Godalming Masonic Hall, Godalming. No Commissioning, Finance and Performance Committee on 17 October Author considers that no exemption applies:

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1 Agenda item: 4.2 Paper No: 14 Committee: Venue: Governing Body Godalming Masonic Hall, Godalming Date: 31 October 2017 Status: FOR REVIEW AND NOTE Title of Report Service Transformation Report Month 6 Presented by Author Karen McDowell, Chief Finance Officer and Deputy Chief Executive Jane Chalmers, Interim Strategic Transformation and Commissioning Lead Finance Lead sign off Vicki Taylor 11 Oct 17 (Appendix 1 only) Conflict of Interest Governance and reporting- at which other meeting has this paper been discussed Freedom of Information No Commissioning, Finance and Performance Committee on 17 October 2017 Author considers that no exemption applies: Executive Summary: Guildford and Waverley CCG (The CCG) has a total Quality, Innovation, Productivity and Prevention (QIPP) plan for 2017/18 of 8.635M. The CCG currently has 19 schemes within its 17/18 QIPP plan. Of these: - 8 are assessed as green projected of 75% or better of plan - 4 are assessed as amber projected of between 50% and 74% of plan - 7 are assessed as red projected of less than 50% of plan The current forecast is the CCG will achieve 63%% of its planned for 17/18 ( 5.42M). The forecast for M5 was that the CCG would achieve 67.9%% of its planned for 17/18 ( 6.63M). Implications: Health/ CCG strategic objectives Financial/ Resource Legal/ Compliance Equality Analysis Patient and Public Engagement We will innovate, lead and transform the way local healthcare is delivered, fostering strong local partnerships to achieve this. In doing so, we will consider the benefits of system-wide and/or local, place based change, in the context of our Sustainability and Transformation Plan (Surrey Heartlands) and devolution arrangements. The CCG has a 2017/18 QIPP Plan of 8.635M If the local health economy fails to achieve the QIPP target the CCG will not achieve its financial strategic objective To be completed on a project by project basis when required To be completed on a project by project basis when required Service Transformation Report Month 6 Governing Body October

2 Risk (including reputational) and rating Top risk for the achievement of the QIPP plan is that the CCG will not deliver the required level of QIPP If the local health economy fails to achieve the QIPP target the CCG will not achieve its financial strategic objective. Scored at 25 and risk held on the Corporate risk register (R0119). Recommendation(s): (1) Governing Body is asked to note progress to date in the development and of the QIPP plan (2) Governing Body is asked to note the change in the forecast against plan from 67.9% in M5 to 63% in M6 (3) Governing Body is asked to note the outputs from the review of Transformational QIPP schemes (4) Governing Body is asked to note the top 2 risks to achievement of the QIPP plan Next Steps: Not applicable Service Transformation Report Month 6 Governing Body October

3 MONTH 6 SERVICE TRANSFORMATION REPORT FOR GUILDFORD AND WAVERLEY CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING HELD ON 31 OCTOBER Introduction Guildford and Waverley CCG (G & W CCG) has a total Quality, Innovation, Productivity and Prevention (QIPP) plan for 2017/18 of 8.635M. This report provides; an assessment of progress against that plan including the joint schemes with Royal Surrey County Hospital (RSCH), an update on collaborative working on QIPP with the other Surrey Heartlands (SH) CCGs, an overview of the work which has been completed in the past month to identify any additional transformational which can be delivered in year and high level detail of the top 2 risks associated with the of the QIPP plan 2. Assessment of Progress Against Plan The CCG currently has 19 schemes within its 17/18 QIPP plan. Of these: - 8 are assessed as being Green projected of 75% or better of plan - 4 are assessed as being amber projected of between 50% and 74% of plan - 7 are assessed as being red projected of less than 50% of plan The table below provides a collated view of this by functional area. Functional Area RAG Rating Green Amber Red Total CCG/RSCH Joint Working CCG Transformational 1 1 STP workstreams 1 1 CCG Transactional Total The schemes for which the forecast has been revised this month are; New Models of Follow Up, Integrated Out of Hospital Services and Medicines Management. Details on the reasons for the revised forecast can be found in section 3 The current forecast is the CCG will achieve 63%% of its planned for 17/18 ( 5.42M). The forecast for M5 was that the CCG would achieve 67.9%% of its planned for 17/18 ( 6.63M) 3. Updates on Individual Schemes (By Exception) to be read in conjunction with Appendix 1 to this paper (PMO QIPP Dashboard M6) This section will provide a high level commentary on those schemes which are either RAG rated Red and additional information is deemed necessary beyond that in the QIPP dashboard or where there has been a significant improvement or deterioration from the previously reported position. The CCG QIPP Delivery and Assurance Group (QDAG) receives detailed monthly updates on each QIPP scheme. Red Rated Schemes - New Models of Follow Up The project is underway and priority specialities have now been identified. A business case will be presented to the CCG s Commissioning, Finance and Performance Committee (CFP) for each speciality. The first one of these rheumatology was considered and agreed at CFP on 17 October. Savings in the original QIPP plan were profiled to start in April but these have not been achieved because the mobilisation of this scheme is taking longer than had 1

4 been anticipated. Following a discussion at Joint Transformation Group on 12 October, it has been agreed that the focus will now be on getting a minimum of 2 (a maximum of 4) schemes fully implemented in The forecast has been reduced significantly to reflect this change in timescales - Integrated Out of Hospital Services There are a number of projects underpinning the overall Integrated Out of Hospital scheme and there has been a level of success in some areas year to date and forecast for the year. The level of are unlikely to be achieved at the scale and pace required to deliver the target and the forecast has been revised down as a result of a review of the performance at Month 6. Forecast also assumes the saving resulting from reduction in funding for Geriatricians. - Medicines Management There are 2 main elements which are behind plan; Repeat Prescription Intervention project and Patent Expires. These 2 schemes constitute 1.68m of the planned for o For Repeat Prescription Intervention project there is scope for recovering some of the position as additional resource has taken post. o For Patent Expires, the previously reported potential top slice by NHSE from this portion of the is not going to happen. Additionally, the had been planned as 1/12 through the year however the patent expiry does not happen until 30 Sept 2017 and it is anticipated that the full value of the (480k) will be achieved by year end. QDAG has requested a deep dive on the Medicines Management schemes at its November meeting - Integrated Specialty Services - No change from M5. - Integrated Respiratory Nursing Service - No change from M5. - Acute Medicines Management No change from M5. - STP Workstreams - No change from M5. - Capped Envelope programme Update provided in paragraph Joint Working with RSCH The Joint Transformation Board met on 12 October. Work is underway to set up the first meeting of the Joint Transformation Working Group. Good progress is being made with the setting up of the GP in Accident and Emergency service. The preferred location for of the service will not be ready for date of commencement as a result of unexpected construction issues. A suitable alternative location has been provided and the service is on track to go live by the end of October as planned. RSCH, CCG and ProCare (the GP Federation) have developed a series of KPIs to measure the performance of the service. 5. Collaborative working on QIPP with the other Surrey Heartlands (SH) CCGs Further work has been completed on the capped envelope plans which each CCG had produced. The Joint CCG EMT has agreed that the following schemes will be progressed: - Procedures of Limited Clinical Effectiveness (POLCE) - Continuing Healthcare - Community Equipment Review - Mental Health CQUIN review - Shared Decision Making 2

5 The development of these schemes will be overseen by the Collaborative QIPP Forum which is chaired by the Chief Finance Officer of Surrey Heartlands CCGs and meets monthly. It is anticipated that in-year may only be achieved for Community Equipment and Mental Health CQUIN review. The other schemes need more scoping work to be completed before they can be mobilised. The scale of potential has not yet been quantified. 6. Overview of the progress to date on the identification of additional in year QIPP Savings There has been a full review of all transformational schemes to identify whether any additional actions can be completed to produce more. - Additional actions have been identified for; Falls, Red Bags, Directory of Services, SOS bus and complex patients which all sit within the Integrated Out of Hospital scheme - New schemes task/finish groups have been set up to scope in year saving opportunities for respiratory and Deep vein thrombosis (DVT). Task/Finish groups planned to produce reports for QDAG on 7 November 7. Top 2 Risks to Delivery of the 17/18 QIPP Plan There was a full review of programme and project risks at QDAG on 3 October. The top 2 risks associated with the of the 17/18 QIPP plan are listed below. There are a further 6 risks being held at QIPP Programme level, scored at 12 or less. Last Updated 12 Oct 17 The Risk Is The Impact is Mitigation The CCG will not deliver the required level of QIPP Senior members of the Clinical Commissioning Team will be required to make increasing levels of commitment to STP work If the local health economy fails to achieve the QIPP target the CCG will not achieve its financial strategic objective Reduction in capacity to lead, manage and deliver CCG QIPP schemes Continue to seek to achieve more from transformational schemes which are in phase, maximise any transactional QIPP opportunities It is anticipated the team will be operating at full capacity by Feb 18. Risk Score Comments 25 Risk held on the Corporate risk register (R0119) Overall Assessment Based on the M6 position, the overall position against plan has deteriorated slightly. Whilst there may be some catch up as some of the late starting schemes gain momentum it will be an on-going a challenge for the remainder of the year if the CCG is to achieve 75% or better of its plan. The work which has been done in the past month to identify additional from the transformational schemes is likely to help close the gap although the exact additional are still to be quantified. Once the additional actions which have been identified are competed it is very unlikely that there will be any further effort which can be applied to the transformational schemes to achieve more within financial year. 3

7 Scheme Annual Plan Forecast at Month 6 Movement in Forecast compared to Previous month % Forecast Month 6 Reporting YTD Month 6 Plan YTD Actuals Month 6 Advice & Guidance 526, , , % 263,165 99, ,314 38% New models of follow up 909, , , ,350 13% 454,987 58, ,662 13% Integrated Specialty Services 527, , % % Integrated out of hospital services 1,138, , , ,204 29% 569,243 63, ,080 11% IBD 239, , ,742-55,258 50% 119, ,742 0% Very High intensity Users 771, , % 385, , ,766 58% Integrated respiratory nursing service 285, , % 142, ,586 0% Critical Care activity coordinator 135,523 67,762-67, % 67, ,762 0% GP frailty 300, , % 150, ,000 0% Acute Medicines Management 250, , % 125, ,000 0% Sub Total Acute 5,083,678 1,701,012-3,382,666-1,012,813 33% 2,278, ,105-1,834,910 19% STP - Cancer % % N/A N/A STP - Maternity & Paeds % % N/A N/A STP - MSK % % N/A N/A Sub Total STP % % Medicines Management 2,500,000 1,600, , ,000 64% 1,250, , ,000 55% Other Acutes 176, , % 88,161 88, % CHC placements 275, , % 137, , % BCF 200, , % 100, , % Primary Care 200, , % 100, , % Corporate 200, , , , % 100, , , % Sub Total Other 3,551,322 2,951, , ,000 83% 1,775,661 1,410, ,000 79% Total All schemes 8,635,000 4,652,334-3,982,666-1,212,813 54% 4,053,676 1,853,766-2,199,910 46% % YTD assessment Last Month KEY - Green - Projected 75% or better of plan; Amber - Projected between 50% and 74% of plan; Red - Projected - less than 50% of plan Notes Stretch / Pipeline Annual Plan Forecast at Month 6 Movement in Forecast compared to Previous month % Forecast YTD Month 6 Plan YTD Actuals Month 6 RSCH patient flow programme % % STP workstreams % % Capped Expenditure programme % % Other acutes - Non QIPP - included in baseline contracts 0 71,716 71,716 0% 0 35,858 35,858 0% Local tariff for AEC - transactional non QIPP 0 700, ,000 0% 0 350, ,000 0% Sub Total Pipeline 0 771, , , ,858 % YTD assessment - Last Month Notes Total Plan including pipeline 8,635,000 5,424,050-3,982, ,097 63% 4,053,676 2,239,624-1,814,052 55% Based on forecast of QIPP against plan GREEN - 75% or above forecast AMBER - 50% - 74% forecast RED - less than 50% forecast

8 Scheme Annual Plan Forecast at Month 5 YTD Month 5 Plan Month 5 Reporting YTD Actuals Month 5 % Forecast assessment - Last Month KEY - Green - Projected 75% or better of plan; Amber - Projected between 50% and 74% of plan; Red - Projected - less than 50% of plan Notes Advice & Guidance 526, , , ,304 66, ,637 57% New models of follow up 909, , , , , ,662 60% Integrated Specialty Services 527, , % Integrated out of hospital services 1,138, , , , ,000-94,369 75% IBD 239, ,000-64,484 99,785 59,871-39,914 73% RSCH Patient flow programme % N/A N/A Very High intensity Users 771, , , ,000-46, % Integrated respiratory nursing service 285, , , ,821 0% Critical Care activity coordinator 135,523 67,762-67,762 56, ,468 50% Local tariff for AEC % N/A N/A GP frailty 300, , , ,000 0% Acute Medicines Management 250, , , ,167 0% Sub Total Acute 5,083,678 2,713,825-2,369,854 1,898,345 1,009, ,315 53% STP - Cancer % N/A N/A STP - Maternity & Paeds % N/A N/A STP - MSK % N/A N/A Sub Total STP % Medicines Management 2,500,000 2,100, ,000 1,041,667 1,041, % Other Acutes 176, , ,468 73, % CHC placements 275, , , , % BCF 200, , ,333 83, % Primary Care 200, , ,333 83, % Corporate 200, , ,333 83, % Capped Expenditure Programme % N/A N/A Sub Total Other 3,551,322 3,151, ,000 1,479,718 1,479, % Total All schemes 8,635,000 5,865,147-2,769,854 3,378,063 2,488, ,315 68% Stretch / Pipeline Annual Plan Forecast at Month 5 YTD Month 5 Plan YTD Actuals Month 5 % Forecast assessment - assessment - RSCH patient flow programme % STP workstreams % Capped Expenditure programme % Other acutes - Non QIPP - included in baseline contracts 0 71, ,882 29,882 0% Local tariff for AEC - transactional non QIPP 0 700, , ,667 0% Sub Total Pipeline 0 771, , ,548 Total Plan including pipeline 8,635,000 6,636,863-2,769,854 3,378,063 2,810, ,766 Based on forecast of QIPP against plan GREEN - 75% or above forecast AMBER - 50% - 74% forecast RED - less than 50% forecast 68% 74%

Agenda item: 4.3 Paper no: 12

Agenda item: 4.3 Paper no: 12 Committee: Governing Body Date: 23/01/18 Venue: Title of Report Status: Presented by: Executive Lead: Author(s): Date of paper Version (if applicable) Finance Lead Sign off