SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP Finance & Performance Committee Minutes of Meeting held on Monday 26th June 2017 Boardroom Kingston House 13:00 – 15:00 Attendees: Vijay Bathla Chair Julie Jasper Vice Chair David Hughes Deputy Chief Finance Officer Laura Mainwaring Head of Financial Management Ian Sykes SCR GP Lead Janette Rawlinson Lay Member *Bev Morris Nursing, Quality and Performance Lead Hazel Barnes PA to Chief Finance Officer Apologies: James Green Chief Finance Officer Martin Stevens Head of Business and Contract Performance Julie Warner Business and Contract Performance Manager *part meeting Item Subject 1. Welcome and Apologies VJ welcomed everyone to the meeting. Received apologies were noted as above 2. Declarations of Interest To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. JJ declared her role as Audit Committee Chair, of Dudley CCG. No conflict was identified IS and VJ declared interest as GP’s. No conflict was identified. 3. Minutes from April 2017 The minutes were approved as a true record no amendments. 4. Action Report The action register was discussed and approval to remove actions was agreed. An updated Action Register will be circulated with the minutes from this meeting. 5. Chair’s report None 1 Item Subject 6. Finance Report DH presented the report for month 2 and advised that there is limited information available. Month 1 data should be treated with caution as it is early to make and assumptions so not too much emphasis has been placed on this data. Two key issues were highlighted: Practice moves and QIPP. The funding allocation transfer in relation to practice moves is yet to be agreed and pose potential risk. Headlines SWB CCG overall Revenue Resource Limit is £798m with a planned surplus for the year of £19m made up of the cumulative surplus of £21m minus the £2.5m mandated draw-down funding. SWB CCG QIPP target for 2017/18 is £25.1m. The CCG is operating within its Running Cost Allowance of £11.5m. Executive Summary DH presented an Executive Summary. All primary indicators are green. The year to date position shows £12k ahead of the planned surplus. Financial Position DH went on to present a Statement of Financial Position with a summary of portfolio. Slight pressures were noted in Community Services in respect of interpreters and non NHS costs as well as Mental Health Joint Commissioning. The CCG’s Revenue Resource Limit of £798m is made up of baseline allocation of £771m with further in year adjustments of £27m which were highlighted in the Finance Paper. Practice Moves DH advised that eight practices will be leaving SWB CCG and one practice will be joining. This amounts to 26.000 patients leaving and 8,000 patients joining. This amounts to £2m movement of expenditure out of SWB CCG. The net movement is £23m but there is difficulty in identifying the same level of expenditure reduction. Following a deep dive it has been identified that Sandwell Practices expenditure is much higher than those in Birmingham creating a cost pressure as a result of Birmingham practice movements. Work is currently being done with Birmingham South Central CCG to agree the value of allocation to transfer. However, it has proved difficult to determine the basis for the funding transfer and obtain historic information on allocations from existing PCT organisations prior the CCG’s existence. Contract Finance DH presented an overview of the main contracts – SWBH Trust and Dudley Group. Prescribing Performance DH highlighted a slight forecast overspend of around £400k which is predominantly driven by a reduction in the amount of rebates since moving to Bayer. 2 Item Subject Primary Care Expenditure is forecast to breakeven with total expenditure against its delegated resource of £78.9m. There has been a £2m increase in resource plus additional monies over and above the delegated resource as well as collaborative payments. QIPP The CCG’s overall QIPP target for the year is £25.1m. DH noted that some of this is contractually secure and some is covered by Prescribing initiatives. However, this QIPP programme is not developing as it should be. Instead the CCG is using the contingency of £3.5m which has been set aside plus £5.5m set aside for investment. DH will bring a quarterly detailed update to Finance and Performance Committee. Statement of Financial Position DH took members through the Balance sheet in the report. Cash Efficiency The CCG current bank balance is slightly higher than we like to run it due to an influx of cash at the end of month 1 which has now been resolved. • Members approved the contents of the Finance Report 6.1 Section 117 Update 13.50 Bev Morris joined the meeting Bev Morris provided members with an update on progress in relation to Section 117 patient reviews undertaken by SWB CCG and Sandwell MBC for patients eligible for Section 117 aftercare and for patients identified as being in comparable joint funded cohorts. A summary table was provided of reviews undertaken so far. The report highlighted 58 patients that the Local Authority have funded. Reviews have taken place on 49 patients. A number of assessments require rescheduling due to non-attendance of patient or social worker. A quarter of patients reviewed had no health issues. Therefore, 15 patients do not qualify for funding. 1 patient is deceased. JJ requested an agreed position statement for each patient and for it to be made clear to the Local Authority that if they do not engage for the remainder of the reviews, joint funding will be withheld. This was agreed by members of the committee. Actions: A further update will be presented to the committee in August LM will feedback at the next joint meeting with the Local Authority, Finance and Performance Committee’s disappointment with the outcome of the review process and make clear that no contributions will be made until reviews are completed. 3 Item Subject 7. Performance Report DH presented the Performance Report in Martin’s absence. IAPT IAPT is currently underperforming between 4 and 5% Infections There have been no new infections in May. RTT DH reported that headline level is satisfactory with improvement in elective activity in April and May. The number of incomplete pathways is falling but there are a number of breaches at specialist level. Plans are in place to achieve at specialty level by July. Diagnostics The Trust failed to meet the 1% target with 1.77%. This was due to the Trust initially refusing to pay an inflated locum cost. However, no cheaper locum could be found so payment was agreed which led to delays. They predict to achieve target in May. A&E A&E performance is currently 84.95% against the STF target of 93%. NHSI have agreed for them to reach 90% by the end of July and the Trust are confident. 20% extra capacity has been created at Sandwell. Cancer The CCG failed to meet the 31 day target and the 62 day target in April. The CCG Cancer Steering Group is establishing a process for following up the breaches. All breaches have now been treated. WMAS Date is consistent with previous months. Results from the pilot are still awaited as these have been further delayed due to Purdah. The number of handover delays has reduced. MSA There were 22 breaches for the CCG and 17 for SWBHT. All were capacity related. Cancelled Operations The Trust failed to meet the target. 6 patients waited over 28 days following cancelled surgeries. All patients have been rebooked and treated. Dementia Little change was reported in dementia diagnoses. There is still work to be done in this area. • Members approved the Performance Report 4 Item Subject 8 SWBHT Contract Update 14.54 JR left the meeting NHS England and NHS Improvement have commissioned an independent review of the whole health care system for Sandwell and West Birmingham in order to identify any concerns regarding MMH and the affordability. GE Finnemore Healthcare (GEFH) has been appointed to undertake the review. Further detail has been with GEFH in order to express the CCGs position regarding the MMH and STP. DH circulated a document produced regarding the review for information. Regular updates will be brought to Finance and Performance Meetings. 9 Finance and Performance Risks FP06 – Reviewed, no change FP09 – Sent for closure following the last meeting – gaps in controls were identified FP10 – Reviewed, no change FP11_2016a – Risk remains the same. JG and DH have met with Finnemore and workshops are being arranged. FP04_17a – Remains the same Date and Time of Next Meeting th Monday 24 July 2017 Boardroom Kingston House 5 Minutes of the SWBCCG Quality and Safety On Monday 19th June 2017, 1-3pm, Kingston House, 2F Board Room Present: Dr Sam Mukherjee – Chair, ICOF (Chair) Dr Inderjit Marok – Vice Chair, ICOF Claire Parker – Chief Officer for Quality, SWBCCG Michelle Carolan – Deputy Chief Officer for Quality, SWBCCG Tom Richards – Quality Manager, SWBCCG Richard Nugent – Lay Member Alison Braham – Primary Care Quality Lead, SWBCCG Therese McMahon – Non-Executive Nurse John Clothier - Healthwatch Representative Jodi Woodhouse – Quality Improvement Team Manager, SWBCCG Jasmin Andrews - Quality Improvement Lead, SWBCCG Jackie James - Quality Improvement Co-ordinator, SWBCCG In Monique Sinclaire - Deputy Designated Nurse for attendance: Safeguarding Children,