery Director for North Somerset CCG JU Anthony Pearce Senior Finance Manager UH Bristol AP David Moss Delivery Director for South Gloucestershire CCG DM Lucy Powell PA to the Chief Financial Officer (Note taker) LP 02 Declarations of Interest There were no additional declarations of interest made. 03 Minutes of last meeting The Committee reviewed the minutes from the December meeting. There were some amendments made to item 4 as follows: The word savings was added to read, The forecast savings outturn There was a redundant that which has been removed.

2 With these amendments the minutes were agreed as correct. The Committee reviewed the action log: 28/09 AC (1) Glyn Howells () explained that he was working with Bristol City Council to resolve the underspends issue and would be discussing this further with them later today. It was agreed that would circulate the background information to the Committee members. A further update is to be provided at the February meeting. 28/09 AC (2) agreed to circulate the consolidated report to the Committee members. 11/12 9(3) The extended February meeting has been arranged for the 26 th February. to check with Julia Ross that this date is suitable. 04 Month 9 Financial Report Glyn Howells () presented the report to the Committee. It was noted that the month 9 position for the BNSSG CCGs was a 29.9m deficit with 5m unmitigated risk. Following discussions with NHS England, this would be amended at month 10 to 35m deficit with no unmitigated risk. noted that the CCGs had mitigated the 5m risk through the savings plan but had received an unexpected increase of 5m in medicines, specifically No Cheaper Stock Obtainable (NCSO). It was highlighted that this was a national issue and the Department of Health were nationally reprocuring the more expensive items. It was noted that the planning guidance for 2018/19 had not yet been released which created a challenging situation for the CCGs as the plans and provider contracts would need to be agreed within 8 weeks. explained that a change in business rules will mean that the CCG will no longer need to provide a 0.5% headroom contingency next year. further explained that due to the financial pressure in the NHS currently, some funds would be released to CCGs to help reduce accumulated deficits. Danielle Neale (DN) asked that once the details of the funding have been released that a summary be circulated to the Committee members. Lisa Manson noted that contract discussions are currently ongoing despite the lack of planning guidance and there is a system workshop planned where there will be system wide discussions to develop joint plans with 2

3 specific focus on A&E and cancer standards. There is also work ongoing on a system level activity plan which will produce more robust monitoring arrangements across the system. The System Delivery Oversight Group is driving this work forward. DN asked whether the provider block funding potential mitigation had been reviewed by the CCGs. explained that this was no longer required nationally to be pursued but that other local CCGs had developed block contracts with their providers so it was an idea worth reviewing in the future. DN asked about the running costs and why there was a forecast underspend expected on this line. explained that this was due to the savings profiling, where more savings were predicted in quarter 4. However, the trend shows that no further savings will be made. Dr David John asked why the NCSO issue had worsened recently. explained that due to competitive pricing procurement centrally, pharmaceutical companies were potentially selling drugs elsewhere for more money, causing the stock reductions. The medicines management team have noticed recently that once the drugs are back in stock, the prices have increased causing cost pressures outside of the dramatic increases for NCSO s. noted that price setting is national so there is little the CCG can do to improve this. John Rushforth queried the variance in the figures relating to diagnostic imaging. agreed to review the report and respond on this issue. 05 Month 9 review of the System Financial Recovery Plan Steve Rea (SR) presented the report to the Committee noting that the month 9 year to date report indicates 30.1m year to date delivery of savings. It was highlighted that the ten plans delivering the majority of the savings ( 23.9m) had not changed from month 8. The plans where savings have deteriorated were highlighted and the reasoning behind the reductions were outlined. SR noted that the report now also included plans which had shown improvements within the month as well. The Committee discussed the plans and the risk assessed ratings. SR noted that a review would take place on the plan ratings and it was believed that some of the green rated schemes would be amended to blue to indicate that the savings had been achieved. This would remove the 10% risk figure attached to green rated schemes and so improve the risk assessed savings delivery figure. 3

4 SR raised that a possible risk to delivery could be the current merger of the CCGs which could potentially lead to reduction in momentum as key control centre staff are part of interviews and consultation meetings. The PMO team have recognised this risk and are working with staff to continue the planning and implementation of schemes. Janet Biard (JB) noted the differences in the finance report and the control centre report regarding referrals. SR noted that the activity monitored was new outpatients referred by GPs and explained that the activity showed less of a decrease than expected rather than an increase in activity. Danielle Neale (DN) queried whether the Control Centres whose schemes are not delivering were being challenged and whether there was an expectation that these undelivered savings would be delivered in 2018/19. SR noted that during the start of the process as many plans as possible were developed in order to bridge the financial gap. During the process some of the plans were reviewed and found to be unsustainable so these were removed from the process. The PMO team have continued to challenge the control centres through 1 to 1 meetings and the Turnaround Steering Group however, this late in the year it is increasingly difficult to recover savings not delivered. SR explained that the PMO team have reviewed the process over 2017/18 and have identified that the PMO team needs to focus on further scrutiny of plans and developing some more robust planning processes for 2018/19. The control centres have been developing plans for 2018/19 and deciding which plans to focus on for the coming year. Lisa Manson noted that the local healthcare system would be working differently in 2018/19 and that any proposed savings plans would need to be developed with the whole system in mind. Glyn Howells () noted that there would be a system savings total as well as a local CCG total to consider. 06 System Financial Recovery Plan: Deep dive Urgent Care Claire Thompson (CT), Jo Underwood (JU) and Anthony Pearce (AP) attended the meeting for this item. CT highlighted the challenge of creating savings in the urgent care system and noted that the lack of a strategic framework for urgent care had impacted on the deliverability of savings in 2017/18. CT outlined the urgent care plans, noting which schemes had delivered the savings this year and which had under delivered. 4

5 JU explained the strategy for 2018/19 onwards, noting that an urgent care strategic framework would be developed across the P footprint and take into account commissioning and provider plans. It was highlighted that the focus for 2018/19 would be prevention and self-care as well as urgent care treatment centres. The Committee discussed the merit of service redesign in these challenging financial times and queried the level of savings a redesigned service could provide against continuing on with the current system. JU noted that by continuing with the current system the urgent care system could save potentially 11m over 3 years. Following modelling of the new system, there would be costs to implement the strategy but following this the service should see costs reductions and service quality improvements. DN noted that the February Committee meeting would be dedicated to reviewing the plans for 2018/19 and so further discussion could be held then. 07 System Financial Recovery Plan: Deep dive Contracts David Moss (DM) and Claire Thompson (CT) attended the meeting for this item. DM explained that unlike the other control centres the contracts control centre had been created in August 2017 in response to a 16m savings opportunity. DM explained that due to the acute contracts having been signed for two years there was little contractual leverage that could be applied to reduce agreed activity, blocks and subsidies. DM highlighted that robust contract management processes that have been implemented have led to savings in areas such as coding challenges and CQUIN review panels and DM outlined the levels of savings. DM explained the reviews of PbR spend and PFI payments planned in 2017/18 had been discussed and not progressed. DM explained that the contracts control centre had standardised delivery of contract monitoring across the BNSSG CCGs however, there was a question as to whether the contracts control centre was an enabler for other control centres and so should cease on its own. Glyn Howells () noted that it would be beneficial to have it continue but provide support for other contracts rather than just acute. 08 Update on the Planning Process and Budgets The Committee agreed that the planning process had been discussed in 5

6 the financial reporting item. 09 Procurement Pipeline and current initiatives Lisa Manson (LM) updated the Committee on the progress of the BNSSG contracts database which should be finalised soon. This would provide a forward view on upcoming expiry of contracts to aid procurement timelines as well as review the contracts that are held for the same provider across BNSSG. 10 Review Activity Trends by Provider The Committee received the report which had been produced by the BI team which showed activity levels by provider. The Committee noted the high level of detail included in the report and noted that the report was too detailed for the Finance Committee. The Committee agreed that activity should be linked to the finance report but by exception only and included within the narrative in the finance report. If activity is a key driver behind a financial outlier then this should be included as an appendix to the finance report. It was agreed to include the exception reporting on activity in the finance report for the next meeting. 11 Review Forward Work Program The Committee noted that the February meeting would focus on the plans for 2018/19 and each control centre would be presenting their 2018/19 plans at this meeting. Lisa Manson (LM) asked that for the March meeting there was a review of modelling assumptions to inform the 3 R s. It was agreed to add this to the agenda. John Rushforth (JRu) asked for a future paper outlining the budget development and future impact in the longer term and a paper outlining how budgets are developed and processed. It was agreed that the latter would be included in the paper recommending the planned budget to the Governing Body. LM 12 Any Other Business Danielle Neale noted that it had been discussed that key messages from the Strategic Finance Committee would be more appropriate for Governing Body than the minutes. 6

7 DN reminded the committee on the 5 working day deadline for the papers to be distributed. DN noted that this would be s last Committee meeting, and thanked him for his hard work over the last 6 months. 13 Review of Committee Effectiveness Danielle Neale highlighted that the Committee membership had been extended to include the 3 Governing Body members. The Committee agreed that the control centre deep dives needed more of a financial focus for future meetings. Lucy Powell PA to CFO 7

BNSSG CCG Governing Body Meeting

BNSSG CCG Governing Body Meeting Date: Tuesday 5 th February 2019 Time: 1.30pm Location: The Royal Hotel, 1 South Parade, Weston-super-Mare BS23 1JP Agenda number: 8.2 Report title: BNSSG CCG Finance Report