Minutes of the Finance and Performance Committee

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1 Minutes of the Finance and Performance Committee Date Wednesday 19 th April 2017 Venue Conference Room, Hollybush House, The Royal Wolverhampton NHS Trust (RWT) Time 8.30am Present: Name Role Mary Martin Jeremy Vanes Junior Hemans Sue Rawlings Mike Sharon Gwen Nuttall Non-Executive Director (Chair) Chairman Non-Executive Director Non-Executive Director Director of Strategic Planning & Performance Chief Operating Officer In Attendance: Name Role Helen Troalen Deputy Chief Financial Officer Simon Evans Deputy Director of Strategic Planning & Performance (Part) Catherine Griffiths Deputy Director of Workforce Claire Richards PA to Director of Strategic Planning & Performance (Note Taker) 27/2017 Introductions M Martin welcomed Helen Troalen, Deputy Chief Financial Officer, to the Finance & Performance Committee Meeting. 28/2017 Apologies for Absence Apologies were received for K Stringer and A Duffell. 29/2017 Minutes of Meeting Held on 22 nd March 2017 The minutes were agreed to be a true record. 30/2017 Action Points From Previous Meeting Trust Financial Report (Review of Agency/Locum Costs) The baseline resource meeting are on track to complete the review by 20/4/17. The data from the review will provide a baseline report for Financial Recovery Board (FRB) in May. Action closed Procurement Strategy Metrics The report has been added to the agenda, see item Action closed BAF (SR1) Sponsorship Costs for Overseas Nurses Sponsorship costs are not relevant for overseas nurses if they obtain British citizenship, however, the certificate of sponsorship costs 1k per annum and is payable upfront so not refundable should overseas nurses later obtain British nationality. Action closed BAF (SR10) Cash Flow A cash flow report has been added to the agenda, see item 32/2017. Action closed. 1

2 30.05 Cannock Chase Hospital (CCH) Transaction Income & Expenditure (I&E) Statement M Martin confirmed that A Quinn had circulated a copy of the paper to the Trust Board. Action closed Cannock Chase Hospital (CCH) Transaction Income & Expenditure (I&E) Statement H Troalen reported back that although she did not know in formal terms where this had landed the topic had arisen in a recent meeting with the NHSI and H Troalen reiterated to them that this funding is included in the Trust s plan for 2017/18. Action closed Urgent Care (Board Development Session) G Nuttall confirmed that L Dowson would be attending a Board Development Session in June to discuss primary care delivery. Action closed. 31/2017 Declaration of Interest No declaration of interests declared. 32/2017 Cash Flow Presentation H Troalen presented the above report. M Martin expressed concerns regarding the lack of information regarding capital expenditure in the report and stated that the report was not what was expected. S Rawlings agreed. M Martin asked if a report could be re-submitted to the Committee to include a more traditional cash flow showing income and expenditure, including capital expenditure and giving a monthly balance. The purpose of the report is to show the Committee how the cash flow is being managed, whether the cash flow will have an impact on the Capital Programme and to highlight if/when a loan would be required to cover cash flow. H Troalen assured the Committee that cash flow is being managed on a daily basis and that the department will be examining University Hospital Coventry s (UHCW) robust cash flow process for areas of good practice. H Troalen to ensure a report is submitted for discussion at next month s Finance & Performance Committee meeting. C Richards to ensure that the Cash Flow Report is added to the agenda as the first agenda item. CR 33/ Governance BAF Update A more in-depth review will take place at next month s Finance & Performance Committee Meeting. M Martin asked for an update regarding the impact of IR35. G Nuttall stated that there had been a mixed response. The Trust had lost some long term locums, gained some staff onto payroll, some staff members had argued their case and an appeal hearing had also taken place, however, the member of staff had lost the appeal. Further discussion took place and concerns were expressed that recruitment agencies were trying to embed the impact of IR35 into costs, creating inflation. G Nuttall stated that the Trust was following the national line, which is not to accept the additional costs. G Nuttall felt that the impact of IR35 would cause a national inflation pressure. 34/ Financial Performance for Period 12 Trust Financial Report H Troalen presented the report to the Committee stating that the Finance Department have put together a brief summary of the 2016/17 position. H Troalen agreed to circulate a copy of the regular Finance reports to the Committee when available and invited queries via . 2

3 The report indicated that the Trust has ended the year with a surplus of 6.1M. However, the position is subject to a decision on arbitration in relation to unrealised transitional costs and external audit opinion on the financial accounts. Further discussion took place regarding the true year end position and the underlying position and the need to ensure that staff were aware of these issues. H Troalen confirmed that the Trust had received STF funding for meeting the Q4 control total and that a further STF award is available for exceeding the anticipated target. The additional award is anticipated to be at least 400k and the real benefit is that it is cash for next year. H Troalen stated that the appeals process around the 4.8M was continuing. The whole sum has been assumed in the year end position, however, a provision for 50% has also been included. J Vanes asked what the impact would be if the appeal was unsuccessful. H Troalen stated that if completely unsuccessful the additional funding would create an additional pressure for 2017/18 of 2.4m. M Martin asked H Troalen to provide a summary of the underlying position and to ensure that it is circulated to the Committee via . H Troalen confirmed that a document was available and would be circulated following validation. M Martin asked that comments/queries be fed back to H Troalen Contract Income Discussions took place regarding the quarterly and full year income position of Division 1 and 2. J Vanes asked for clarify regarding the Other section. M Martin stated that this would become transparent once the summary was circulated. See above action. Cash M Martin stated that she was pleased to see an improved cash position Financial Recovery Board (FRB)Report M Sharon presented the report to the Committee. The Trust delivered M of its M 2016/17 CIP target, which equates to 68.3% of the revised target. The Trust has identified 8.729M of its M 2017/18 CIP target. As a result, the Financial Recovery Board (FRB) met on 18 th April 2017 to review 2016/17 CIP performance and identify potential mitigations to increase the 2017/18 plan. M Sharon stated that discussions had taken place at the FRB Meeting regarding what savings can be deemed CIP savings. A reminder was issued during the FRB Meeting that 20M CIP was the maximum achievable realistic target but now had to accept an increased target of 27M for 2017/18. M Sharon stated that the reporting had been revised to clearly display approved PIDS and PIDs in the pipeline. Executive leads have now been confirmed and Deep Dive Execute Challenge Meetings are scheduled to take place next week. M Martin asked for an update regarding the management of Service Re-design. M Sharon confirmed that a business case had been submitted to NHSI to extend the Deloitte contract for a further 6 months. The business case has not yet been approved, despite chasing. The Trust is now out of contract with Deloitte and is looking to obtain business case funding as soon as possible. S Evans confirmed that the Trust is hoping to receive a response this week. M Martin stated that the Non-Executive Directors would be happy to support the request, if needed. 3

4 M Sharon confirmed that the Trust has stated that it will not participate in FIP2. However, Deloittes have been asked to provide a proposal to address current CIP, identifying where the Trust can benefit most in regards capacity and capability and to help the Trust exploit opportunities available with Safehands. A business case outlining an alternative proposal to FIP2 will be submitted to NHSI once agreed. The Trust is also developing 4 Long Term Strategy schemes focusing on Frailty and Ambulatory Care, Stroke, Safehands and Vertical Integration (VI). J Vanes asked for clarity regarding the possibilities around Safehands. M Sharon stated that this would revolve primarily around internal efficiencies. M Martin felt that it would be helpful to develop the Trust team to provide national assistance to other Hospitals using the software. This may provide some benefit to the Trust. M Martin asked for an update regarding the future of Dermatology. A discussion took place regarding current locum costs and lack of interest during recruitment exercises. G Nuttall stated that early joint working discussions had taken place with Walsall Healthcare NHS Trust and Shrewsbury and Telford Hospital NHS Trust (SaTH). A meeting is due to take place with Commissioners next week to discuss whether there is a need to restrict referrals on site. G Nuttall informed the Committee that a Consultant who is currently long term sick leave may be returning sooner than anticipated and that existing staff are currently working incredibly hard. Further discussion took place regarding the pressures regionally and whether the NHS should revisit the criteria for this speciality NHS FY 15/16 Benchmarking Report Summary M Martin challenged the data in the data in the report. M Sharon stated that he had not had sight of the report before it had been submitted to the Committee for perusal. H Troalen agreed to discuss the requested revisions with K Stringer and to circulate a revised copy to the Committee. M Sharon stated that a final report has been issued and the Black Country Back Office Steering Group are meeting, followed by a meeting of the CEOs to discuss conclusions in May. Trusts have been asked which areas they would like to be lead provider. RWT have responded stating that it would like to be lead provider for Payroll. 35/ Performance Performance Element of the IQP Report (National & Contractual Standards) G Nuttall presented highlights from the above report. Patient Experience G Nuttall was happy with the targets that had been met but expressed disappointment regarding the cancelled operation due to lack of consent. G Nuttall stated that Doctors are aware of the process and that this should not have happened. Waiting Times (Referral to Treatment) Diagnostics remain a concern due to an increase in rate of referrals to specialised CT and MRI Heart investigations. The Radiology Department continues to work closely with the Cardiac Directorate to utilise scan capacity, additional sessions have been made available for April and May. Unfortunately one of the Cardiology Doctors has left the Trust following the IR35 changes. 4

5 Urgent Care Total time spent in the Emergency Department achieved 91.24% in March. Organisational Efficiency G Nuttall stated that there was a need to focus on the theatre utilisation workstream and Ear, Nose and Throat (ENT) in particular. G Nuttall informed the Committee that there had also been a dip in activity in Maxillo Facial during March. Further discussions will take place during FRB. G Nuttall informed the Committee that there are going to be challenges surrounding social care in terms of delayed discharges due to funding constraints, despite the additional money allocated to social care. G Nuttall also stated that 100% of performance element payment of the STF (which represents 30% of total payment) is related to achieving the trajectory for ED. Trajectories have been submitted for key performance standards for A&E, RTT Diagnostics and Cancer 62 day wait. The Trust has only received one pushback in relation to the Cancer 62 day wait target which was been increased from the original request of 80% to 81 82% Workforce C Griffiths reported that sickness absence is begun to show a downward trajectory. ESR is being used as a single point for sickness data. J Vanes asked if there was a reason why ambulance conveyances had reduced for City & Sandwell and increased for RWT. G Nuttall stated that there was no specific reason for the reduction in ambulance conveyances. J Vanes asked for clarification regarding the delay to transfers awaiting family choice. G Nuttall stated that there was always a small percentage of delay which was usually caused by families taking some time to visit/consider care homes prior to making a choice on discharging patients. M Martin asked if theatre utilisation figures included weekends and bank holidays as available sessions. G Nuttall confirmed that weekends and bank holidays were removed from the equation as planning took place around available working hours. M Martin asked if there had been any consideration to theatre utilisation during weekend or bank holiday periods. G Nuttall and M Sharon stated that at present the Trust was focusing on full capacity during weekdays and the possibility of extending some working days/sessions to provide an as efficient and effective service as possible. G Nuttall informed the Committee that some sessions were provided on Saturdays for some specialities but that this was not routine. J Vanes asked if the capital scheme to rebuild/refurbish theatre 6 had been completed. G Nuttall confirmed that the work had been completed but that there had been some challenges with water testing. The Trust was hoping to start theatre cleaning next week. The project was currently running 3 weeks behind schedule Performance against Contractual Standards (Fines) S Evans outlined the fines report. S Evans stated that the Trust had accrued 4.3M of fines but that this figure could not be levied because of STF. Unfortunately ambulance fines were not included in the STF waiver and the number of ambulance fines has increased throughout the year, totalling 375k. 5

6 35.3 STP Update M Sharon provided an update. The Trust had been asked to comment on the STP Governance Response Template by 18 th April. M Sharon stated that he had provided a response on behalf the Trust and informed the Committee that there is a move to create a more executive structure for STP. M Sharon felt that this would be difficult to approve as it would involve a large number of organisations but stated that it would be key to ensure Local Authority engagement Tender Report M Sharon provided an update on the report and stated that there were no unsuccessful tenders during Quarter 4. M Martin asked if the value of the tenders would be included where possible. M Sharon agreed that this would be provided where possible but stated that some of the tenders were to bid for the possibility of becoming a future provider for a service and in some cases costings were not available. M Sharon informed the Committee that current tenders included Lead Provider Occupational Health and Pharmacy Technician Training. Both tenders were short notice and low in value, eg Pharmacy Technician Training would provide 7k per annum. A discussion took place regarding the Transforming Cancer Care (TCC) Tender. Due to fundamental irreconcilable differences between Consortium and Authority, which revolved around VAT and level of risk in managing increase in demand for cancer services the CCG were unable to award the contract. J Vanes asked if there had been any feedback from the Consortium. M Sharon stated that a wrap up call was due to take place next week. M Sharon outlined future tenders on the horizon; Community Outreach, Community Equipment Service (ILS), Transforming End of Life Care and Addictions Maternity. G Nuttall stated that the Community Outreach tender would not be released until September and that a decision would need to take place as to whether the Trust should bid. An AQP Tender for Community Eye Care Services in Wolverhampton was rejected at Divisional level as it felt that the service fell more in the domain of community optometrists and the Trust is already part of the pathway. M Sharon stated the Trust was the only bidder for the 0-19 Healthy Child Programme and that Wolverhampton City Council have abandoned the bidding process. The Trust has not won or lost the contract but are now re-negotiating with Wolverhampton City Council, without any competitive process, for the service. The Trust aim to negotiate a 5 year contract. The value of this contract is 6.5-7M per annum. 36/ Financial Planning Procurement Strategy M Martin asked that the Procurement Strategy Report be re-submitted at next month s Finance & Performance Committee Meeting to provide an update on the national position. C Richards to liaise with N Simmonds, update the work plan and add the report to next month s agenda. NS/CR 6

7 37/2017 Reports to Note for Period Financial Monitoring NHSi Return The return will be circulated outside of the meeting due to later submission date in April Annual Work Plan The plan was noted. M Martin asked C Richards to add the two Finance & Performance Committee objectives to the yearly work plan for review on a quarterly basis: Improve/Review supplementary finance report Coding/Data Capture M Martin asked C Richards to review the Procurement Strategy dates with N Simmonds and update the work plan accordingly. CR CR/NS 37.3 Finance Minutes The minutes were noted Capital Programme Update M Martin highlighted the significant positive variances for the refurbishment of the Renal Unit and Theatre 6. G Nuttall stated that the additional funding was for possible relocation of the Renal Unit whilst work was being completed. However, relocation was not required as the work was completed in two halves. 38/2017 Any Other Business There was no further business, the meeting closed at 10:30am. 39/2017 Date and Time of Next Meeting The next Finance & Performance meeting will take place on Wednesday 17 th May 2017 at 8:30am, Conference Room, Hollybush House. Reports will be required by 12:00 midday on Friday 12th May

Minutes of the Finance and Performance Committee 30 July 2018

Minutes of the Finance and Performance Committee 30 July 2018 Safe & Effective Kind & Caring Exceeding Expectation Agenda Item No: 12.4 ` Minutes of the Finance and Performance Committee Date Wednesday