Agenda item: 4.3 Paper no: 12

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Dwight Hardy
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1 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 Relevant Legislation and Source Documents Conflict of Interest Governance and Reporting (relevant committees/forums the paper has previously been presented to) Attachments: Boardroom, Dominion House M9 Service Transformation Report FOR REVIEW AND NOTE Karen McDowell, Chief Finance Officer. Surrey Heartlands CCGs Karen McDowell, Chief Finance Officer. Surrey Heartlands CCGs Jane Chalmers, Interim PMO Lead 12/01/18 Vicki Taylor, Deputy Chief Finance Officer 8 January (Appendix 1 only) None identified Committee: Commissioning, Finance and Performance Committee Date: 16/01/18 Outcome: Report was noted Appendix 1 - CCG Performance against the QIPP programme as at 31st December 2017 () Executive Summary Guildford and Waverley CCG (G & W CCG) has a total QIPP plan for 2017/18 of 8.635M. The M9 forecast is the CCG will achieve 70% of its planned savings for 17/18 ( 6.02M). The forecast for M8 was that the CCG would achieve 68% of its planned savings for 17/18 ( 5.83M). The CCG currently has 21 schemes within its 17/18 QIPP plan. Of these: - 11 are assessed as being Green projected savings of 75% (or better) of plan - 2 are assessed as being amber projected savings of between 50% and 74% of plan - 8 are assessed as being red projected savings of less than 50% of plan Implications: Health/CCG strategic objectives Financial/Resource Legal/compliance We will innovate, lead and transform the way local healthcare is delivered, fostering strong local partnerships to achieve this. 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 M9 Service Transformation Report/ Governing Body January

2 Equality Analysis Risk (including reputational) and rating To be completed on a project by project basis when required 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): Governing Body is asked to: (1) NOTE progress to date in the of the QIPP plan (2) NOTE the year-end forecast has improved from 5.83M (68%) to 6.02M (70%) (3) NOTE the top 2 risks to achievement of the QIPP plan Next Steps: Note applicable For further information contact Jane Chalmers, Interim PMO Lead M9 Service Transformation Report/ Governing Body January

3 MONTH 9 SERVICE TRANSFORMATION REPORT FOR GUILDFORD AND WAVERLEY CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING HELD ON 23 JANUARY 2018 Overview 1. Guildford and Waverley CCG (G & W CCG) has a total 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 and high level detail of the top 2 risks associated with the of the QIPP plan 2. The current forecast is the CCG will achieve 70% of its planned savings for 17/18 ( 6.02M). The forecast for M8 was that the CCG would achieve 68% of its planned savings for 17/18 ( 5.83M). 3. The CCG currently has 21 schemes within its 17/18 QIPP plan. Of these: - 11 are assessed as being Green projected savings of 75% or better of plan - 2 are assessed as being amber projected savings of between 50% and 74% of plan - 8 are assessed as being red projected savings 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 1 1 CCG Transactional Total Acute/Joint Delivery Programme 4. Updates on Individual Schemes (By Exception) to be read in conjunction with Appendix 1 to this paper (PMO QIPP Dashboard M9) Red Rated Schemes - IBD Nurse The IBD nurse is now in post however there has been an expected time lag before any savings materialise as a result of the delays in this recruitment and the forecast has been adjusted to reflect this. - New Follow Up Models Provisional agreement has been reached to pursue the development of new follow up models for Cardiology, Rheumatology and Respiratory in Q4. However, it is unlikely that this work will contribute to increased savings for this scheme in 17/18 because of the time it will take to mobilise this work. 1

4 Amber Rated Schemes - Very High Intensity Users The Project lead is now in place - Critical Care Co-ordinator The impact of the postholder being in place for a few month is now being seen. Savings have increased to 60% of plan this month (29% in M8) Other Programmes 5. Updates on Individual Schemes (By Exception) to be read in conjunction with Appendix 1 to this paper (PMO QIPP Dashboard M8) 17/18 CCG QIPP - Medicines Management Although still RAG rated Red there has been an improvement in achievement of savings against plan this month from 33% in M8 to 47% in M9 - Transactional QIPP work continues to quantify the size of savings. The impact of some of the contractual challenges which were issued in Q3 is expected to start to come through in M10. The forecast remains unchanged at M9 Collaborative QIPP - The 3 CCGs continue to work together to identify potential collaborative QIPP opportunities for 2018/19. To date 7 areas have been identified as potential collaborative opportunities; Continuing Healthcare, Procedures of Limited Clinical Effectiveness, Shared Decision Making, Contracting, Prevention, Urgent and Emergency Care and Patient and Citizen engagement. Work is now underway to identify in more detail what the opportunities are and to understand how the schemes link to Surrey Heartlands Health and Care Partnership (SHP) workstreams 2

5 Risks 6. 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 Reviewed 15 Jan 2018 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 SHP 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 savings from transformational schemes which are in phase, maximise any transactional QIPP opportunities Greater alignment of CCG and SHP transformational work Risk Score Comments 25 Risk held on the Corporate risk register (R0119) 16 This risk will be reviewed in M10 Overall Assessment 7. The overall position has continued to improve in M9. It is anticipated that a few schemes; Critical Care Co-ordinator, Very High Intensity Users and Advice and Guidance will deliver a higher percentage of savings in the last quarter. However, several of the transactional QIPP savings are still to be quantified. It remains a challenge for the CCG to achieve 75% (or better) of its plan. 3

6 CCG Performance against the QIPP programme as at 31st December 2017 () Financial Headlines for Year to date performance at is actual savings of 4.2m against the plan of 6.3m resulting in adverse variance of 2.1m (66% performance). This is after stretch schemes delivering 1m ytd. Forecast for the year is actual savings of 6m against the plan of 8.6m resulting in an adverse variance of 2.6m (70% performance). This is after stretch schemes delivering 1.4m forecast for the year. Reporting Scheme Annual Plan Forecast at Movement in Forecast compared to Previous month % Forecast YTD Plan YTD Actuals Advice & Guidance 526, ,801 62,472-51, % 394, ,601 46, % New models of follow up 909,973 84, ,528-17,318 9% 682,480 63, ,146 9% % YTD assessment savings Last Month Integrated Specialty Services 527, , % 263, ,825 0% Integrated out of hospital services 1,138, , , % 853, , ,299 75% IBD 239,484 59, , % 179, ,613 0% Very High intensity Users 771, , , ,326 52% 578, , ,744 52% Integrated respiratory nursing service 285, , % 213, ,878 0% Critical Care activity coordinator 135, ,533-12,990 88,652 90% 101,642 61,266-40,376 60% GP frailty 300, , % 225, ,000 0% Acute Medicines Management 250, , % 187, ,500 0% Sub Total Acute 5,083,678 2,118,475-2,965, ,029 42% 3,680,846 1,513,320-2,167,527 41% 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 1,474,000-1,026, ,000 59% 1,875, , ,000 47% Other Acutes 176, , % 132, , % CHC placements 275, , % 206, , %

7 BCF 200, , % 150, , % Primary Care 200, , % 150, , % Corporate 200, , % 150, , % Sub Total Other 3,551,322 2,525,322-1,026, ,000 71% 2,663,492 1,668, ,000 63% Total All schemes 8,635,000 4,643,797-3,991,203-70,029 54% 6,344,338 3,181,811-3,162,527 50% Stretch / Pipeline Annual Plan Forecast at Movement in Forecast compared to Previous month % Forecast YTD Plan YTD Actuals RSCH patient flow programme % % STP workstreams % % Capped Expenditure programme % % Other acutes - Non QIPP - included in baseline contracts 0 71,716 71, % 0 53,787 53,787 0% Local tariff for AEC - transactional non QIPP 0 700, , % 0 525, ,000 0% NEW COPD % % NEW Transactional deep dive review programme 0 605, , % 0 453, ,750 0% % YTD assessment - savings assessment - savings Sub Total Pipeline 0 1,376,716 1,376, ,032,537 1,032,537 Total Plan including pipeline 8,635,000 6,020,513-2,614,487-70,029 70% 6,344,338 4,214,348-2,129,990 66% Based on forecast of QIPP against plan GREEN - 75% or above forecast savings AMBER - 50% - 74% forecast savings RED - less than 50% forecast savings Black - project stopped

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

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