GOVERNING BODY LEAD: Finance Committee Chair ATTACHMENT: M1 ACTION: For Information NOTES OF THE FINANCE SUB COMMITTEE HELD ON TUESDAY 25 MARCH 2014 GROVES MEDICAL CENTRE, NEW MALDEN PRESENT: Paul Gallagher (Chair) Lay Member & Audit Chair David Knowles Vice Chair & Lay Member Neil Ferrelly Chief Finance Officer Phil Moore Governing Body Deputy Chair - Clinical IN ATTENDANCE: Jenny Sinnott Head of Finance Tonia Michaelides Chief Operating Officer Simon Shelton SL CSU Contract Lead Jo Dandridge Business Manager APOLOGIES: David Smith Chief Officer Naz Jivani Governing Body Chair Peter Edward Associate Director SL CSU Muneeb Choudhry GP 14/36 WELCOME AND APOLOGIES: Those present were welcomed to the meeting. 14/37 DECLARATIONS OF INTEREST: None. 14/38 MINUTES OF THE LAST FINANCE SUB COMMITTEE The minutes of the last meeting held on 11 th February 2014 were agreed as an accurate record. 14/39 MATTERS ARISING 28.1 Children with disabilities This action remained outstanding. ACTION: Tonia Michaelides agreed to circulate an anonymised list of care packages for children with disabilities in order to identify the areas of forecast overspend that had been previously reported. Version: Final 1
29.1 C-Diff penalty reinvestment As Naz Jivani was not at the meeting to update members, Tonia Michaelides reported that it had been agreed that a one off reinvestment of 75% of the financial penalty levied would be passed back to Kingston Hospital. The exact amount to be returned would depend on the number of C-Diff cases reported above target at year end. The CQRG had been asked to relook at the list of initiatives that had been produced by Kingston Hospital to check they are the most appropriate schemes to invest in. Members also noted that compared to the rest of SW London, Kingston have a lower C-Diff target in 2013/14. The target for 2014/15 reflects the 2013/14 reported incidents because of good performance in previous years. The Committee noted for 2014/15 the penalties were being reduced to 10k whereas in 2013/14 they had been set at between 40-50k. 29.2 Acute Contracting At the last meeting, David Smith had agreed to raise the following issues with Kingston Hospital at the next Chair & Chief Executive meeting with Kingston Hospital: C-Diff MSK Cancer Alliance membership Diagnostic waiting times ACTION: Paul Gallagher agreed seek feedback from David Smith on discussions held with KHT Chair & Chief Executive. 14/40 KINGSTON PCT CHARITABLE FUNDS 40.1 Surbiton Hospital Fund Neil Ferrelly reported that he had sought legal advice and had been advised to make an application to the Charities Commission to change the status of the restricted fund to enable it to cover Surbiton Health Centre and associated services. It was agreed to keep Mrs Mary Clark informed of the changes. 14/41 2013/14 FINANCE REPORT MONTH 11 A copy of the finance report for Month 11 had been previously circulated and members noted the following key points: the CCG reports a forecast 2.01m surplus for the year in line with the financial plan the 0.5% contingency reserve is assumed to be fully utilized during the year the running costs budget has been reported to underspend by 195k at year end. QIPP is reporting an expected full year achievement to plan the CCG made a bid against the SW London risk pool for the unforeseen costs in respect of specialist commissioning & St George s Non Elective Threshold Activity (NETA) contract variations which has been approved and the full initial contribution of 984k by the CCG has been returned. there remains a risk of 1.17m in respect of duplicated charges for property that is still to be resolved. Version: Final 2
Members noted the reported surplus position excludes the following uncertain costs: 41.1 NHS Property Services As reported previously, NHS Property Services have nationally advised CCG s that premises and accommodation charges will be made based on estimated costs prepared in 2012/13 rather than actual 2013/14 costs. This has created an additional risk of 1.17m as the CCG is funding Property Services for costs that are already paid through SLA s with other parties Your Healthcare and South London CSU. Further discussions are being undertaken with the NHS Property national and local team to mitigate this risk. This risk has resulted in the CCG reporting an amber RAG rating on the assurance framework. Members were advised that Kingston CCG had raised invoices and these had been recognized as tangible amounts. Discussions were ongoing between the London team and the national team. 41.2 Legacy Balances Members noted that all CCG balances will transfer to NHS England with the exception of those associated with fixed assets. The CCG will not benefit from any PCT balances and these balances have not previously been included in the reported financial position. Members were also advised that legacy fixed assets have now transferred to the CCG ledger and the deadline for other receiving organisations to query asset transfers has now passed. However, a query has been received from CHP after the deadline relating to assets transferred to them. This has yet to be resolved and there is a possibility that assets transferring to the CCG could increase. ACTION: The Legacy Team were currently trying to resolve this dispute with NHS England and the CHP and an update would be circulated to members by Neil Ferrelly/Jenny Sinnott. Continuing Care Members noted that continuing care is showing a forecast outturn overspend of 2m. The overspend is driven by increases in admissions in earlier months, particularly for palliative and physically frail patients. The forecast assumes a steady state to the end of the year and an additional 1% is built into the forecast to incorporate any sudden growth in admissions due their unpredictable nature. Children with Disabilities Members noted that spend on children with disabilities is forecast to overspend by 791k, which is a 40% overspend on plan. This is due to an increase in complexity of care and the hours of care required per child. A new contract was negotiated with the main supplier with the aim of increasing quality and the reviewed care packages re more costly. In addition, new placements have been approved during the year. Members also noted that the changes to the Children and Families Bill would also need to considered. Members noted the Month 11 Finance Report. Version: Final 3
14/42 ACUTE CONTRACTING UPDATE A report detailing a consolidated view of NHS Kingston CCG contracting performance at Month 9 had been previously circulated. 2013/14 Members noted the following key messages: gross position of all acute contracts at M9 is an over performance of 2.38m gross position and 0.9m net of challenges (M8 0.8m) which represents a monthly under spend of 0.1m. Challenges at M9 build on the success of Qtr 2 closedown process (specifically with Kingston Hospital). The value of agreed challenges at Q2 was approx. 0.9m. The challenges include the application of KPIs such as first to follow up ratio, ambulance handover breaches and CDiff. It also includes successful challenges on maternity case-mix and the correct application of the associated tariff. At M9 the challenge figure stands at 1.2m for Kingston Hospital. These are additional challenges to deductions already made at source within the SLAM that amount to 1.6m. Therefore, 2.8m total deductions at M9. The Kingston Hospital contract remains the main cause of the acute over performance 1.5m. A number of other trusts are currently under performing which mitigates the impact of this individual over performance. The key performance issue for the CCG and at Kingston Hospital remains the C- Diff incidences above target trajectories. KHFT had 21 incidences at the end of December the Annual target itself being 15 incidences. Members noted that initial information shows there were no incidences in January. Kingston CCG have failed the 6 week diagnostic target from August to December. The issue is at Kingston Hospital and all in non-obstetric ultrasound. An action plan is in place where the Trust will use In-Health to clear the backlog throughout January and February with a trajectory to get back on track in March. Ambulance Handover Times: a new HAS system was implemented in September. Handover breaches are monitored by the CSU through the bi-weekly SWL CCG Pressure & Performance conference calls with all SWL Trusts. There were 9, 30 minute breaches at Kingston Hospital in December which represents a red ragrated performance, although is comparable to other Trusts. 2014/15 Position Kingston Hospital The deadline for signing contracts is 31 st March 2014. Currently there is a gap of 800k between the CCG s cash envelope and the hospital s proposal. The focus is on closing this gap as to find this at the start of the year would significantly reduce the CCG s commissioning reserves. Version: Final 4
St George s Hospital Currently, arbitration between the CCGs and St George s is being sought. The issue relates to the funding of the non-elective threshold adjustment (NETA). The NETA reserve for Kingston CCG is 800k and is used to support community based services to prevent non-elective admissions. St George s is seeking the return of the NETA money to re-invest in services based at St George s. The total re-investment being sought from the CCG is 600k. The arbitration panel is due to sit in mid-april 2014. 14/43 BUDGET PLANNING 2014/15 Members were advised that provision was being made this year to fund the continuing care retrospective balance. 14/44 PCT LEGACY BALANCES TRANSFER UPDATE This item was discussed earlier. [See minute 14/41.2] 14/45 SWL CCGs FINANCE REVIEW GROUP Members noted that Kingston CCG had retained its full 984k contribution and that the remaining 200k balance had been agreed to be passed to individual CCGs. However, this does not affect Kingston. Members noted that a meeting was taking place early April to talk through risk sharing for 2014/15. 14/46 ANY OTHER BUSINESS None. 14/47 DATE OF NEXT MEETING Members noted that a further meeting of the Finance Sub Committee would be required to sign off the draft Annual Accounts 2013/14. 22 nd April 2014 (1.00-2.00pm) Guildhall 1 Version: Final 5