Appendix:6.2 MEETING: Islington Clinical Commissioning Group Governing Body DATE: Wednesday 6 May 2015 TITLE: Strategy and Finance Committee Update for May 2015 LEAD GOVERNING Dr. Jo Sauvage Clinical Vice Chair BODY MEMBER: AUTHOR: Paul Sinden Director of Commissioning CONTACT P.sinden@nhs.net DETAILS: SUMMARY: 1. Executive Summary This report outlines the agenda items, discussion and decisions made by the Strategy & Finance Committees held on 26 February 2015 and 26 March 2015. 2. Approvals and recommendations The Governing Body is asked to NOTE that the Strategy and Finance Committee made the following approvals and recommendations to the Governing Body in February 2015: Recommendation of the diabetes value based commissioning business case for approval at the March 2015 Governing Body meeting in particular: The continued joint working by Islington and Haringey CCGs; That patients in this cohort should be able to access diabetes services within the model across Islington and Haringey; The preferred option of a lead provider model with the lead provider co-ordinating care rather than being a single provider, supported by an initial partial bundle payment to providers (activity paid directly to each provider and outcome funds to the lead provider for distribution across providers according to delivery of joint outcomes) to a full bundle payment (all funds to lead provider for distribution to other providers according to activity levels and joint outcome delivery). The Committee recommended the business case outlining the clinical model principles and financial baseline for the integrated NHS 111 and GP out-of-hours service for approval at the March 2015 Governing Body meeting prior to proceeding with the procurement process; The Committee agreed the collaborative programme for London CCGs set out in the response of London CCGs to the London Health Commission report Better Health for London, a maximum investment of 0.15% of the CCG s financial baseline for the supporting transformation fund as set out in the CCG s budget for 2015/16, and the proposed governance arrangements. This report contributes to: Reports to the Strategy and Finance Committee cover overall delivery of financial performance and strategic objectives for the CCG. Plans to remain within budget, deliver
investment plans and meet savings targets are therefore within papers considered by the Committee. Prior consideration by Committees and other partners: This report outlines the agenda items, discussions and decisions made by the Strategy and Finance Committee. Patient & Public Involvement (PPI): This paper is for information only and is available on the CCG website for consideration by patients and the public. Membership of the Strategy & Finance Committee includes two community members. Equality Impact Assessment: No Equality Impact Assessment is planned or has been undertaken for the report. Risks: This paper identifies risks arising from the review of financial performance and strategic delivery. RECOMMENDED ACTION: The Governing Body is asked to CONSIDER the report and NOTE that the Strategy and Finance Committee made the following approvals and recommendations to the Governing Body in February 2015: Recommendation of the diabetes value based commissioning business case for approval at the March 2015 Governing Body meeting in particular: The continued joint working by Islington and Haringey CCGs; That patients in this cohort should be able to access diabetes services within the model across Islington and Haringey; The preferred option of a lead provider model with the lead provider co-ordinating care rather than being a single provider, supported by an initial partial bundle payment to providers (activity paid directly to each provider and outcome funds to the lead provider for distribution across providers according to delivery of joint outcomes) to a full bundle payment (all funds to lead provider for distribution to other providers according to activity levels and joint outcome delivery). The Committee recommended the business case outlining the clinical model principles and financial baseline for the integrated NHS 111 and GP out-of-hours service approved at the March 2015 Governing Body meeting prior to proceeding with the procurement process; The Committee agreed the collaborative programme for London CCGs set out in the response of London CCGs to the London Health Commission report Better Health for London, a maximum investment of 0.15% of the CCG s financial baseline for the supporting transformation fund as set out in the CCG s budget for 2015/16, and the proposed governance arrangements. SUPPORTING PAPERS: None
1. Introduction This report outlines the agenda items, discussion and decisions made by the Strategy & Finance Committees held on 26 February 2015 and 26 March 2015. 2. Strategy & Finance Committee 26 February 2015 The table below summarises the agenda items, discussion and agreed actions from the meeting as follows: Agenda item Matters Arising Risk register Summary of report and discussion None. The Committee noted the report on risks relating to the work of the Committee, and that the report was now earlier on the agenda at the request of the Committee to allow for full discussion. The Committee agreed to the addition of two new risks relating to the re-procurement of the NHS 111 and GP out-of-hours services and the re-tender of dietetic services by local providers led by Royal Free Hospitals. Finance, Performance and QIPP Report The Committee were advised that at month 10 the CCG was on target to deliver the planned surplus for 2014/15 ( 7.1m), inclusive of the 0.7m increase for a technical adjustment for retrospective continuing healthcare claims. The CCG also had an opportunity to declare an additional surplus ( 1m) at month 10 in agreement with NHS England. The additional surplus ( 0.7m plus 1m) will be returned in 2015/16. The main risks to delivering the planned surplus accrues from acute contract over performance. This position had stabilised at month 10. The Committee noted the financial risk of tariff options in 2015/16 to the CCG ( 1m to 1.5m) following withdrawal of the national tariff. The Committee noted the financial position for the CCG as at the end of January 2015. Update on contracts The Committee received a report on the month 10 position on provider contracts. The main pressure remained as over performance on the UCLH contract with mitigating actions including: Acting on the results of the consultant-to-consultant audit; Ensuring the removal of referral-to-treatment backlog activity funded centrally; Investigation into the increase in critical care costs and casemix acuity at UCLH, with the overspend partially offset by underspends on critical care in other contracts; Claims management with 0.5m prosecution of successful claims for Islington CCG in the UCLH contract.
It was noted that providers had to choose their preferred tariff for 2015/16 by 4 March 2015. Diabetes Value Based Commissioning Business Case The Committee received the business case and covering report setting out: Work undertaken with service users and providers to develop the outcomes hierarchy and service model; On-going development of Patient Reported Outcome Measures; Payment mechanism with 20% of payment to providers being determined by performance against outcomes, with outcomes standards stretching over the course of the five-year contract; The preferred option of a lead provider model with the lead provider co-ordinating care rather than being a single provider, supported by an initial partial bundle payment to providers (activity paid directly to each provider and outcome funds to the lead provider for distribution across providers according to delivery of joint outcomes) to a full bundle payment (all funds to lead provider for distribution to other providers according to activity levels and joint outcome delivery). The Committee recommended the Business Case for approval at the March 2015 Governing Body meeting in particular: Continued joint working by Islington and Haringey CCGs; That patients in this cohort should be able to access diabetes services within the model across Islington and Haringey; The preferred provider and contract model as set out above. NHS 111 and GP out-ofhours procurement The Committee received the business case and covering report setting out the clinical model principles for the service. The financial model for the business case went to Part Two of the Committee. The integrated service model presented was consistent with the outcome of the Camden and Islington urgent care review carried out in 2013 and with themes emerging from the current engagement process for the procurement. The procurement was scheduled to start in March 2015, with contract award in September 2015 and service commencement in April 2016. The Committee recommended the business case outlining the clinical model principles for the integrated NHS 111 and GP outof-hours service for approval at the March 2015 Governing Body meeting prior to proceeding with the procurement process. London Health commission Collaborative Work The Committee received a report outlining the combined response of London CCGs to the London Health Commission report Better Health for London setting out agreed areas of London-wide collaboration on services and identification of a transformation
Programme fund from CCGs to support this work. It was reported that the collaborative programme in the report was consistent with the CCG s long term plans and financial. The Committee agreed the collaborative programme, a maximum investment of 0.15% of the CCG s financial baseline for the supporting transformation fund as set out in the CCG s budget for 2015/16, and the proposed governance arrangements. Individual Funding Requests (IFR) Activity Report The Committee received a report setting out the continued improvement in the turnaround time of individual funding requests, and that relevant requests were now covered by updated policies for IFRs and IVF signed off by the CCG in January 2015. Care Update The update report on the integrated care programme received by the Committee provided a summary of the national Care Pioneer Annual report including contributions from islington, and the evaluation framework for the programme. Operating Plan for 2015/16 The Committee received an overview of the draft Operating Plan to be submitted to NHS England on 27 February 2015, with the final submission being made on 7 April 2015, with the draft plan submitted being consistent with existing CCG plans for the Better Care Fund, delivery of NHS Constitution targets, delivery of the four CCG strategic transformation programmes, and financial plans for 2015/16. IT Update Digital Care Record and Person Held Record The Committee received an update report on the procurement and business case for the Digital Care Record (IDCR) and Person Held Record (PHR), and notified that the project was now supported by 1.35m ( 1.8m requested) from national Digital Tech Funds. Discussion focused on: The recommended move of the procurement process to an Open OJEU process from the original framework agreement; Actions to assure benefits realisation; Project timeline with the full business case going to the May 2015 Governing Body for approval, contract award ratified by the Governing Body in July 2015, and service commencement in April 2016. The committee supported the transition of the procurement to an Open OJEU process from the framework agreement. Planning Guidance The Committee received an update on the Vanguard (forerunner) application submitted by Islington CCG along with Islington
New Models of Care Council, Haringey GCCG, Haringey Council, Whittington Health, and Camden and Islington Foundation Trust in response to the roll-out of new models of care set out in the Five Year Forward View published by NHS England in 2014 and Operating Planning guidance for 2015/16. The Committee noted the New Models of Care report and the local expression of interest submitted to become a Vanguard site. Workplan for 2014/15 Matters Arising Part II - NHS 111 and GP out-of-hours procurement The Committee noted the workplan and the plan for 2015/16 as requested at the February 2015 meeting. None. The Committee received the financial section of the business case after the Committee had approved the clinical model principles for the service in Part I of the Committee. It was noted that the financial case was within the budget held by the CCG for the integrated NHS 111 and GP out-of-hours service. The Committee recommended the financial for the integrated NHS 111 and GP out-of-hours service for approval at the March 2015 Governing Body meeting. 3. Strategy & Finance Committee 26 March 2015 The table below summarises the agenda items, discussion and agreed actions from the meeting as follows: Agenda item Matters Arising Summary of report and discussion It was noted that the local Vanguard application, as reported to the February 2015 Committee, had progressed to the final selection stage but had not been chosen as a forerunner site for the new models of care set out in planning guidance. All parties to the application had agreed to progress the application locally outside of the national Vanguard process. For this purpose the Whittington Transformation Board had been stood down in favour of a wider Sponsor Board comprising the parties to the Vanguard application. The Sponsor Board would first meet on 31 March 2015 and oversee delivery of the objectives and outcomes set out in the Vanguard proposal. Risk register The Committee noted the report on risks relating to the work of the Committee, with no additions or deletions to the register compared to the February meeting. For existing risks it was noted that a risk-share capping the risks on mental health inpatient beds had been agreed for 2014/15 and would be part of the contract with Camden and Islington Foundation Trust in 2015/16, and that all five CCGs had now
approved the business case for the integrated NHS 111 and GP out-of-hours service. The Committee asked that in April the meeting focus on identifying risks for 2015/16. Finance, Performance and QIPP Report The Committee were advised that at month 11 the CCG was on target to deliver the planned surplus ( 8.2m) for 2014/15. It was also noted that the CCG was forecasting to achieve the 15.2m QIPP savings target for 2014/15. The main risks to delivering the planned surplus accrues from acute contract over performance, in particular at UCLH. The Committee noted the financial position for the CCG as at the end of February 2015. Update on contracts The Committee received the month 11 report on provider contracts. New actions to support delivery of contracts within the CCG s financial plans included: An audit of Whittington Health charging for lower level organ support that is materially above that from other providers; Investigation into the increase in reported outpatient referrals into UCLH. Operating Plan for 2015/16 The Committee received an update report on development of the CCG s Operating Plan for 2015/16 in preparation to submission to NHS England on 7 April 2015. Plans had been updated from the original submission made on 27 February 2015 for: Ensuring activity levels for provider contracts are sufficient to delivery NHS Constitution waiting time standards; Negotiation of contracts to the national deadline of 17 April 2015. The Committee proposed that the supporting narrative for the Operating Plan include cancer screening and early diagnosis although commissioned by NHS England in order to acknowledge the Public Health assurance role in screening programmes. The Committee noted progress to date. QIPP Plans for 2015/16 The Committee received a report on the development of QIPP savings plans for 2015/16, with the target being 12m (4% of the CCG s baseline). An overview of each scheme was provided noting the distinction between transformation (service development including value based commissioning) and
transactional (contractual including metrics). The risk of delivering metrics through contract negotiations with providers was noted. The Committee asked for a report on Whittington Health community services at the April 2015 meeting to provide assurance that the Trust was delivering activity levels commensurate with the Business Transfer Agreement (April 2011) and subsequent investment. The Committee noted the progress in identifying and developing QIPP savings schemes for 2015/16. Section 75 Quarterly Reports This report provided the Committee with an overview of pooled budgets held between the CCG and Islington Council and covered by Section 75 Agreements; with the two most significant variances from planned expenditure being under performance on the pooled budgets for intermediate care and carers. The Committee received assurance on the partnership arrangements between Islington CCG and islington Council. IT Update Digital Care Record and Person Held Record The Committee received an update report on the procurement and business case for the Digital Care Record (IDCR) and Person Held Record (PHR) following the Governing Body meeting held on 4 March 2015. Discussion focused on: Further assurance on the move of the procurement process to an Open OJEU process from the original framework agreement as requested by the Governing Body; Supplier days held to acquaint potential providers with the outline business specifications, with provider questions in turn being used to further develop the specification; Further development of the risk register; Project timeline with the full business case going to the May or July 2015 Governing Body for approval, contract award ratified by the Governing Body in July 2015, and service commencement in April 2016. The committee noted the update report. Workplan for 2014/15 Matters Arising The Committee noted the workplan for 2015/16. None.