Attach 12 REPORT TO BOARD 10 th June 2015 Agenda No. 8.1 Title of Document: St George s University Hospital Foundation Trust Review Report Author: Lead Director/ Clinical Lead: Contact details: Hardev Virdee Hardev Virdee Chief Finance Officer hardev.virdee@wandsworthccg.nhs.uk Summary: 1. SGUHFT financial position has deteriorated substantially 2. CCG is assessing the risks, responses and assurances required 3. Aim is to ensure services for patients are delivered as planned focussing on quality Key sections for particular note (paragraph/page), areas of concern etc: All Equality Analysis Has an Equality Analysis been carried out? Key issues from assessment Information Privacy Issues NO: this is a briefing paper Has a consideration of privacy impacts been undertaken and controlled for? Yes Key issues from assessment Please state which of the following priorities/objectives this document links to or provides evidence for: PPI: QIPP Plan: Operating Plan: Activity and performance targets Workforce: Corporate Objectives/Risks: Part of risk review and focus on quality Financial Implications: Througout report Reviewed by: Finance
Attach 12 Recommendations: To note the report Committees that have previously agreed the report: Finance Resource Committee have regularly received updates on the financial position including most recently on 27 May
Report on SGUH FT June 2015
St George s University Hospital FT CCG Overview RISKS Finance Quality Response Assurance Performance Contracting DELIVERY 2 CCG Board
FINANCE 3 CCG Board
Summary 2014 - Trust was reporting a surplus forecast of 7m Jan 2015 - Trust indicated financial pressure 2 Feb 2015 - St Georges Hospital gained FT status Feb 2015 -Trust reported a forecast deficit position of c 10m Trust Board report for Month 12 = deficit of 13.6m against a planned surplus of 7m. May 2015 Monitor launch investigation Trust will be forecasting a deficit position for 2015/16 FTs across England reported a year end deficit of 349m 4 CCG Board
Risks and Response Risks Outcome from investigation SWL impact case for change Sustainability Significant impact on financial performance Response Review of finances Sharing of information 5 CCG Board
Assurance Assurance Regular meetings at executive level Process for escalation Tripartite meetings Working with other commissioners 6 CCG Board
Quality
Risks Financial pressures can affect quality Learning from Francis report is that financial challenges can lead to drop in quality CIPs and run-rate savings will drive down use of agency staff used to cover vacancies Absence of CQUINs as a mechanism to improve quality Commissioners have a critical role to play in ensuring safe, quality care 8 CCG Board
Response Enhanced surveillance is in place Established approach to quality assurance will continue (data analysis, triangulation, multidisciplinary reviews and support improvement) Trust have shared internal enhanced quality oversight plan CCG will supplement this by increasing walkrounds, encouraging GPs to report issues, and reviewing patient feedback data 9 CCG Board
Assurance Agreed process for monitoring CIPs CCG is scrutinising selected Cost Improvement Plans for quality impacts High level measures to monitor impacts have been agreed Impact of run-rate savings will be monitored through scrutiny of safe staffing data 10 CCG Board
Assurance Committee structure to support assurance CQRMs for acute and community will play key role in reviewing quality metrics, monitoring CIPs and supporting improvements in Trust Concerns that cannot be resolved will be escalated to Integrated Governance Committee Consider further Board to Board with quality focus 11 CCG Board
PERFORMANCE 12 CCG Board
Risks Trust have identified performance risks Challenges to achievement of A&E waits and RTT targets will continue in 15/16 Increasing pressure on diagnostic waits and cancer wait times 13 CCG Board
Response Sustainability plan has been agreed Trust and CCG have collaborated on detailed demand and capacity plan Staged increase in capacity will take place over the year SRG funding has been committed, 2.3m to Trust Trajectories for meeting A&E and RTT still to be agreed and will be monitored through Systems Resilience Group 14 CCG Board
Assurance Enhanced monitoring of performance Currently reviewing structures around SRG to ensure most effective groups are in place to drive performance improvements Delivery of capacity and other improvement plans will be closely monitored Regular review of data (with CSU support) to alert to any deviations from agreed trajectories Contractual levers will be applied as appropriate 15 CCG Board
CONTRACTING 16 CCG Board
Risks Destabilising the health economy Unintended consequences Changes during the year 17 CCG Board
Response Contract agreed Teams working on issues to manage risk Planning for 16/17 starting early Commissioners working together Capacity and Quality issues addressed 18 CCG Board
Assurance Technical Reference Group in place Escalation process available Tripartite approach Clinical engagement 19 CCG Board
Summary Challenging position poses risk to CCG Working with the Trust many risks can be and have been mitigated Assurance process in place For 15/16 the challenge to have a successful year is delivery for the system and more importantly for the patient 20 CCG Board
Recommendation CCG Board is asked to note the report 21 CCG Board