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

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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

1 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: (Linking to Strategic Objectives) Kelly Knowles Head of Strategic Financial Planning Annette Walker Chief Finance Officer To provide Bolton CCG Board with an update on the 2016/17 QIPP Performance as at Month 7 LINKS TO CORPORATE OBJECTIVES (tick relevant boxes): RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) COMMITTEES/GROUPS PREVIOUSLY CONSULTED: Delivery of Year 1 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 CCG Board is asked to: recognise the QIPP performance at Month 7 recognise the QIPP forecast for 2016/17 as at Month 7 CCG Executive Finance & QIPP Committee REVIEW OF CONFLICTS OF INTEREST: VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT: View of patients, carers and the public will be obtained on appropriate QIPP Projects; this is embedded into each project plan. Public views on the commissioning plans are gathered these include ideas for reducing waste and redesigning services which will be used to influence our QIPP projects. 1

2 QIPP Programme Update Month 7 October 2016 Summary of position Highlights/Lowlights Key schemes delivery Scheme overview Activity and referral monitoring 2016/17 Kelly Knowles Head of Strategic Financial Planning

3 QIPP Update 16/17 1. QIPP Performance Month 7 2. Highlights/Lowlights 3. Progress on key schemes 4. Risk Management/Paperwork 5. QIPP Scheme Overview 2016/17 6. Activity and referral monitoring 2016/17

4 1. QIPP Performance Month 7 Month 7 YTD FOT FYE Plan Actual Variance Plan Actual Variance Plan Actual Variance FYE Bolton CCG ,889 5,316 1,427 7,700 8, ,134 QIPP is ahead of plan in Month 7 mainly due to over performance on admin costs, CHC and Prescribing schemes. QIPP is ahead of plan YTD due to over performance on some schemes. FOT reflects risk in delivery of some schemes which have not yet started. FOT at Month 7 shows an over delivery of QIPP for 16/17 of 778k. This has been updated to reflect slippage on some schemes.

5 1. QIPP Performance Month 7 cont 1. Prescribing 2. Continuing Healthcare 3. Estates 4. Running Costs CCG YTD FOT 17/18 Plan Actual Variance Plan Actual Variance Actual 000 s 000 s 000 s 000 s 000 s 000 s 000 s 1,108 1, ,900 1,900-1, , ,442 1, ,439 Gastro Drugs Data now received for m6 16/17 showing over performance vs. plan 5. Urgent Care Redesign 6. Mental Health Redesign 7. Community Redesign 8. Planned Care Redesign Adjustment for schemes over plan Total ,320 1, , ,036 1, ,005 2, , ,889 5,316 1,427 7,700 8, ,134 Adjusted by 147k for schemes above plan

6 1. QIPP Performance Month 7 - Graphs 2016/17 QIPP Delivery Month 7 Forecast showing over delivery of QIPP for 16/17 at Month /17 Cumulative QIPP Delivery Month 7 Over delivery of QIPP Actual vs. Plan for all months YTD at Month 7

2. Highlights/Lowlights Highlights 1. Agreement of Bolton FT contract value ensuring delivery of QIPP contract savings YTD. 2. Higher than anticipated QIPP savings for running costs YTD ( 230k). 3.

Forecast outturn for 2016/17 currently 778k above plan ( 8.5m) at Month 7. 6. Prescribing has achieved 572k above the QIPP target YTD at Month 7. Lowlights 1.

7 2. Highlights/Lowlights Highlights 1. Agreement of Bolton FT contract value ensuring delivery of QIPP contract savings YTD. 2. Higher than anticipated QIPP savings for running costs YTD ( 230k). 3. Higher than anticipated QIPP savings for EUR at BMI Beaumont for M1-7 ( 35k). 4. Current plan for schemes is 147k over 2016/17 QIPP target. 5. Forecast outturn for 2016/17 currently 778k above plan ( 8.5m) at Month Prescribing has achieved 572k above the QIPP target YTD at Month 7. Lowlights 1. Some element of risk around delivery of upcoming schemes m schemes still in either Stage 1 or Stage 2 of planning process. This is the same position as Month 6. Other comments Forecasts reduced for the following schemes in Month 7 due to slippage : - Home Oxygen - slippage - ( 10k) - NWAS - not yet started - ( 100k) - CHC High Cost - not started - ( 40k) - Mental Health - slippage - ( 70k) - Diagnostic review - not started - ( 9k)

8 3. Progress on key schemes Bolton Quality Contract Prescribing data received up to month 6 QIPP position has been matched to the ledger and shows a 572k over achievement of QIPP YTD. Integration INT benefited from a refresh of data and thus increased savings YTD at Month 7 Intermediate Tier - savings remain higher than anticipated for Month 1-7 Care Homes - issues with data have continued in Month 7 meaning that no updated data could be included. This is expected to be resolved for Month 8. Bolton FT Contract New contract model has led to reduced risk of activity over performance allowing delivery to be shown against QIPP target YTD at Month 7. Activity still being monitored for Bolton FT related schemes to ensure tracking of real delivery vs. plan.

9 4. Risk Management/Paperwork QIPP Governance structure updated for 16/17. Monthly meetings between theme leads and FCI team to review performance and identify risks/mitigations to be escalated as necessary. QIPP Proposal documents (Stage 1) - reviewed at CCG Executive on 13 th July. QIPP Project documentation (Stage 2) paperwork for schemes in delivery/monitoring went to Exec on 7 th September. Project leads have attended through September/early October to present detailed plans. Planning for 17/18 QIPP will begin in November/ December.

10 /17 QIPP Scheme Overview 11 th November 2016 In Development In Delivery Stage 1 Ideas Generation Stage 2 Design and Planning Stage 3 Delivery Stage 4 Monitoring QIPP Proposal Project Action Plan QIPP Tracker QIPP Tracker Finance and Activity Risk Log QIPP Matrix Project Action Plan Project Highlights QIPP Performance Report EIA QIPP Update Report QCIA KPIs NWAS Conveyance Review of Children s CHC Review of CHC High Cost Cases Mental Health OOA review Diagnostics Review Pain management CCG Medicines Optimisation Home Oxygen Admin budget savings CHC Compliance with Policy Bolton FT Contract a new way EUR Compliance Lithotripsy GM CATs CCG Medicines Optimisation 0.25m 0.25m 1.4m 5.9m

11 6.1 QIPP Scheme Monitoring Accident & Emergency Aligned incentives bucket: Cost risk share 8,000 7,500 7,000 6,500 6,000 5,500 A&E Attendances - Activity at Bolton NHS FT (In-month position) - Activity Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Activity Plan 16/17 Activity Actual 16/17 Activity Actual 15/16 Key Messages - Month 6 Activity - Activity below plan in month 6 by 34 attendances - Activity below plan YTD by 42 attendances - Activity higher than in September 2015 by 135 attendances - Activity higher than same position YTD in 15/16 by 503 attendances 000's A&E Attendances - Activity at Bolton NHS FT (In-month position) - Cost Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Cost Plan 16/17 Cost Actual 16/17 Cost Actual 15/16 Key Messages - Month 6 Cost - Cost below plan in month 6 by 27k - Cost below plan YTD by 172k - Cost higher than in September 2015 by 17k - Cost higher than same position YTD in 15/16 by 15k Lower activity and cost vs. plan in month and YTD however both are higher than in 15/16.

12 6.2 QIPP Scheme Monitoring Non Electives Aligned incentives bucket: Cost risk share 's 5,000 4,000 3,000 2,000 1,000 NEL Admissions - Activity at Bolton NHS FT (In-month position) - Activity Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar - Activity Plan 16/17 Activity Actual 16/17 Activity Actual 15/16 NEL Admissions - Activity at Bolton NHS FT (In-month position) - Cost Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Cost Plan 16/17 Cost Actual 16/17 Cost Actual 15/16 Key Messages - Month 6 Activity - Activity above plan in month 6 by 44 admissions - Activity below plan YTD by 632 admissions - Activity higher than in September 2015 by 1.2k admissions - Activity higher than same position YTD in 15/16 by 6,117 admissions Key Messages - Month 6 Cost - Cost below plan in month 6 by 55k - Cost below plan YTD by 223k - Cost higher than in September 2015 by 273k - Cost higher than same position YTD in 15/16 by 1.8m Cost and activity remain below plan YTD however both cost and activity higher than 15/16 both in month ( 273k) and YTD (1.8m)

13 6.3 QIPP Scheme Monitoring Daycases & Electives Aligned incentives bucket: Activity Reduction incentive 2,500 2,000 1,500 1, Daycase & Elective - Activity at Bolton NHS FT (In-month position) - Activity Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Activity Plan 16/17 Activity Actual 16/17 Activity Actual 15/16 Key Messages - Month 6 Activity - Activity above plan in month 6 by 12 admissions - Activity above plan YTD by 578 admissions - Activity higher than in September 2015 by 182 admissions - Activity higher than same position YTD in 15/16 by 1,475 admissions 000's 2,500 2,000 1,500 1,000 Daycase & Elective - Activity at Bolton NHS FT (In-month position) - Cost Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Cost Plan 16/17 Cost Actual 16/17 Cost Actual 15/16 Key Messages - Month 6 Cost - Cost above plan in month 6 by 21k - Cost above plan YTD by 261k - Cost higher than in September 2015 by 108k - Cost higher than same position YTD in 15/16 by 691k Higher activity and cost implication vs. 15/16 both in month ( 108k) and YTD ( 691k)

14 6.4 QIPP Scheme Monitoring Outpatients Aligned incentives bucket: Activity Reduction incentive 25,000 20,000 15,000 10,000 5,000 0 Outpatients - Activity at Bolton NHS FT (In-month position) - Activity Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Activity Plan 16/17 Activity Actual 16/17 Activity Actual 15/16 Key Messages - Month 6 Activity - Activity above plan in month 6 by 37 attendances - Activity above plan YTD by 2,799 attendances - Activity above plan in August by 96 attendances - Activity higher than same position YTD in 15/16 by 3,266 attendances 000's 2,500 2,000 1,500 1,000 Outpatients - Activity at Bolton NHS FT (In-month position) - Cost Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Cost Plan 16/17 Cost Actual 16/17 Cost Actual 15/16 Key Messages - Month 6 Cost - Cost below plan in month 6 by 10k - Cost above plan YTD by 309k - Cost lower than in September 2015 by 20k - Cost higher than same position YTD in 15/16 by 461k Higher activity and cost implication vs. 15/16 YTD ( 461k), in month cost was lower ( 20k)

15 7. All Providers Referrals: April 2012 September 2016 Number of Referrals May-12 Aug-12 Nov-12 GP Referrals & Other Referrals Feb-13 May-13 Aug-13 Nov-13 Feb-14 May-14 Aug-14 Nov-14 Feb-15 May-15 Aug-15 Nov-15 Feb-16 May-16 Aug-16 GP Referrals Other Referrals Key Messages 6,062 GP referrals in Sept 2016 vs. 5,096 in Sept 2015 this is an increase of 966. Average GP referrals per month Average other referrals per month Total referrals per month 2012/13 5,395 3,600 8, /14 5,542 3,939 9, /15 5,414 3,697 9, /16 5,156 3,776 8, / ,825 9,611 3,542 other referrals in Sept 2016 vs. 3,789 in Sept 2015 this is an increase of 247.

16 7.1 Bolton NHS FT Referrals: April 2012 September GP Referrals & Other Referrals Key Messages Number of Referrals Apr-12 Jul-12 Oct-12 Jan-13 Apr-13 Jul-13 Oct-13 Jan-14 Apr-14 Jul-14 Oct-14 Jan-15 Apr-15 Jul-15 Oct-15 Jan-16 Apr-16 Jul-16 GP Referrals Other Referrals 4,537 GP referrals to BFT in Sept 2016 vs. 3,923 in Sept 2015 this is an increase of 614 Average GP referrals per month Average other referrals per month Total referrals per month 2012/13 3,903 2,639 6, /14 3,986 3,113 7, /15 3,924 2,837 6, /16 3,826 2,886 6, /17 4,277 3,019 7,328 2,791 other referrals to BFT in Sept 2016 vs. 2,901 in Sept 2015 this is a decrease of 110

17 7.2 Other Providers Referrals: April 2012 September 2016 Number of Referrals Apr-12 Jul-12 Oct-12 Jan-13 Apr-13 GP Referrals & Other Referrals Jul-13 Oct-13 Jan-14 Average GP referrals per month Apr-14 Jul-14 Oct-14 Average other referrals per month Total referrals per month 2012/13 1, , /14 1, , /15 1, , /16 1, , / Jan-15 Apr-15 Jul-15 Oct-15 Jan-16 Apr-16 Jul-16 GP Referrals Other Referrals Key Messages 1,525 GP referrals in Sept 2016 vs. 1,473 in Sept 2015 this is an increase of other referrals in Sept 2016 vs. 888 in Sept 2015 this is a decrease of 131.

18 7.3 Bolton NHS FT break down of referrals: April 2012 September Referral Break Down 5000 Number of Referrals A&E Community Consultant/ Internal Dental Practitioner GP National screening programmes Optometrist/ Orthoptist Other Self Apr-2012 Jun-2012 Aug-2012 Oct-2012 Dec-2012 Feb-2013 Apr-2013 Jun-2013 Aug-2013 Oct-2013 Dec-2013 Feb-2014 Apr-2014 Jun-2014 Aug-2014 Oct-2014 Dec-2014 Feb-2015 Apr-2015 Jun-2015 Aug-2015 Oct-2015 Dec-2015 Feb-2016 Apr-2016 Jun-2016 Aug-2016

19 Appendix 1 - QIPP Performance Detail 2016/17 QIPP Tracker Month 7 Strategic Theme Plan 2016/17 ( 000's) High Level Scheme Plan Actual Variance Plan Actual Variance Plan Actual Variance '000 '000 '000 '000 '000 '000 '000 '000 '000 '000 '000 '000 Prescribing 1,900 CCG Medicines Optimisation team ,108 1, ,900 1,900-1,900 1,900 - System Wide Prescribing TOTAL Prescribing ,108 1, ,900 1,900-1,900 1,900 - CHC , ,312 1, ,309 1, Continuing Healthcare 1,442 Children's CHC High Cost Cases TOTAL CHC , ,442 1, ,439 1, Estates Improving Estates Utilisation TOTAL Estates Running Costs 380 Admin budget savings Non Recurrent In Year slippage TOTAL Admin budgets Urgent Care Redesign Urgent Care Redesign 1,320 Reduced Length of Stay NWAS conveyance Bolton FT contract ,120 1,120-1,120 1,120 - TOTAL Urgent Care ,320 1, ,320 1, Mental Health Redesign 120 Out of Area Decommissioned Schemes TOTAL Mental Health Integration Home Oxygen Community Redesign 680 ESD/Neuro Rehab Rheumatology infusions Integrated Children's Community Paeds Bolton FT Contract TOTAL Community EUR Compliance (BMI) Service Redesign Planned care Redesign 2,005 Standardisation of pathways Diagnostics review Monitoring Bolton FT Contract ,250 1,250-1,250 1,250 - TOTAL Planned Care ,036 1, ,005 2, ,079 2,079-9 Total 7,847 Subtotal ,889 5,316 1,427 7,847 8, ,134 8,478 0 Schemes above Plan Total ,889 5,316 1,427 7,700 8, ,134 8,478 0 Note: Lines shaded in grey are system saving schemes Oct - 16 YTD FOT FYE Last Month's forecast Change to forecast since last mth

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