Kingston Clinical Commissioning Group Report Summary

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Kingston Clinical Commissioning Group Report Summary Meeting Title Governing Body in public Date 6 th March 2018 Report Title Finance Committee Minutes Agenda Item 12 Attachment J1 Purpose (please

1 Kingston Clinical Commissioning Group Report Summary Meeting Title Governing Body in public Date 6 th March 2018 Report Title Finance Committee Minutes Agenda Item 12 Attachment J1 Purpose (please indicate with X) Approval/ Ratification Discussion / Comment Information x Report Author: (name & job title) David Knowles, Lay Member & Vice Chair Presented by: (name & job title) David Knowles, Lay Member & Vice Chair MINUTES OF THE FINANCE COMMITTEE HELD ON TUESDAY 19 th DECEMBER 2017 KING CHARLES CENTRE, SURBITON PRESENT: David Knowles Lay Member & Chair Paul Gallagher Lay Member & Audit Chair Naz Jivani Governing Body Chair Annette Pautz Governing Body GP Yarlini Roberts Local Director of Finance, K&R LDU Jim Smyllie Lay Member Tonia Michaelides Managing Director, K&R LDU Sarah Blow Accountable Officer, SWL Alliance IN ATTENDANCE: Adrianna Wicinska PA & Finance Support Minutes APOLOGIES: Phil Moore Governing Body GP James Murray Chief Finance Officer, SWL Alliance Jenny Sinnott Head of Finance Ben Okoye NEL CSU Laura Winder NEL CSU Julia Travers Director of Commissioning Sue Lear Interim Deputy Director of Commissioning Kathryn MacDermott Director of Primary Care & Planning Version: Final J1-1

2 17/197 WELCOME AND APOLOGIES: Those present were welcomed to the meeting. 17/198 DECLARATIONS OF INTEREST: There were no declarations. 17/199 MINUTES OF THE LAST FINANCE COMMITTEE MEETING The minutes of the last meeting held on Tuesday, 28 th November were agreed as an accurate record. 17/200 MATTERS ARISING 17/165 Running Costs Action remains outstanding: James Murray to provide report on cost savings that have resulted from the federation of CCGs into LDUs. 17/201 FINANCE REPORT MONTH 8 A copy of the Month 8 Finance Report had been circulated. Members were also presented with a summary of the Month 8 position as follows: The CCG expects to meet its planned in year 0.5% surplus of 1,151k. Cash and Better Payment Practice Code (BPPC) targets were met in month 8. 20k non-recurrent allocation adjustment has been received for Charge Exempt Overseas Visitor (CEOV) in month 8. The cost impact of Identification Rules (IR) is excluded from the acute position. Analysis work is being carried out with NHSE specialised and it is anticipated that funding will be received to cover the shortfall. A small improvement from month 7 QIPP savings are forecast, however delays in starting some QIPP schemes mean that the CCG anticipates to under-achieve against plan. The CCG is using non-recurrent support to manage the forecast position, enabling delivery of the planned in-year surplus of 0.5%. Members were advised that the CCG would not achieve its 2017/18 QIPP target. The work is in place within the LDU and the Alliance for ways to identify the QIPP shortfall for next year. The CCG is also looking at the SWL estates which are expected to give a small amount of recurrent revenue savings through void costs. Members agreed the KMS contract was a considerable achievement. The work is continuing but no problems are foreseen at this stage. Contract details are expected to be followed up and finalised in January Acute Commissioning Kingston Hospital s reported forecast position has worsened slightly by 61k since Month 7 to 4.4m, with the largest variance in Emergency which shows 1.9m over plan year to date. Version: Final J1-2

3 Members were given a quick update on the Contract Alignment issues in terms of some of the principles around the arbitration. In addition, members noted there were some issues with regards to the pressure being put on the service lines which should be addressed. St George s Hospital reports a forecast overperformace of 786k. Largest variances are in elective ( 76k), emergency and NEL ( 586k) and critical care ( 347k). Members noted that St George s Hospital reported forecast position does not include the Identification Rules (IR) impact on the 2017/18 tariff. It is assumed that an allocation will be received to cover the IR cost. This assumption is reported to NHS England, any change will be likely to impact the CCG s financial position. Non acute Commissioning Continuing Care Members were advised that the Continuing Healthcare (CHC) position has worsened since month 7 by 31k, with a forecast overspend of 928k by year end. This is mainly due to Funded Nursing Care (FNC) which is continuing to increase as the number of people eligible for CHC reduces. These are subject to regular reviews. Children s forecast has worsened by 10k since month 7, now expected to overspend by 475k. This is due to two very expensive new children being funded. Reviews of high cost placements have been requested from the provider and the position will be monitored closely. Primary Care The overspend in Prescribing has been noted. The position includes the cost from the NCSO drugs but does not take into account the expected increase in cost in future months. A future risk of circa 380k has been reported to NHSE. Members were also given an update on the IR Impact. The Specialised Commissioning Identification Rules review letter from Richard Jeffery, Director of Financial Management, NHSE was circulated prior to the meeting. Members noted the NHSE have recognised there was a discrepancy. There is an expectation that additional funding will be forthcoming from NHS England. It is probable that the details of the review will be ready in time for the Month 9 reporting. QIPP Performance Members were informed although the overall in-month QIPP position forecast shows an under achievement there has been a slight improvement. In addition, members noted the transformational position was weakening. Members were advised the KCC Locality Teams and Frequent Attenders in A&E are both forecast to underachieve by year end by 74.6% and 58% respectively. The progress is being made and more tangible feedback should be available in the forthcoming months. Version: Final J1-3

4 The Finance Committee NOTED the Month 8 Finance Report. 17/202 QIPP Update 2018/19 Members were informed that we are yet to receive a report following the recent Deloitte. Review. Considerable efforts were undertaken to improve the QIPP position. Following the SMT Meeting in November the summary of the schemes were presented to the Governing Body. Members were informed there is a Deep Dive Budget Review meeting scheduled later that week, to discuss the year-end forecasts and 2018/19 QIPPs and were we are in terms of implementation. An update on QIPP Plan and update on an outcome of the Deep Dive Budget Review will be brought to future meetings of the Finance Committee. 17/203 NEL CSU INTEGRATED REPORT MONTH 7 A copy of the NEL CSU Integrated report had been disseminated. No further comments were raised with relation to the report. 17/204 KCCG & KINGSTON HOSPITAL JOINT RESPIRATORY POST A copy of the Joint Respiratory Post with Kingston Hospital paper had been circulated for approval. Members were informed there was a lot of evidence for this kind of role saving money and improving care. The 6% reduction in COPD readmissions within 30 days has been seen in Royal Surrey County Hospital upon developing a similar post. It is a post hosted by the Kingston Hospital, which has already committed funding for half of the cost. The Kingston CCG would be asked to contribute 50% of the WTE + on costs + Annual Leave totalling to 33,179 as opposed to 29,102 which does not cover the annual leave. Alternatively the CRIS team could be approached and asked to cover the annual leave component of the post. The post holder would be expected to work across the Kingston Hospital and the community, maintaining close links with the CRIS team and the GPs to improve the Care and reduce admissions as well as preventing re-admissions in the long run. Members noted there is a scope to develop a lead post for the respiratory cases in Kingston. In addition, members noted this post could be linked with some of the QIPPs. Whilst this post was originally brought as a 12 month fixed term it has a scope of becoming permanent this should allow for the post to be reviewed. Finance committee APPROVED the post and the contribution of 33,179. Version: Final J1-4

5 17/205 IDENTIFICATION RULES (IR) UPDATE This has been covered earlier in the meeting. 17/206 ANY OTHER BUSINESS Members were advised that the Kingston Hospital have received the Winter Resilience funding of 1.4m with 1.2 for Kingston Hospital and the remainder for the community. Joint Funding of Placements between CCG and RBK - Update Tonia Michaelides has received an from Derek Hoddinott with regards to a proposal from Steve Taylor suggesting we have a default position of 50/50 to avoid delays in decision making for Joint Placements and to apply the 50/50 default to historic cases to avoid delays. The funding tool, which was brought to the September meeting of the Finance Committee, proposed a sensible way forward to minimise variations and have a consistent approach in implementing a model that should help in assessing the eligibility for Joint Funding. The Finance Committee has subsequently agreed to run it as a pilot for a period of three months. Members were made aware the Mental Health Placements have not been assessed since 2017/18 and there were 12 outstanding historic cases that needed to be looked into. The CCG has agreed to apply this tool retrospectively for these 12 cases only. Therefore members agreed that the attempt to retrospectively amend the terms of the proposal is not appropriate. The proposal will be reviewed at the end of the three month pilot. 17/207 DATE OF NEXT MEETING Tuesday, 23 rd January 2018 Future Meeting Dates: Tuesday, 27 th February 2018 (1.30pm-3pm) Tuesday, 27 th March 2018 (1.30pm-3pm) Tuesday, 24 th April 2018 (1.30pm-3pm) Tuesday, 22 nd May 2018 (1.30pm-3pm) Tuesday, 26 th June 2018 (1.30pm-3pm) Tuesday, 24 th July 2018 (1.30pm-3pm) Tuesday, 25 th September 2018 (1.30pm-3pm) Tuesday, 23 rd October 2018 (1.30pm-3pm) Tuesday, 27 th November 2018 (1.30pm-3pm) Tuesday, 18 th December 2018 (1.30pm-3pm) Version: Final J1-5

Kingston Clinical Commissioning Group Report Summary

Kingston Clinical Commissioning Group Report Summary Meeting Title Governing Body in public Date 7 th November 2017 Report Title Finance Committee Minutes Agenda Item 15 Attachment O1 Purpose (please indicate