GOVERNING BODY. 2. To ensure the CCG financial position recovers to meet all statutory financial duties. X

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Karen Sheena Stevenson
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1 Enclosure: H Agenda item: 10 GOVERNING BODY Title of paper: QIPP Report Date of meeting: 21st September 2016 Presented by: Regina Shakespeare Prepared by: Regina Shakespeare and Nick Varney Title: Turnaround Director Title: Turnaround Director And Director of PMO Corporate Objective addressed by this paper (please select one or more with an X): 1. To commission sustainable high quality services to meet the health needs of the population of Greenwich and reduce health inequalities. 2. To ensure the CCG financial position recovers to meet all statutory financial duties. X 3. To continue to ensure that the CCG is a clinically driven organisation. 4. To ensure diverse patient and public voices are fully considered. Purpose of the report: The attached monthly QIPP report has been presented to FRB and FPQ as appropriate. FPQ has been asked to assure itself as to the delivery and implementation of the QIPP Programme to support the CCG in delivering its financial position as agreed in the Operating Plan. Therefore this report is presented to this meeting for information and assurance purposes with no decisions required. Issues arising: 1. The QIPP Process and assured financial value has been externally assured by Deloitte, and had been subject to an 8% abatement to take account of the risk of delay; the FRB has accepted this. 2. The QIPP Programme is moving its main focus from developing QIPP schemes to managing their implementation and delivery 3. A Formal launch to staff of QIPP templates, guidance and processes took place on 7 th July 2016; this has been well attended and well received. Summary of actions, if any, following this meeting: None

2 Previous committee involvement: The Governing Body receives a QIPP report at each of it s meetings. Recommendations to the Greenwich CCG Governing Body To note the content of the report. (Please provide details below where Yes is indicated ) Impact on Governing Body Assurance Framework (x) Yes No X N/A Impact on Environment (x) Yes No X N/A Legal Implications (x) Yes No X N/A Resource and or financial implications (x) Yes X No N/A Equality impact assessment (x) Yes No X N/A Privacy impact assessment (x) Yes No X N/A Impact on current NHS Outcomes Framework areas (x) Yes No X N/A Patient and Public Involvement (x) Yes No X N/A Communications and Engagement (x) Yes No X N/A Impact on CCG Constitution (x) Yes No X N/A There are financial implications arising from the delivery of QIPP which impact upon the CCG s delivery and its statutory duty to balance and achieve its Operational Plan for 2016/17. Attachments: (i) QIPP Report for September

3 QIPP Presentation for Governing Body Editor: Nick Varney September 2016

4 1. Activity in month The QIPP Programme has moved its main focus from identifying opportunities and building a QIPP Pipeline to ensuring the robust and timely delivery of schemes. QPDM is now formally holding project leads to account through rolling programme of project lead attendance. Detailed Project delivery tracking has been continued and is having an impact on driving implementation Contract due diligence work has started a detailed deep dive on invoices paid to suppliers MSK Contract has been awarded Children s Therapies Contract has ben awarded Work has begun on 2017/18 Commissioning Intentions and QIPP.

5 2. Approved business cases The following Business Cases were approved by FRB: Approved 1. Repatriation 2. Stroke Length of Stay The following cases were discussed at FRB 1. Home First 2. Cruse Bereavement 3. Dermatology

6 3. Matters for noting by Governing Body Governing Body is asked to note the following : 1. MSK. ( 133k 20016/17; 1.7m 2017/18) The contract has been awarded and the QIPP has been rated as blue 2. Children s Therapies Reprocurement ( 340k) The Children s Therapies contract is being formally awarded and the planned saving, together with the additional 76k, have been rated as blue 3. Stroke Association Notice was served to decommission the Stroke Association service on 15 th July, to take effect from 1 st September Following discussion this was extended to 1 st November 2016, giving a saving of 75k in 2016/17 4. MCCH Notice was served on MCCH, with an offer to pay for Quarter 1, ( 300k). This would leave a gross saving of 900k against a current assured value of 600k. However, as health assessments are being undertaken on residents at present, the 300k additional value has not been recognised as QIPP and is being held as a prudent reserve against the outcome of those assessments.

7 4. QIPP Summary as at 18 th August 2016 Movement in period Assured QIPP Identified QIPP for 17/18 QIPP Stratification Weighted QIPP Analysis as at 18th August 2016 Assurance Category Gross Value '000 Assurance Factor '000 Assured QIPP at 15th July New Schemes (Note below) Repatriation 77 Stroke Length of Stay 55 Cruze 24 Interpreting Schemes turning Blue MSK 27 Childrens Therapies 66 Stroke Association Scheme value adjustment Dermatology (20) Assured QIPP at 18th August Note: The new schemes are rated as amber and are subject to FRB approval on 24th August 2016 Risk Assured QIPP '000 % '000 Blue Green Amber Red Impact on 17/18 QIPP Scheme Title '000 Non-Recurrent 92 Public Health Services Decommissioned 9 Staffing - Natural Wastage (487) Return of Development Grant (Non Recurrent) 200 Adherence to current evidence based policy (625) GP Long Term Conditions Contract (Non Recurrent) 486 Intermediate Care Beds - Seasonality Flexing 215 Extension to current evidence based policy 105 Stroke Association 182 Intermediate Care Beds, Utilisation, Demand and Capacity. 113 Children's Therapies Reprocurement 61 Consultant Connect 175 Malnutrition Services 75 The Source 200 Falls Services 161 Long Term Conditions - Demand Management - Paediatric Asthma 160 Long Term Conditions - Demand Management - COPD 154 Long Term Conditions - Demand Management - Heart Failure, Hypertension and Diabetes 600 MCCH Decommissioning 100 Medicines Management (Community pharmacy medicines optimisation scheme ) 263 GP Access 138 Termination of Pregnancy Service (TOPS) 210 Referral Management & Booking Service (RMBS) 1,567 Musculoskeletal services 222 Dermatology Services 162 Repatriation 155 Stroke - Length Of Stay 37 Primary Care Interpreting 25 Cruse 345 Recovery College Still to Find ,100 Total 2017/18 QIPP Total 20640

8 5. Existing QIPP Financial Assurance Tracker as at 18 August 2016 Initial Plan Initial Plan Scheme Title Start Date 16/17 QIPP QIPP Assurance Rating 16/17 QIPP (Assured) '000 '000 '000 '000 Scheme Title Start Date 16/17 QIPP QIPP Assurance Rating 16/17 QIPP (Assured) Non-Recurrent Patient Transport Apr Children's Therapies Reprocurement Sep Acute Hospital Productivity Apr Consultant Connect Sep Atlas House - (Phase 1) Apr Malnutrition Services Oct Children s services Apr The Source Oct Jackwood House Apr Falls Services Oct Medicines Management (Over The Counter) Apr Long Term Conditions - Demand Management - Paediatric Asthma Oct Staffing Interim to Permanent Apr Long Term Conditions - Demand Management - COPD Oct Public Meeting Adverts Apr Long Term Conditions - Demand Management - Heart Failure, Hypertension and Diabetes Oct Public Health Services Decommissioned May MCCH Decommissioning Oct Staffing - Natural Wastage May Medicines Management (Community pharmacy medicines optimisation scheme ) Oct Return of Development Grant (Non Recurrent) Jun GP Access Oct Atlas House (Phase 2) Jun Termination of Pregnancy Service (TOPS) Oct Care Home Blood Tests Jun Referral Management & Booking Service (RMBS) Oct Review Care Packages & Controls - Jun Musculoskeletal services Dec Medicines Management Jun Dermatology Services Jan Adherence to current evidence based policy Jul Repatriation GP Long Term Conditions Contract (Non Jul Stroke - Length Of Stay Medicines Management (PbR Excluded drugs) Jul Primary Care Interpreting Contract Due Diligence Initial Target Jul Cruse Intermediate Care Beds - Seasonality Flexing Aug-16 1, Mencap Extension to current evidence based policy Aug Advocacy Stroke Association Aug Recovery College Intermediate Care Beds, Utilisation, Demand and Capacity. Sep Total 2017/18 QIPP Still to Find QIPP Total

9 7. QIPP Opportunities for 2016/17 The following initiatives are being worked on around unscheduled care and will impact on the delivery of QIPP during the second half of 2016/17. Home First Team Aims to avoid admissions and speed discharges using a single access hub. Business case being presented to FRB on 28 th September for approval Lean Discharge Develop a single list used by the whole system, and decrease in delays in assessment and discharge planning in line with the requirements of the 2012 Care Act. Business case being presented to FRB on 28 th September for approval Ambulatory Care Revising Ambulatory Care pathways through A & E to increase the quality of patient care and support the 4 hour target. Bailey and Moore To provide an assessment of whether the basis of counting, coding and charging of adult and paediatric emergency activity based on 2015/16 outturn is in accordance with the NHS Data Dictionary and the National Tariff Payment System guidance. This will be taken into account in agreeing a contract value for the second half of the year Contract for months 8-12 non-elective contract sum CCG to develop an affordable envelope in the w/c 19 th September 2016 Agreement to take account of Bailey and Moore recommendations and also reduction in activity in the year to date.

10 8. QIPP Position for 2017/18 Commissioning Intentions A series of three Commissioning Intentions workshops have been held with CCG Staff, GP s, Providers and Patient representatives They were used to reinforce the current years QIPP requirements, especially about: Forward view of 2017/18 supporting the implementation of existing schemes and the need to develop schemes for 2017/18 The QIPP already delivered in respect of 2016/17 will have an impact of c 5m in 2017/18, which is just under 50% of the planned QIPP target for that year of 10.5m This assumes that the CCG will achieve its 2016/17 QIPP target in full and will not have to cover off any shortfall by delivering additional QIPP over the 10.5m in 2017/18

11 9. CCG Assured QIPP Delivery Profile 2016/17

12 10. QIPP Financial Planning Assurance as at 18 August 2016 Pipeline 12.2m Identified as high level opportunity 4.05m 5.0m Identified, assured and in implementation 9.35m 2.9m Achieved in 16/17 contracts Gap 12.25m 3.5m Already delivered Development of opportunity into QIPP business case subject to assurance. Assurance controls: Named clinical lead Named project manager Contract due diligence Assured business case Implementation plan & milestones Tracking of delivery and benefits QIPP schemes secured in signed 2016/17 contracts with key providers Actions Note: Deloitte Assured figures shown in amber totalling 10.9m No further action required, the saving is already removed from budget line

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