agenda part 1 - NHS Wigan Borough CCG

WIGAN BOROUGH CLINICAL COMMISSIONING BOARD MEETING TUESDAY 24 July 2012, 1.30pm MEETING ROOM 17, WIGAN LIFE CENTRE

AGENDA PART 1 Agenda Item

Time

Presenter

Paper/ Verbal

1.30pm

Tim Dalton

Verbal

1

Chairman’s Welcome

2

Apologies for Absence

Tim Dalton

Verbal

3

Declarations Of Interest

All

Verbal

4

Minutes of Previous CCG Board Meeting held on 26.6.12

All

Paper

5

Actions/Decisions Log from Previous CCG Board Meeting

All

Paper

6

Questions from Members of the Public

1.40pm

7

New Business

1.50pm

7.1 Preparing for your future – Advanced Care Planning

1.35pm

Action Required

Approval

Approval

Verbal

Trish Anderson (Paul Carroll)

Paper

7.2 CQC

Commission – Registration Primary Care Medical Services

Julie Southworth

Paper

Approval

7.3 Improving Quality the Commissioner Visit Toolkit

Julie Southworth

Paper

Approval

Approval

1

8

Strategic Business Items

2:15pm

8.1 Feedback from NHS Greater Manchester  Actions May 2012  Board Agenda June 2012

Trish Anderson

8.2 Finance i. Month 03 Finance Update ii. Month 03 QiPP Report iii. Month 02 Performance Report

Mike Tate

Paper

Information

Information

Paper

8.3 Governance Towards Establishment

Julie Southworth

Paper

Julie Southworth (Paul Turner)

Paper

Information

Trish Anderson/Kim Godsman

Paper

Information

Trish Anderson/Kim Godsman

Paper

Information

8.4 Performance i.

ii.

iii.

9

First quarterly report on root cause analysis findings from patient feedback regarding avoidable infections

RTT

Diagnostics

Updating

2:35pm Information

9.1 ATHERLEIGH

Deepak Trivedi

Paper

9.2 PATIENT FOCUS

Mohan Kumar

Paper

Information

Ashok Atrey

Paper

Information

9.3 TABA

2

Tony Ellis

Information

9.5 Wigan North

Pete Marwick

Information

9.6 United League

Sanjay Wahie

Paper

9.7 Chairperson’s Report Corporate Governance Committee (17.5.12)

Tony Ellis

Paper

9.8 Chairperson’s Report Finance and Performance

Mohan Kumar

Paper

9.4 WCC

10

11

Items For Information

Information

Approval

Approval

3:00pm

10.1

Authorisation Progress QA Process

Trish Anderson

Paper

Information

10.2

CCG Communications Plan

Trish Anderson

Paper

Information

Any Other Business (to be accepted at the Chair’s discretion)

3:20pm

Date and Time of Next Meeting: Tuesday 28th August 2012, 1.30pm, Meeting Room 17, Wigan Life Centre

3

MEETING:

WBCCG Board

Item Number: 7.1

DATE: 24th July 2012 REPORT TITLE:

Advanced Care Planning

REPORT AUTHOR:

Wigan Borough Palliative Care and End of Life Strategy Group

PRESENTED BY:

Paul Carroll

RECOMMENDATIONS/DECISION REQUIRED:

Approval to pilot the document

EXECUTIVE SUMMARY The Advance Care Planning (ACP) document has been developed by the Wigan Borough Palliative and End of Life Care Strategy Group (PSCG) and the Wigan ACP in Care Homes Best Practice Group (ACPBPG). The intention is to implement it across the Borough following approval by the CCG and other stakeholders. It is a patient-held document, with the option for the person completing it to provide copies to health and social care professionals involved in their care. The benefits of ACP have been highlighted in the National End of Life Care Strategy (2008), NHS North West End of Life Care Clinical Pathway Group report (2008), and GMC “Treatment and care towards the end of life: good practice in decision-making” (2010). ACP can increase the likelihood of meeting patients’ preferences in regard to end of life care with a potential to reduce inappropriate admissions to hospital. At present, ACP is undertaken by some professionals in the borough, but does not take place routinely for all palliative and end of life care patients, nor are there robust mechanisms for sharing information about a patient’s preferences with other care providers once they have been determined. Members of the PSCG and the ACPBPG decided to develop a tool for use across the Borough which combined the best features of existing tools. The document has gone through extensive review by the two groups, which include professionals with vast experience in palliative and end of life care. The intention is to pilot the document in several settings to ensure its feasibility in practice. It will then be rolled out across the Borough, This project has the potential to impact enormously on the quality of end of life care provided to patients in Wigan Borough Note that the document has been approved by 5 Boroughs MH trust and is also being presented to the WWL and BCHT boards

FURTHER ACTION REQUIRED:

Approval to pilot document

Page 2 of 2

Preparing for your Future Care Advance Care Planning Adapted from the NHS Gloucestershire document and National Preferred Priorities for Care Guidelines A

Wrightington, Wigan and Leigh NHS Foundation Trust

Bridgewater Community Healthcare

Ashton, Leigh and Wigan

NHS Trust Ashton, Leigh and Wigan Division

Introduction Why have you been given this document? You may have been given this document by someone who is involved in your care or the care of someone you are close to. It is an Advance Care Planning booklet and links with the NHS (2009) leaflet, ‘Planning for Your Future Care.’ Advance Care Planning is about preparing for the future. It gives you the chance to think about, discuss and write down your preferences and priorities for your future care, including how and where you wish to receive care towards the end of your life. Whatever is important to you can be included.

Why is it a good idea to fill in this document? Planning for your future care can help you and your family, friends and healthcare professionals to understand what is important to you. This means that they can try to respect your wishes in relation to all aspects of your care management, should you no longer be able to express them. Completing the document provides a good opportunity to discuss, talk about and record in writing, your views, thoughts and feelings with those closest to you. It can help your decisions, to think about the things you would like to happen and those that you wouldn’t. Remember that your wishes and feelings may change and you can change what you have written at any time. It is a good idea to review your plan regularly and share this information with the people involved in your care. Usually you should fill in this document yourself, however there may be times when somebody may fill it in on behalf of somebody else with the support of the healthcare team.

Remember ... This booklet doesn’t need to be completed all at once. It can be filled in over time, as and when you feel comfortable to do so.

There are 5 sections to this document. (✓ when completed). It is advisable to complete a minimum of sections 1 and 2 at first and continue the others in your own time. 1. Administration Section

Page 3

2. General Preferences for Health & Social Care

Page 4

3. Advance Decision Making

Page 6

4. Practical Planning

Page 11

5. Next Steps

Page 13

❐ ❐ ❐ ❐ ❐

P R E PA R I N G F O R Y O U R F U T U R E C A R E 2

Section 1

Administration

PHOTO optional

About Me Name: .................................................................................................... Like to be known as: .................................................................................................................. Address: ...................................................................................................................................... Date of Birth: ................................................................................................................................ Home Telephone: ....................................................

Mobile: ..............................................

Religion / Personal Beliefs or Values: ........................................................................................ Diagnosis: ....................................................................................................................................

Next of Kin Name: .................................................................. Relationship: .............................................. Address: ...................................................................................................................................... Contact Number(s): ....................................................................................................................

GP Details Name: .......................................................................................................................................... Telephone: ....................................................

Mobile: ..........................................................

NAME OF OTHER HEALTH / SOCIAL CARE PROFESSIONALS INVOLVED IN YOUR CARE

Name

Job Title

Base


Contact Tel.

Section 2 General Preferences for Health & Social Care In this section you can record your specific wishes and preferences relating to a time when you may be ill and require care or treatment. This will give your family, carers and professionals a clear idea of what is important to you, if for any reason you are unable to make your wishes known. This section is not legally binding but should be taken into consideration by healthcare professionals.

In relation to your health, what has been happening to you recently? .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... ....................................................................................................................................................

Do you have any special requests or preferences regarding your future care? .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... ....................................................................................................................................................

If your condition deteriorates, where would you most like to be cared for? First Choice: .............................................................................................................................. Second Choice: ..........................................................................................................................

Is there anything that you wouldn’t like to happen to you? (Complete Section 3 if an advance decision to refuse treatment is appropriate) .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... P R E PA R I N G F O R Y O U R F U T U R E C A R E 4

Section 2 General Preferences for Health & Social Care Do you have a particular faith or belief that is important to you? Please let us know of any particular faith / religious practices or rituals that would be important to you if you became seriously ill. ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... Your Signature: ........................................................................

Date: ....................................

NOK / Carer Signature: ..........................................................

Date: ....................................

Health / Social Carer Signature: ............................................

Date: ....................................

Details of any other family members involved in Advance Care Planning discussions: ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... Details of healthcare professionals involved in Advance Care Planning discussions: ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... Are you happy for the information in this document to be shared with relevant healthcare professionals? NO YES

❐

❐

REVIEWS:Signed:

Date:

Signed:

Date:

Signed:

Date:

Signed:

Date:

Remember to regularly review your information to ensure this still represents your wishes. Sign and date any changes you make. P R E PA R I N G F O R Y O U R F U T U R E C A R E 5

Section 3

Advance Decision Making

This section looks at the legal aspects of your future planning.

Appointing someone to make decisions for you Sometimes there can be unforeseeable situations where a person may deteriorate mentally, for example if they develop dementia or some other condition which affects their memory or ability to understand. You may want to ask a specific person to take responsibility to make decisions for you, in case you become unable to make them for yourself. That person is given ‘Lasting Power of Attorney’ (LPA) That person can be a friend, relative or a professional. More than one person can act as attorney on your behalf.

There are two types of Lasting Power of Attorney:Property and Affairs Lasting Power of Attorney This LPA gives another person the power to make financial decisions such as managing bank accounts or selling property. This comes into effect when the LPA is registered with the Office of the Public Guardian and unless specified, only when you lose the capacity to manage your own financial affairs

Personal Welfare Lasting Power of Attorney This LPA allows your nominated person to make decisions regarding your health and personal welfare, for example where you should live or decisions about your medical treatment. Again this only comes into force if/when you lose the ability to make these decisions yourself and is only valid once it has been registered with the Office of Public Guardian. LPA’s can be organised without the input of a solicitor, however it can make the process easier if legal help is sought. There may be a cost attached.

For more information follow the link: http://www.direct.gov.uk - then type in lasting power of attorney. Tel. 08454 330 2900. Have you already appointed a Lasting Power of Attorney?

YES

❐

NO

❐

If yes, please state which type: .................................................................................................. Name and contact details of LPA: .............................................................................................. ...................................................................................................................................................... ...................................................................................................................................................... Who else would you like to be involved if it ever becomes difficult to make decisions? Name: .......................................................................................................................................... Relationship to you: .................................................................................................................... Address: ...................................................................................................................................... ..................................................................................

Telephone: ............................................


Section 3


Advance Decision to Refuse Treatment An Advance Decision is a formal LEGALLY BINDING document which allows a person to refuse specific treatments. It is entirely voluntary. It does not allow a person to request medical treatment nor to have their life ended. An Advance Decision may be used when particular treatments would not be acceptable to someone. An example of this would be if a person had a severe stroke which resulted in swallowing problems. If the thought of being fed by alternative methods, such as a tube into the stomach was not tolerable then this could be documented formally as an Advance Decision. Likewise somebody with an advanced progressive disease such as Motor Neurone Disease may not wish to be resuscitated if their heart and lungs stopped functioning. In order to ensure your wishes are met, advice should be sought from someone who understands this process of drawing up an Advance Decision to Refuse Treatment, such as your GP, solicitor or other professional involved in your care. The more people that are aware of your wishes, the better. If a person wishes to refuse life sustaining treatment, it must be in writing, signed and witnessed and include the statement ‘even if life is at risk’. An Advance Decision will only be used if; at some time in the future you lose the ability to make your own decisions about your medical treatment. It will only be valid if you have made it before you lost the ability to make such decisions. Your decision can be amended at any time, provided you still have the capacity to do so. It is a good idea to review your decisions regularly with your family, friends and health and social care professionals

For further Information visit:www.adrtnhs.co.uk www.direct.gov.uk www.endoflifecareforadults.nhs.uk


Section 3


My Advance Decision to Refuse Treatment Document (Page 1 of 3) Your Name: ................................................................................................................................ Date of Birth: .............................................................................................................................. Any distinguishing features in the event of unconsciousness: .................................................................................................................................................... Address: .................................................................................................................................... ..................................................................................

Telephone: ..........................................

What is this document for? This advance decision to refuse treatment has been written by me to specify in advance which treatments I don’t want in the future. These are my decisions about my health care in the event that I have lost mental capacity and can’t consent to or refuse treatment.

Advice to the person reading this document I have written this document to identify my advance decision. I would expect any health care professionals reading this document in the event I have lost capacity to check that my advance decision is valid and applicable, in the circumstances that exist at the time.

Please Check ... Please do not assume I have lost capacity before any actions are taken. I might just need help and time to communicate. Please help to share this information with people who are involved in my treatment and care and need to know about it. Please also check if I have made any other statements about my preferences or decisions that might be relevant to my advance decision. This advance decision does not refuse the offer and or provision of basic care, comfort and support. I am writing this at a time when I am able to think things through clearly and I have carefully considered my situation. I am aware that I have been diagnosed as suffering from:.................................................................................................................................................... Signature: ....................................................................

Date: ..............................................


Section 3


My Advance Decision to Refuse Treatment Document (Page 2 of 3)

Name: ..........................................................................................................................................

Treatment to be refused (eg. resuscitation, stoma formation, surgery)

Details of situations you have anticipated in which the refusal would be valid

Remember If you wish to refuse a treatment that is or may be life sustaining, you must state in the box above that you are refusing that treatment even if your life is at risk as a result. It must be signed and witnessed.

Examples

• If my heart and lungs stop functioning I do not wish for them to be restarted (Cardiopulmonary Resuscitation)

• I do not wish to be artificially fed or hydrated • I do not wish to receive antibiotics for a particular infection (please state) • I do not want to receive Electro Convulsive Therapy (ECT) in the event of being depressed

Signature: ....................................................................

Date: ................................................


Section 3


My Advance Decision to Refuse Treatment Document (Page 3 of 3) Witness Name of Witness: ...................................................................................................................... Date of Birth: .............................................................................................................................. Address: .................................................................................................................................... ..................................................................................

Telephone: ..........................................

Witness Declaration:I/we testify that the maker of this advance decision signed it in our presence and made it clear to us that he/she understood what it meant. We do not know of any pressure being brought on him/her to make such a decision and I/we believe it was made by his/her own wish. Signature(s): ................................................................

Date confirmed: ..............................

Person to be contacted to discuss my wishes Name: .................................................................. Relationship: ............................................ Address: .................................................................................................................................... ..................................................................................

Telephone: ..........................................

I have discussed this with (eg. name of healthcare professional): .................................................................................................................................................... Profession / Job Title(s): ............................................................................................................ Signature of professional: .......................................................................................................... I give permission for this document to be discussed with my relatives / carers (Please ✓) YES

❐

NO

❐

My GP is: .................................................................................................................................... Address: .................................................................................................................................... ..................................................................................

Telephone: ..........................................

Review 1. Comment: .................................................................................................................................. .................................................................................................................................................... Witness Signature: ......................................................

Date: ..............................................

Review 2. Comment: .................................................................................................................................. .................................................................................................................................................... Witness Signature: ......................................................

Date: ..............................................


Section 4

Practical Planning

It can be helpful, when planning your future care needs, to take care of some of the practical things as well. This may reduce not only your anxiety when you are unwell, but also that of your family/next of kin. The table below may act as a reminder for things you wish to organise or locate to give you peace of mind should you become too unwell. You do not need to document account numbers but perhaps where these documents are kept. Name:

Date of birth:

Bank name / Account details (please don’t write account numbers)

Comments:

Insurance policies

Comments:

Pension details

Comments:

Mortgage details

Comments:

Passport

Comments:

Birth / Marriage certificates

Comments:

Other important documents

Comments:

Making a Will If you have very clear ideas about where you would like your estate/possessions to go to in the event of your death, then the only sure way of achieving this is by making a will. If you don’t have a will, it can be a lengthy process which can be stressful and expensive for your loved ones. You can make a will without a solicitor, however the Law Society advises that specialist advice is sought from a solicitor. Think about who you would like to benefit from your will A list of your possessions Arrangements for dependants or pets Decide who will be your executor

For Further Information visit www.citizensadvice.org.uk or telephone the Solicitors Regulation Authority - tel. 0870 606 2555 I have made a will and a copy / copies are held at the following places: ...................................................................................................................................................... These people are aware of my Will: ............................................................................................ ...................................................................................................................................................... Signature: ....................................................................

Date: ................................................


Section 4

Practical Planning

Funeral Planning Person I wish to be responsible for making my funeral arrangements: .................................................................................................................................................... .................................................................................................................................................... My preferred funeral director is: .................................................................................................................................................... .................................................................................................................................................... My pre-paid funeral plan is with: .................................................................................................................................................... .................................................................................................................................................... I wish to be buried / cremated / other, eg. donation for medical science (Specific documents will need to be signed): .................................................................................................................................................... .................................................................................................................................................... My faith is important to me and should be reflected in my funeral: .................................................................................................................................................... .................................................................................................................................................... I would like the venue to be: .................................................................................................................................................... .................................................................................................................................................... I would like the following hymns, music or readings included: .................................................................................................................................................... .................................................................................................................................................... I would like the following person to conduct the service where possible: .................................................................................................................................................... .................................................................................................................................................... Other details (consider donations to named charity, flowers, people to be informed): .................................................................................................................................................... .................................................................................................................................................... P R E PA R I N G F O R Y O U R F U T U R E C A R E 12

Section 5

Next Steps

It can take time to plan for your future care but the more information your family and carers have, the more likely you are to receive the care that you would want.

Remember You can change your mind at any time. Just ask somebody involved in your care to review what you have written down and help you to update your wishes and preferences.

You will need to ensure the following people have a copy of your completed document:-

• One for you to keep/ to be kept in your care plan • One for your GP to keep in your records • One to be kept with someone who you wish to be consulted about your treatment should this ever be necessary. (eg. next of kin, solicitor)

• One to be kept with the Palliative Care team, Hospice team, District Nurse, Community Matron, Mental Health Team or Care Home as appropriate. The Table on page 3 may also help you to remember who needs a copy. Please complete the list below of who you have given a copy to. Paramedic Clinical lead: North West Ambulance Service

0161 796 7264

Fax Number: ................................................................ Out of Hours GP Service

01942 248939

Fax Number: ................................................................ Copies of this document have been given to:-

Name

Relationship

Telephone No.

Remember to inform these people if you update any of the information you have recorded in this document. P R E PA R I N G F O R Y O U R F U T U R E C A R E 13

Developed by the Wigan Borough Palliative and End of Life Care Strategy Group and the Advance Care Planning in Care Homes Best Practice Group. Version 1. Publication Date January 2012. Many thanks to the contributions from health and social care professionals and patient representatives.

Further Information:Making Decisions - A Guide Information about the Mental Capacity Act www.legislation.gov.uk Planning For Your Future Care - A Guide The National Council for Palliative Care National End of Life Care Programme The University of Nottingham.

MEETING:

WBCCG Board

DATE:

24th July 2012

Item Number: 7.2

REPORT TITLE:

CQC Commission – Registration Primary Care Medical Services

REPORT AUTHOR:

Tracie Smith Health and Safety/Facilities Manager

PRESENTED BY:

Julie Southworth Chief Operating Officer


The Board are asked to:  Note the timetable for CQC Registration 

Support the proposed next steps

EXECUTIVE SUMMARY The purpose of this report is to: To ensure engagement with Practices and move this area of work forward we will now:  Work with the local leads to identify a focus group (Locality CQC Compliance Focus Group) of key staff/stakeholders to help all practices through this process, paying particular attention to the required evidence to support the outcomes.  Work with the Locality CQC Compliance Focus Group to draft and agree an action plan to ensure all areas of assessment areas are covered.  Ensure good practice by sharing documents/procedures/polices rather than generating separately 65 times.  Establish Communications with Locality Practices this will include a Share Point to enable all Practices within the Locality to access documents/procedures/polices for general use. The above will be managed by the Locality CQC Compliance Focus Group (which is a sub group of the Locality Managers Meeting) and monitored by the Corporate Governance Sub Committee


Continued engagement with independent contractors. Project team and work programme developed Good practice identified

BRIEFING PAPER CARE QUALITY COMMISSION (CQC) REGISTRATION – PRIMARY CARE MEDICAL SERVICES

Introduction The Regulation of Primary Care is being aligned with other Health and Social Care Services under the Health and Social Care Act 2008. This Legislation means that providers of health and adult social care have to be registered with the Care Quality Commission (CQC). The aim of regulation is to ensure that patients can expect all health and adult social care services to meet essential standards of quality, to protect their safety and to respect their dignity and rights wherever care is provided. By being registered with the CQC, Providers can demonstrate to patients that they are providing a service that meets essential standards of quality and safety. When registering Providers and monitoring how they continue to comply with the essential standards, the CQC will be led by the information they know about them. The CQC will target areas where they have concerns and act in proportion to the level of risk for patients. The Regulations The Health and Social Care Act (Regulated Activities) Regulations 2010 set out different timescales for when providers from different sectors have to be registered with CQC. These regulations included timelimited exemptions for NHS Primary Medical Services, which are defined as those that are provided using one of the following contracts or agreements: • General Medical Services (GMS) • Personal Medical Services (PMS) • Alternative Provider Medical Services (APMS) • NHS Act 2006 Section 3 (contracts with the Secretary of State). Timetables In the initial timetable for registration, all providers of Primary Medical Services were required to register with the CQC by April 2012. However, following a Department of Health consultation, the Government has now confirmed that providers of NHS General Practice and most other Primary Medical Services do not need to be registered until 1 April 2013. If Practices fail to register then the CQC can force Practices to stop providing Primary Medical Services and the CQC believes that GP’s could be in breach of their contractual requirements. Current Status The overall registration process began in Summer 2012. As part of their application Practices will need to declare compliance with the Regulations that underpin the CQC’s main 16 Essential Standards of Quality and Safety for the regulated activities provided at every location. Most Practices will already have governance systems and information in place and will potentially be able to use existing information on which to declare compliance against. It is worth noting that the focus of the CQC evidence requirements is on the outcomes that people who use services receive. This is an area where Practices will have to carefully consider and review the evidence they will base the assessment on.

Draft Version 1/Chairpersonsreport/050312

To ensure that the WBCCG supports all Practices across the Borough we have ensured attendance at the Locality Managers Meeting and are keen to provide support and advice. Next Steps To ensure engagement with Practices and move this area of work forward we will now: 

Work with the Local Leads to identify a focus group (Locality CQC Compliance Focus Group) of key staff/stakeholders to help all Practices through this process, paying particular attention to the required evidence to support the outcomes.



Work with the Locality CQC Compliance Focus Group to draft and agree an action plan to ensure all areas of assessment areas are covered.



Ensure good practice by sharing documents/procedures/polices rather than generating separately 65 times.



Establish Communications with Locality Practices this will include a Share Point to enable all Practices within the Locality to access documents/procedures/polices for general use.

The above will be managed by the Locality CQC Compliance Focus Group (which is a sub group of the Locality Managers Meeting) and monitored by the Corporate Governance Sub Committee.

Report prepared: Tracie Smith Health and Safety Facilities Manager 16 July 2012

Draft Version 1/Chairpersonsreport/050312

MEETING: WBCCG Board

Item Number: 7.3

DATE: 24 July 2012

REPORT TITLE:

Briefing Paper: Improving Quality - The Commissioner Visit ‘Toolkit’

REPORT AUTHOR:

Lynn Mitchell, Head of Risk Management

PRESENTED BY:

Julie Southworth, Chief Operating Officer


The Board are asked to note the content of the briefing paper

EXECUTIVE SUMMARY The purpose of this report is to: Raise awareness of the ‘Toolkit’ at a Senior Leadership Level, and to gain assurance that that the CCG is committed to and proactively engaged in commissioning for quality improvement. The intention also being to seek support and identify resources to enable the organisation to move this forward and progress this work stream.




Further development required up to April 2013.

Page 1 of 4

TRACKING Committee /Meeting Consideratio n required y/n Date of submission

CCG Operations

Clinical Governance

Corporate Governance

Finance & Performance

Yes

25.07.2012

Page 2 of 4

Locality Audit Group

CCG Strategic Leadership

CCG Board

NHS GM Board

Briefing Paper

IMPROVING QUALITY - THE COMMISSIONER VISIT TOOLKIT 1. Background The NHS Greater Manchester Operating Plan 2012/2013 set the agenda for commissioning for Harm Free Care in all care settings. As the Commissioners of local healthcare for the Wigan Borough the Wigan Borough Clinical Commissioning Group (the CCG) will strive to work in partnership with all our Providers and Stakeholders to establish a sound platform to enable this to develop and advance. To engage with the process we will utilise the national tools available under Energise for Excellence (E4E) e.g. Safer Nursing Care workforce tool and the Safety Thermometer. E4E toolkit advice (such as Safer Nursing Care Tool) has been provided to Locality CCGs as a way of obtaining reassurance that providers are keeping care at a safe level alongside financial savings and identifying areas for improvement where there is a need to challenge underperformance. The CCG has aligned contractual incentives thorough the CQUINS and Performance Indicators to this intent. However the CCG will be commissioning for visibility of care and this will require Executive Walkabouts for both Commissioner and Provider to emphasise the ‘Leadership’ responsibility to understand and organise care from the patients‘perspective. 2. Purpose The main purpose of the briefing paper is to raise awareness of the ‘Toolkit’ at an Executive Level, and to gain assurance that that the CCG is committed to and proactively engaged in commissioning for quality improvement. The intention is to also seek support and identify resources to enable the organisation move this forward and progress this work stream. 3. The Commissioner Assurance of Care, The CCG is accountable and holds a duty to patients and public for the care that is commissioned, and also recognises the need to:   

Connect with patients at the point of care Further develop relationships between clinical commissioners and providers Understand and experience the care environment that has been commissioned

4. The Requirements for the CCG - Implementation of the Commissioner Visit Toolkit The actions that are required of the CCG are briefly outlined within the schedule below. Identify the CCG Governing Body Member for Quality

 

Agree the schedule for commissioner Visits with the Quality Lead Advice the Provider on the planned visits

Identify the ‘Walk Around Team’

 

Quality Lead to co-ordinate the Team Visit Team agrees which Provider area to focus on

Use the Tool to complete the ‘Walk Around’



Complete visit to the Provider using the Commissioner Toolkit

Feedback to the CCG Governing Body Member

 

As a team compare information that has been gathered Feedback to the CCG member for Quality

CCG Governing Body Member identifies actions and next steps

 

Decide what to do with the information CCG Governing Body quality assurance paper

Repeat the challenge in agreed timescale



Repeat as required – see figure 2

Page 3 of 4

5. The Review Process The 3 stages as described are cyclic as detailed below. 1. Assurance Visit 2. Collation of evidence of commissioned care 3. Repeat within agreed timescale.

The timescale for the review will be dependant upon the findings of the ‘walk around’ and any concerns; risk factors that are indentified as part of this process 6. Next Steps 1. Brief Clinical Governance Sub Committee (25 July 2012) and report to then go to CCG Board. 2. Engage the CCG Governing Body Member for Quality (AA) and the Executive Lead for Quality and Governance (JS) to define the Commissioners responsibility and remit, agree actions. 3. Identify and brief the CCG ‘Walk Around Team’. This should involve the Provider Clinical Quality Review Leads. 4. Produce an action plan to demonstrate how this work will be taken forward to ensure we have the required assurances. Involve provider services in the action planning process. 5. Final draft plan to go to Clinical Governance Sub Committee and CCG Board 6. The CCG will as part of this process undertake to support the Patients Association Good Care Campaign and will be working to secure full participation of all partner organisations and stakeholders.

Reference: NHS Greater Manchester - A toolkit for the Commissioner Visit (June 2012)

Page 4 of 4

Item 8.1

Minutes NHS Greater Manchester Board Meeting Date: 10 May 2012 Venue: Salford Suite, St James House, Pendleton Way, Salford, M6 5FW Present:

Professor Eileen Fairhurst - Chairman Mr Terry Atherton – Non-Executive Director Dr Mike Burrows - Chief Executive Mrs Claire Yarwood - Director of Finance Mr Warren Heppolette –Director of Policy and External Relations Dr Julie Higgins - Director of Commissioning Development Mrs Hilary Garratt - Director of Nursing, Quality and Performance Mr Kevin Moynes – Director of HR and OD Dr Kailash Chand – Associate Non-Executive Director Mr Alan Stephenson – Non-Executive Director Mr Rob Bellingham - Board Secretary Dr Raj Patel – Medical Director Ms Melanie Sirotkin – Director of Public Health Mr Michael Greenwood – Non-Executive Director Mr Paul Horrocks – Non-Executive Director Mr Riaz Ahmad – Non-Executive Director Ms Leila Williams – Director of Service Transformation Cllr Cliff Morris – Association of Greater Manchester Authorities (AGMA) + 8 members of the public/ NHS Staff

Minute No 12/63

Item Apologies for Absence Mr David Edwards – Non-Executive Director Ms Evelyn Asante-Mensah – Non-Executive Director

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Declaration of Interests No declarations of interest were made.

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Minutes of the meeting held on The minutes of the meeting held on the 9th February 2012. 8th March 2012 and the 29th March 2012 were approved as an accurate record of the meetings.

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Matters Arising: Ms Williams gave a verbal update relating to minute 12/29 regarding the title Safe and Sustainable. Ms Williams confirmed that extensive work had been undertaken with key stakeholders and patient groups to ensure that the new name resonates with the public and what the programme is trying to achieve. Ms Williams advised that a short list of names had been agreed and these would be tested in more detail to confirm the final title. Mr Greenwood asked for clarification as to whether or not the GM Surgical Centre was open and in use and if so how may beds were in use. Dr Burrows confirmed that the GM Surgical Centre was not currently in use. Ms Sirotkin gave a verbal update relating to minute 12/31 to confirm that the AAA Screening contract had been signed. Dr Patel gave a verbal update relating to minute 12/32 about the risks identified around Responsible Officers in the north east sector. Dr Patel confirmed that an update is given in the Medical Directors report (item 7 on the agenda) but noted that via secondment arrangements the gaps in cover will be addressed. Dr Patel also updated the Board that Dr Dawes will return from retirement one day a week to ensure an appropriately qualified controlled drugs officer in Oldham until recruitment to this post is finalised. A written update had been provided with regard to minute 12/33 to confirm that the transfer of community services from NHS Stockport to Stockport FT had been signed. A written update had been provided relating to minute 12/35 regarding the completion and subsequent submission of the Integrated Plan to the SHA. Dr Burrows provided a verbal update with regards to minute 12/38, updating the Board that he had written to Mr Deegan – Chief Executive of CMFT to express the Board’s concerns about the outcome of the employment tribunal. Dr Burrows noted that Mr Deegan had responded and had shared their plans to address the concerns shared. Dr Burrows advised the Board that he would be happy to share the information provided, which does include some personal information, on a redacted basis Mrs Yarwood gave a verbal update relating to minute 12/41 regarding NHS Oldham’s recurrent surplus. Mrs Yarwood explained that the scrutiny had been undertaken and the full details would come to Board in a future Finance Report. A written update had been provided relating to minute 12/56 regarding investment in learning difficulties. Dr Burrows commented that it was interesting to note the significant variation in expenditure across Greater Manchester. Dr Burrows proposed that the Board ask the CCGs to undertaken a piece of work collaboratively to look at the reasons for such variation. Professor Fairhurst advised the Board that she proposed to drop item 15

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from the agenda as draft minutes are not routinely presented to the Board. Professor Fairhurst requested that for future meetings if ratified minutes were not available an update report to be provided instead. 12/67

Chairman’s Communications Professor Fairhurst updated the Board on the sad news of the death of Professor Joe Moore who was a former Dean of the Manchester Dental and Medical Schools. Professor Fairhurst noted that it was important to remember and formally acknowledge the valued contribution he made to healthcare in Greater Manchester, championing the needs of local people. Professor Fairhurst updated the Board on the very positive meeting she had had recently with the Chairman of Pennine Acute Hospitals NHS Trust, noting that the conversation was both useful and productive.

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Report of the Chief Executive Dr Burrows introduced his report drawing the Board’s attention to the following sections. Section 1: Accreditation of the Greater Manchester Major Trauma Centre Collaborative. Dr Burrows noted that the accreditation was received for the Greater Manchester Major Trauma collaborative arrangements however, advised that a piece of work will be done to establish the optimal configuration and final arrangements at the end of the twelve month period. Section 2: Bolton NHS Foundation Trust Compliance with Monitor’s Terms of Authorisation. Dr Burrows confirmed that NHS Greater Manchester would support Bolton CCG as much as possible in their performance management of these issues with the trust. Section 12: Management Arrangements for the Primary Care Commissioning Function. Dr Burrows provided an update on the process to transfer this function to NHS Greater Manchester and the work being done with staff affected by the changes. Section 13: Patient Safety Transitional Research Centre Bid. Dr Burrows updated that NHS Greater Manchester was one of two areas to have been successful in securing a grant for Patient Safety research. Section 15: Leading Large Scale Change Programme. Dr Burrows noted that NHS Greater Manchester had successfully applied to become part of the national Leading Large Scale Change Programme. He indicated that he felt that this would be very beneficial and would support the

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Safe and Sustainable programme in the future by helping to influence the cultural and organisational change needed to support large scale service change. Section18: Committee Structure and Governance. Dr Burrows drew the Board’s attention to the request to delegate authority to the Chief Executive to approve any Performers Panel Hearings as required in advance of the Contracts and Lists Committee meeting being established. Dr Burrows invited comments or questions relating to the paper. Mr Horrocks asked if there were any of the Greater Manchester district hospitals that could have and had not been accredited to stabilise patients on the inbound pathway for major trauma. Specifically Mr Horrocks wanted to know if there were any gaps in the Greater Manchester provision. Mr Heppolette confirmed that a detailed accreditation process had taken place, the outcome of which had been reported and approved at the previous Board meeting. Mr Heppolette confirmed that all patients in Greater Manchester were within the 45 minute national standard transfer time standard, with the majority being within 20 minutes of a unit. The Board approved that delegated authority be granted to the Chief Executive to approve Performer Panel Hearings as requested in advance of the Contracts and Lists Committee Meeting. The Board noted the contents of the report. 12/69

Report of the Medical Director Dr Patel introduced his report confirming that the Clinical Strategy Board had been established and had met twice to date. Dr Patel drew the Board’s attention to section eight of the report which, as requested at Part 2 of the March Board meeting, included a summary of the continuing investigations across Greater Manchester for independent contractors. More detailed information is available in Part 2 of the meeting. Dr Patel asked the Board to note the update with regard to the migration arrangements of the professional affairs functions of the ten locality arrangements into on single Greater Manchester structure with consistent policies and procedures. The NHS Greater Manchester Board noted the contents of the report.

PERFORMANCE 12/70

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Performance Report Mrs Garratt introduced her report, advising that the executive summary and exception data highlighted the key issues in a form that Board were now familiar with. Mrs Garratt asked the Board to note the following specific

updates: 



 

 

NWAS performance – Year-end target was narrowly missed. It had been anticipated that this target would be met and the final result was therefore disappointing. April 2012 performance has been met but NHS Greater Manchester is escalating concerns with NWAS via an Executive Team to Executive Team meeting in the first instance. Referral To Treatment (RTT) – Bolton FT has achieved for April and are projecting to achieve in May. This is very positive although ensuring the sustainability of the recovery remains a priority. Wrightington, Wigan and Leigh FT are struggling to achieve the RTT and Diagnostic targets and a meeting is being arranged for CCGs and NHS GM to meet with them to escalate concerns. Cancer – An improving position was noted, with the standards achieved for Q4 despite disappointing results in January and February 2012. CDiff – Good progress was reported, with significant effort and resource being applied at both provider and commissioner level to reduce avoidable occurrences. It was anticipated that, as it takes time to see the effects of measures put in place, the figures should show improvement in the next two to three months. A&E – Improvements seen at Bolton FT from April, NHS Greater Manchester continue to support. Challenges continue at CMFT, specifically at MRI. These issues are being escalated. Information Governance – Extra support is to be mobilised at a GM level to support CCGs to achieve this standard.

Mrs Garratt invited questions or comments about the report. Dr Burrows stated that, whilst not seeking to excuse poor performance, there was an inherent challenge to a cluster of the size of NHS Greater Manchester in the way that the SHA scorecard is calibrated. This is largely due to the way that thresholds are applied. For example, one A&E department failing to achieve the standard results in a “red” rating for the cluster as a whole. Dr Burrows confirmed that if a mean scoring mechanism were used, Greater Manchester would be in the middle of the league table rather than the bottom. Dr Chand asked how NHS Greater Manchester would support CCGs around recognising and achieving information governance. Mrs Yarwood responded that the issues around information toolkit compliance, in some part, stems from resilience issues following the transfer of community services. A GM lead will be appointed to concentrate on developing a detailed action plan. This plan will prioritise training and development for CCGs to assist them in discharging their responsibilities in this area. Progress will be monitored via the IM&T Programme Board. Mr Greenwood commented that he was concerned with the lack of continual improvement with regards to Cancer Performance in Greater Manchester. Dr Burrows challenged this assessment. He agreed that the post Christmas figures were disappointing but stressed that they were not a reflection of the Page 5 of 15

overall performance. He stated that although there are some issues to resolve in Greater Manchester, there had been a significant improvement in performance over the last twelve months. The current performance level is assessed as “green”, with an expectation that this will be maintained. Mr Greenwood asked if there was any data to support this position of continued improvement. Dr Burrows advised that such data was produced and indicated that he was happy to share with the Board if they thought this would be helpful. Mr Greenwood advised he was reassured by Dr Burrows’ comments and would be interested to see the data in more detail. Dr Burrows agreed to send Mr Greenwood the data for his information. Mr Atherton noted his support for the escalation with NWAS as he was concerned about the turnaround times within Greater Manchester. Dr Burrows noted Mr Atherton’s concerns and assured him that they were shared by the Executive Team. Dr Burrows committed to keep the Board updated on the upcoming meeting with NWAS. The Board resolved that:  Whilst recognising the improvement with regard to levels of Clostridium Difficile in Greater Manchester, they required assurance that plans were in place to deliver further significant reductions. The Board expected to see very clear plans to address the issue of inappropriate antibiotic prescribing and in turn reduce the number of avoidable cases of CDiff.  They required assurance with regard to improved performance from NWAS via the Executive to Executive Team meeting.  They required assurance from CCGs with regard to how they will demonstrate improvement in their Information Governance performance. 12/71

Quality and Safety Performance Report Mrs Garratt introduced her report which updated the Board on the areas of work supporting commissioners to commission for quality and safety. Mrs Garratt asked the Board to note that the completion of the quality accounts has been delegated to CCGs with support and guidance from NHS Greater Manchester. Mrs Garratt updated the Board on the very successful meeting held with Medical and Nursing Directors from both commissioning and provider organisations within Greater Manchester. The meeting covered Never Events and agreement was reached at that meeting to develop a learning set to share best practice and learning. NHS Greater Manchester would facilitate this process. Mrs Garratt asked the Board to note that the assessment centre element of the recruitment process for Nurses to sit on CCG Governing bodies was

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completed and ten nurses were successfully identified. CCGs can now choose to take these candidates to the next stage of interview. One nurse has already been appointed to HMR CCG. Dr Patel updated the Board that he had been asked to co-ordinate a similar process to identify Doctors for CCG Governing Bodies. Dr Patel advised that he had hosted an event for Doctors who had expressed an interest in these posts. The event was very well attended, with over 50 Doctors present. The NHS Greater Manchester Board noted the content of the report and the work ongoing. 12/72

HR Performance Report Mr Moynes introduced the report, noting that it was a regular Board report that reported progress against agreed productivity measures. Mr Moynes highlighted a number of corrections required to the published report as follows:    

Page 97, table 1, peripheral workforce utilisation, the percentages for NHS Manchester should read 34% rather than 245.3%, NHS ALW should read 34.1% not 0% and NHS Trafford should read 5.4% not 0%. On page 98, table 2, sickness absence rates should say poorest to best rather than best to poorest.

Mr Moynes highlighted some issues with the presented data which makes direct comparisons difficult. For example in NHS Manchester, domestic service and estates staff provide a service for multiple organisations, thus apparently inflating the spend in this area. Mr Moynes observed that there appeared to be relatively good intelligence and monitoring but not a consistent approach to performance management across Greater Manchester. He committed to ensuring that HR Business Partners work with Managers to improve the performance management processes. Mrs Yarwood reiterated the point that it is not always possible to make like for like comparisons. She added that in some localities the Electronic Staff Record, (ESR), is used proactively with staffing reconciled to the financial data. In other localities it is not utilised to the same degree. Different localities are utilising bank, agency and consultancy staff for different reasons, some because of QIPP and some to help manage the transition. She cautioned that in order to performance manage these targets it must be clear why we are monitoring and what it will help achieve. Mr Greenwood queried the headcount data in the report which appeared to indicate a year-on-year increase in staffing numbers. This was felt to be incorrect and would be reviewed following the meeting. The NHS Greater Manchester noted the contents of the report and the challenges. The Board were supportive of HR Business Partners working with Managers to improve performance measures. Page 7 of 15

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Staff Survey Results Mr Moynes introduced his report which outlined the key findings of the ninth national staff opinion survey and highlighted key achievements and areas for further development. Across the ten Greater Manchester localities there was an average response rate of 66%. Mr Moynes noted it was important to acknowledge that the survey took place against a backdrop of significant transition and change, the second year with a pay freeze and a period of uncertainty for staff. Mr Moynes advised there were no “red flags” identified in key areas such bullying and harassment, discrimination or quality of care. Concern was expressed with regard to the lack of access to learning and development, appraisals and Personal Development Plans in some areas. Mr Moynes invited questions or comments on the report. Professor Fairhurst questioned the recommendation set out in section 3.3 of the report, particularly with regard to the ownership of the action, given the pending dissolution of the PCTs. Mr Moynes understood the concern but stressed the importance of staff engagement, particularly in times of change and that issues do need to be addressed during transition. Dr Burrows agreed that responsibility should be handed to CCGs and CSS to create the leadership around any key areas identified that require action, as the successor organisations will need to take these issues on board. Mr Atherton agreed that successor organisation should take on board the issues and responsibility to address them now and in the future. Dr Higgins commented that there were actions that should be taken immediately via staff’s current line management such as completing appraisals and PDPs. Other issues should be linked to the transition plans and operating plans for successor organisations. In the mean time she suggested that a discussion with CCGs about what can be addressed now and in the future would be helpful to inform the planning and development and ownership of the action plans. The NHS Greater Manchester Board:  Noted the contents of the report  Acknowledged the achievement of sustained engagement levels and a relatively positive report despite the ongoing change and reform programme.  Agreed to the development of a staff led action plan to address key performance areas across Greater Manchester going forward, on the understanding that this is discussed with and linked to the operating plans for CCGs and CSS.

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Public Health Performance Report

Ms Sirotkin introduced her report which gave an update on the current performance against key performance indicators for Greater Manchester, including all age all cause mortality, an update on the update of the influenza vaccine of health care workers, an update on measles notifications in Greater Manchester. Ms Sirotkin advised the board that overall Greater Manchester was performing well for all age all cause mortality, but three areas Bolton, Oldham and Tameside are not making the expected levels of progress. Ms Sirotkin drew the Board’s attention to the Public Health Performance Dashboard on page 116 which provided an overview of performance on key public health indicators by locality. Ms Sirotkin advised the Board that more detailed work was to be done on a number of key issues, particularly smoking, maternity outliers and screening. The outcomes of this work would be presented to a future Board Meeting, together with suggestions for required actions. Ms Sirotkin noted a wide variation of uptake of the influenza vaccine of health workers in a number of Trusts and PCTs. Ms Sirotkin stated that Board level leadership was crucial with regard to this matter. Ms Sirotkin invited questions or comments relating to the report. Dr Burrows noted that the variation in uptake of the flu vaccination was concerning. He commented that the worst performing Acute Trust also has a challenge with regard to A&E performance, highlighting potential linkages between the two issues. Dr Burrows agreed that this poor performance should be raised with the Board’s of the poorly performing organisations, highlighting areas where high levels of uptake have successfully been achieved. Mr Horrocks commented that, in his experience, there was misunderstanding amongst some health workers about the value of the vaccination and its potential side affect and felt that an information campaign may be needed with regard to this issue. Ms Sirotkin expressed her surprise that such misunderstanding existed and that she would look to re-addressing the incorrect message. It was agreed that the Chairman would write to her counterparts in Acute Trusts with below average levels of performance to express the concerns of the NHS Greater Manchester Board. Ms Williams stated that she would welcome further data about the maternity outliers highlighted in the report to allow further analysis to take place. Ms Sirotkin advised that her overall priority is to work to understand the key messages arising from the data contained within the report, to allow her to put a prioritised action plan in place. This plan would be presented to the NHS Greater Manchester Board as well as Health and Wellbeing Board’s, to ensure a focus on the key public health issues. The NHS Greater Manchester Board noted the contents of the report. Page 9 of 15

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Finance Report – 2011/12 Mrs Yarwood introduced her report, stating that all PCTs had achieved their statutory financial duties in the first year of the NHS Greater Manchester Cluster. All PCTs have achieved QIPP targets. Mrs Yarwood reported that some contracts for secondary care have over performed which presents challenges for CCGs. Mrs Yarwood drew the Board’s attention to the table in section four on page 130 highlighting the changing performance pattern. The main areas of growth highlighted were now in outpatients, critical care and high cost drugs and devices. Mrs Yarwood reported that final year end position is good but noted there are still significant challenges for CCGs. Mrs Yarwood invited questions or comments on the report. Dr Burrows offered congratulations on the significant achievement of reaching financial balance in all localities and achievement of QIPP targets. NHS Greater Manchester localities collectively delivered a £136 million QIPP plan, which is an enormous success. Dr Burrows noted that a negative variance of £25.881m had been identified in the “All other points of delivery” category in the table on page 130 and asked for a breakdown of this activity could be brought as a matter arising to the next Board meeting. Dr Chand reiterated Dr Burrows’s congratulations. Dr Chand asked about redundancies and associated costs, and how this would impact on the next financial year and the legacy for CCGs. Mrs Yarwood explained that the financial plan had been submitted and all organisations do believe they can achieve their plans. She added that the transition process gives the impetus to look at crucial redesign work to achieve the financial challenge and get the infrastructure right for the future. Mr Greenwood commented that CCGs had a real opportunity to get a grip on commissioning models and CCGs would benefit from a collaborative approach to commissioning with the big strategic organisations. Mr Greenwood asked that this is discussed at CCG Chairs meetings. Professor Fairhurst confirmed that the next round of bi lateral meetings with the CCGs would take place in June and these types of issues will be raised with them then. Dr Patel confirmed that CCGs did consider this issue at the last meeting and are being directly addressed by the CCGs as part of their development programme. Mrs Yarwood added that the Clinical Strategy Board are recommending more single contracting teams in contrast to existing lead commissioner arrangements. Dr Higgins advised that as part of the Transition Programme CCGs will be asked about what projects they are going to put in place, how they

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collaborate with the CSS and manage the financial risks. NHS Greater Manchester have talked about how we can support and help CCGs to do this. Dr Chand stated that a break from the past is required and that accountable officers at CCGs should be clinical,. Professor Fairhurst noted the point made by Dr Chand but reaffirmed the role of the Board was to support the transition not to be prescriptive. The NHS Greater Manchester Board noted the contents of the report. 12/76

Finance Plan Report 2012/13 Mrs Yarwood presented her report noting that the Board approved the financial plans for 2012/13 at its meeting on the 29th March 2012. Mrs Yarwood updated that since that meeting the SHA has increased the lodgement and decreased the surplus required from four of the PCTs, by an equal amount. No other changes were noted to the previously reported position. The final submission will be made to the SHA at the end of May 2012. Mrs Yarwood explained that the report is now set out to reflect the new architecture and the appendices do begin to show the scale of the budgets to the new organisations in the structure. Mrs Yarwood asked the Board to approve the proposal to pool the 0.6% non recurrent funds set aside for redundancy costs into a central allocation managed by NHS Greater Manchester. Mrs Yarwood gave assurance that allocation of costs would take due regard of costs incurred by localities in 2010/11 and 2012/12 to ensure equity across the ten localities. Mrs Yarwood invited questions or comments on the report. Dr Burrows commented that the appendices with breakdowns were very helpful, whilst acknowledging that some aspects still represented work in progress. Mr Greenwood questioned how the final lodgement would be apportioned across the receiving organisations, and asked how this would affect future budgets. Mrs Yarwood confirmed that this had not yet been clarified by the Strategic Health Authority and Department of Health. Mr Greenwood expressed concern that in pooling the redundancy monies, some organisations could be disadvantaged. Mrs Yarwood advised that it was difficult to assess. For example, staff transferring to the CSS could fall disproportionally across PCTs in a manner outside of their direct control. She advised that there is a need to get the new structures confirmed then take a central view once it is known which staff will be successful in securing positions in the new structure. Mr Greenwood asked that this is kept under review.

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Mrs Yarwood committed to providing all the detail and monitoring to the Transition Programme Board including all the costs occurred in 2010/11 and 2011/12. Mr Atherton agreed that this item should be kept under review as he felt this solution might cause tension in localities that feel they have to give other localities money to support action that could have been taken sooner. Mr Ahmad agreed that the he was not in favour of such subsidisation between localities. Mrs Yarwood explained that she had resisted the pooling of these funds on a North West footprint which had initially been considered and stressed that the money has already been top sliced from CCGs and Public Health and is available in a separate reserve. Dr Higgins noted that the key issues around Transition need a more in-depth discussion. She commented that the current ten Greater Manchester PCTs are transitioning into 27 receiving organisations and as such there has to be a Greater Manchester Transition approach. Dr Higgins stated that it is sensible to take Greater Manchester level actions on issues to support the transition process, with the pooling of redundancy resource representing one such action. Mr Stephenson noted the concerns expressed by colleagues but agreed that transition issues do need to be managed at Greater Manchester level. He noted that increasingly large numbers of staff are working between organisations and gaps need to be identified and taken account of. Professor Fairhurst noted that much of the discussion had been centred around Transition and proposed to have a Board Strategy session dedicated to this issue. The NHS Greater Manchester Board:  Noted the presentation of the previously approved financial plans in the format of the new governance architecture.  Agreed to hold a separate Board Development Session dedicated to Transition issues and will consider the pooling of the redundancy monies in more detail. 12/77

Cluster Budget 2012/13 Mrs Yarwood presented the report which gave the Board an update on the budget required for NHS Greater Manchester for 2012/13. Mrs Yarwood explained that since the last Cluster Budget report, the Cluster have a fuller understanding of what is needed to support the transition. The Board were asked to note that the budget does not represent additional costs but a reclassification and distribution of costs from within the ten PCTs across Greater Manchester within running cost limits set by the Department of Health The Board approved the NHS Greater Manchester budget for 2012/13

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PROCESS 12/78

Board Assurance Framework Mr Bellingham provided an update to section 2.2 of the report, asking the Board to note that the final version of the 2011/12 Board Assurance Framework had been presented to Audit Committee meeting held on the 3rd May 2012 and was signed off and closed down. Mr Bellingham drew the Board’s attention to Appendix one and the narrative outlined in section 3.3. Mr Bellingham confirmed that a review of the top risks for Greater Manchester will be undertaken to ensure that the correct risks are captured and triangulated with the Assurance Framework and the Integrated Plan. Mr Bellingham invited questions or comments relating to the paper. Mrs Yarwood highlighted one new risk to the Board, number five on Appendix one. The risk concerns failure to deliver a robust estates function up to and beyond the transition to the NHS Property Services function. Mrs Yarwood asked the Board to note that this was a very challenging piece of work as NHS Property Services had not yet been established. Although this work is ongoing and NHS Greater Manchester are helping the co-design, the Board were asked to note that this receiving organisation requires significant further development and as such carries an associated level of risk. The Board:  Noted the 2011/12 Board Assurance Framework was closed down by Audit Committee on the 3rd May 2012.  Agreed the top strategic risks for the 2012/13 Board Assurance Framework.  Noted the development process underway for the 2012/13 Board Assurance Framework TRANSITION

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Managing the Transition Update Dr Higgins introduced the report, giving the Board an update on the progress relating to the delivery of the transition programme. Dr Higgins noted that the CCGs and CSS are continuing to progress towards authorisation and accreditation in line with national guidance. CCGs have informed the SHA of their preference for which wave of authorisation assessment they want to be part of. Oldham CCG are the only Greater Manchester CCG forming part of wave one of the accreditation process. Dr Higgins confirmed that feedback was awaited for the CSS checkpoint assessment. Dr Higgins drew the Board’s attention to section 2.6 to highlight a proposed change to previously reported governance arrangements. It was proposed that the Public Health Transition Group reports to the Transition Programme Board rather than the Direct Commissioning Board. Dr Higgins also

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confirmed to the Board the mobilisation of PA Consulting who were delivering a robust programme management approach to managing the transition. Dr Higgins invited questions and or comments relating to the report. The Board:  Noted the update, including the operational management arrangements for managing the Transition Programme.  Approved the amendment to the reporting arrangements so that the Public Health Transition Group reports to the Transition Programme Board. 12/80

Service Transformation Report Ms William’s introduced the report which updated the Board with regard to the activity that had taken place since the last report in March 2012. Ms Williams advised that, since the report had been produced, the Clinical Strategy Board had agreed to add another workstream ‘Primary Care’ to the Safe and Sustainable programme. This made a total of eight work streams in all. Ms William’s invited questions or comments. Professor Fairhurst questioned how the Primary Care Workstream would be linked to the community budget work and the work ongoing with social care. Mr Heppolette advised that the proposed reforms in Primary Care underpin the changes in secondary care. He added that AGMA are very engaged in the understanding that Primary Care and Social Care underpins whole scale change. Cllr Morris confirmed that AGMA recognise the priority of this agenda and are very keen to work together to get the required whole scale changes needed. There was recognition that the Act of Parliament relates to both health and social care and as such, there are plans to change the name of the health commission to reflect this. The NHS Greater Manchester Board noted the contents of the report.

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Clinical Commissioning Board Report Mr Heppolette introduced the report and updated the Board that the report provides an update of the recent business of the Clinical Commissioning Board’s final meeting held on the 23rd February 2012 and its successor the Clinical Strategy Board, inaugural meeting held on the 3rd April 2012. The NHS Greater Manchester Board:

MINUTES AND REPORTS 12/82 Page 14 of 15

Audit Committee Reports

The Board noted the contents of the reports of the Audit and Integrated Governance Committee meetings held on the 23rd February 2012 and the 15th December 2011 12/83

Locality Board Summary Document The NHS Greater Manchester Board received and noted the contents of the Locality Board Summary Documents. Mr Bellingham drew the Board’s attention to the first two CCG Board Summary Documents received after their first meetings held in April 2012.

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NHS Greater Manchester Remuneration Committee Minutes – 12 January 2012 The minutes of the meeting were agreed and the contents noted

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North of England Specialist Commissioning Meeting Minutes – 16th February 2012. Dr Burrows updated the Board on the outcome of the legal challenge made in connection with the national Paediatric Cardiac Surgery review. Three Court of Appeal judges have found the process for public consultation to be fair, lawful and proper, meaning that a final decision can now be taken at a meeting to be held on 4 July. The contents of the minutes of the meeting were noted. FOR INFORMATION

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Any Other Business No items

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Reflections The Board reflected that they no longer needed the lengthy introductions from the Executive Team and are much more familiar with the issues and concerns.

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Date and Time of Next Meeting 14th June 2012 – Restricted item agenda at 2 pm Exclusion of Press and Public To resolve that publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted and that the public be excluded.

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Item 8.1

Minutes NHS Greater Manchester Board Meeting Date: 14th June 2012 Venue: Salford Suite, St James House, Pendleton Way, Salford, M6 5FW Present:

Professor Eileen Fairhurst - Chairman Mr Terry Atherton – Non-Executive Director Dr Mike Burrows - Chief Executive Mrs Claire Yarwood - Director of Finance Dr Julie Higgins - Director of Commissioning Development Mrs Hilary Garratt - Director of Nursing, Quality and Performance Ms Leila Williams – Director of Service Transformation Mrs Andrea Anderson – Director of HR and OD Mr Riaz Ahmad – Non-Executive Director Dr Kailash Chand – Associate Non-Executive Director Mr Alan Stephenson – Non-Executive Director Mr Rob Bellingham - Board Secretary Mr Michael Greenwood – Non-Executive Director Mr Paul Horrocks – Non-Executive Director Mr Warren Heppolette –Director of Policy and External Relations Mr David Edwards – Non-Executive Director + 3 members of the public/ NHS Staff

Minute No 12/89

Item Apologies for Absence Dr Raj Patel – Medical Director Cllr Cliff Morris – Association of Greater Manchester Authorities (AGMA) Ms Evelyn Asante-Mensah – Non-Executive Director Ms Melanie Sirotkin – Director of Public Health

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Declaration of Interests No declarations of interest were made. Professor Fairhurst welcomed Mr John Jesky the Chairman from Pennine Acute to the meeting and explained that the meeting was a limited agenda Board Meeting.

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Extract of the Minutes of the meeting held on the 10th May 2012. Professor Fairhurst noted that the attached minute relating to the performance and finance elements of the previous meeting were attached as

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an aide memoir only. 12/92

Matters Arising: A written update had been provided with regard to minute 12/75, giving further information on contract performance by care group. PERFORMANCE

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Performance Report Mrs Garratt introduced the performance report, indicating that the data provided within the report was based on the year end position up to the 31st March 2012, with the exception of the A&E figures which were based on the end of April 2012 data. Mrs Garratt stated that the report set out the key challenges for NHS Greater Manchester, highlighting that the Operating Framework 2012/13 outlines a requirement that RTT targets be achieved by individual specialty rather than as an overall aggregated figure. Mrs Garratt invited comments and/or questions from the Board. Dr Chand noted the recent media coverage about diabetic care standards, with particular issues in the North West. Dr Chand asked for clarification about what Greater Manchester was doing about preventative measures, such as screening and disease management to address the issue and ensure that diabetes does not become a much larger problem within secondary care in the future. Mrs Garratt advised that the Primary Care Performance Report was being developed and would come to the next full Board meeting in July 2012. She advised that it was important to get behind the headline measures and find out what exactly is happening to start to begin to address the issues. Dr Burrows added that a number of CCGs do have this work prioritised within their delivery plans. He added that he would be happy to raise this issue with the CCGs. Ms Williams confirmed that diabetes does form part of the Long Term Conditions’ work being undertaken as part of the safe and sustainable programme. Mr Ahmad enquired that as community services had now been transferred to a number of providers across Greater Manchester, was there appropriate assurance with regard to the services being delivered. Mrs Yarwood stated that this was an issue which was currently under review. She updated the Board that across Greater Manchester there existed a large variety of contract metrics to monitor performance but that these may not be common across providers. Mrs Yarwood advised the Board that a suggestion has been made that, via

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the Contracts Steering Group, CCGs work as a group to create consistent Community Service specifications. She added that the current Community services contracts would terminate in 2013/14. Therefore the work to rationalise service specifications needs to start. Mrs Garratt confirmed that some extra resource from the SHA had been secured to undertake a high level review of contractual breaches in community services and mental health. Mr Horrocks referred to section 2.11 of the report and asked what level of confidence Greater Manchester had that the action plans for Bolton FT and Pennine Acute trust were robust. Mrs Garratt advised that both economies had their own specific issues. The Pennine Acute Trust action plan was on track and had been agreed between the Trust, NHS Greater Manchester and NHS North of England. The plan is being closely monitored, with commissioners having sight of where each patient is within the system. Mrs Garratt went on to explain that Greater Manchester did not currently have the same level of confidence with regard to the delivery of the Bolton Foundation Trust action plan. She noted that Bolton’s performance had made a very sharp turnaround, following the recent intervention by Monitor. NHS Greater Manchester remained concerned as to whether the changes made were sustainable. Dr Burrows reiterated that at the Annual Review Meeting, SHA North of England had made the position clear, with regard to the levels of performance expected, with regard to the key access targets. He added that Greater Manchester does still have a challenge, particularly with regard to the waiting time targets. Dr Burrows stated that the national NHS senior leadership team were visiting Greater Manchester in July and that these issues would be a key agenda item. Mrs Garratt also noted that NHS Greater Manchester was working with CCGs to ensure that the appropriate contract sanctions were being applied in the event of failure, recognising the need to continue to work with providers to help them to resolve the problems/issues. Mr Heppolette updated the Board that the Clinical Strategy Board had agreed the future commissioning support arrangements for the North west Ambulance Service with NHS Blackpool hosting the contract. Mr Heppolette noted that the proposal was accepted with some specific conditions. Going forward the process of performance management for Greater Manchester will be led from within Greater Manchester, supported by information from the central team. The Clinical Strategy Board voted to keep the options open beyond 2013 and have built a six month review clause into the agreement. Mr Atherton assured the Board that the Clinical Strategy Board had made it clear that Greater Manchester performance represented a central issue, building in the option to review the arrangement should there be concerns in this regard. Page 3 of 6

Mr Greenwood questioned why no finance report was available at today’s meeting. Mrs Yarwood explained that it was for a number of reasons including the timing of the meeting, the fact that 4 PCTs had transferred to a new ledger system on 1 April and that a full ledger download had not been completed and reconciled in all localities. She indicated that she did not feel that this presented any material risks with regard to the delivery of the financial position and that a full report would be presented to the July Board. Mr Ahmad asked the Board to note that the Audit Committee had met during the previous week to approve the annual accounts for the 10 Greater Manchester PCTs and expressed his compliments to the finance teams for a job well done. The NHS Greater Manchester Board were assured of the work ongoing to address the key performance issues within Greater Manchester. 12/94

New Health Deal for Trafford Ms Williams introduced the report, asking the Board to note that the first document, the pre consultation business case had been independently reviewed and the comments received had been incorporated. She noted that the consultation strategy had been shared with the Trafford Strategic Programme Board, with meetings being held with the Trafford and Manchester Overview and Scrutiny committees. Ms Williams circulated a letter received from the Trafford Overview and Scrutiny committee, outlining their comments on the consultation document. Ms Williams apologised for tabling the letter, explaining it had only been received the day before the meeting. Ms Williams drew the Board’s attention to the key points outlined in the letter and the additional assurances that Trafford Overview and Scrutiny committee were requesting including: 

Ensuring that the proposals adequately convey the wider health economy plans for integrated care



Including further information with regard to the vision for Altrincham and Stretford Memorial Hospitals

Ms Williams confirmed that she would ensure that the request for information contained within the letter would be met. Ms Williams asked the Board to receive and consider both documents. Ms Williams invited questions and/or comments. Mr Greenwood asked for clarification as to why there was no detailed information about the finance included in the documents. Dr Burrows noted that the financial detail was outlined in the summary but noted the point also made by Trafford Overview and Scrutiny Committee that Page 4 of 6

this should be made more explicit. Mr Greenwood noted that the document identified a preferred option. He asked for clarification that the other options were fully costed and evaluated before the recommendation for the one option was decided. Dr Burrows clarified that the Board was being asked to support going out to consultation. Mrs Yarwood confirmed that all options were fully costed and reviewed by the Trafford Strategic Programme Board. Mr Greenwood asked if the option outlined was the most cost effective. Mrs Yarwood explained that the underlying deficit had been considered and addressed by all the identified options. Ms Williams gave the Board assurance that extensive debate had taken place around the options. Mr Greenwood asked what allowances had been made for savings in overheads with Central Manchester Foundation Trust and asked who would ensure the savings were realised. Mrs Yarwood advised that the savings were phased over a 2 year period, as some fixed costs could be removed immediately and some would require service re-design. Mrs Yarwood gave assurance that an extensive piece of work had been undertaken with regard to this process, which had been reviewed by KPMG. Mr Atherton noted that the Trafford Strategic Programme Board had sought assurance from the providers Central Manchester Foundation Trust and University Hospitals of South Manchester with regard to their commitment to implementing the urgent and integrated care service re-design plans. Mr Atherton advised he voted for the proposals based on these assurances and the minutes of the meeting would reflect this clearly. Professor Fairhurst suggested that the word confidential should be removed from the document and further work should take place to make the final version more user friendly. She also advised that acronyms should not be used in the document. Ms Williams advised that the final changes will be undertaken and the consultation process will include a summary document, DVD, website etc to ensure that people can access the information NHS Greater Manchester Board approved the submission to the NHS North of England for authorisation to commence public consultation in July 2012

Page 5 of 6

FOR INFORMATION 12/95

Any Other Business Annual Accounts: Professor Fairhurst advised that the delegated authority was given to the Chair of the Audit Committee to approve the annual accounts for the 10 Greater Manchester PCTs at the June Audit committee. The process had concluded successfully and the results will be presented to the July Board meeting. Industrial Action by BMA Members: Mr Moynes updated that he was working with the resilience team to understand and manage the impact to ensure continuity of service. Communications will be managed at a Greater Manchester level. At Professor Fairhurst’s request, Mr Jesky provided a brief verbal update on the position and plans for Pennine Acute Hospitals.

12/96

Reflection No points of reflection discussed. Date and Time of Next Meeting 12th July 2012 at 2:00 pm – Exclusion of Press and Public To resolve that publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted and that the public be excluded.

Page 6 of 6

MEETING:

WB CCG Board

DATE:

24th July 2012

Item 8.2.i

REPORT TITLE:

Finance Report to 30th June 2012

REPORT AUTHOR:

Mike Tate

PRESENTED BY:

Mike Tate


To note the contents of the paper on the financial performance of the locality PCT (CCG/NCB/LA). To inform the Clinical Commissioning Board of the financial position of the organisation up to 30th June 2012

EXECUTIVE SUMMARY At month 03 the locality PCT (CCG/NCB/LA) is forecasting to achieve its statutory duties in 2012/13, and achieve a surplus of £2,807k. The Year to Date (YTD) surplus (£702k) is line with the projected planned surplus. Financial reporting in 2012/13 will be structured to show budgets and expenditure under the following headings: • • •

Wigan Borough CCG budgets; NCB budgets; and Wigan LA budgets.

Further detail is presented in month 03 in line with NHS Greater Manchester. As reported last month, NHS GM wrote to Directors of Finance suggesting that for consistency CCG finances are reported in a set format across Greater Manchester. This request features in this report as a series of appendices that are cross referenced to the appropriate elements within section ‘C’, Wigan Borough CCG Budgets.


TRACKING Committee /Meeting

CCG Operations

Clinical Governance

Corporate Governance


Locality Audit Group

Consideration required y/n Date of submission

Page 2 of 3

CCG Strategic Leadership

CCG Board

NHS GM Board

1. Purpose of Report 2. Introduction/Background 3. 4. 5. 6. Conclusions 7. Recommendations

Front Cover Guidelines Executive Summary should be no more than ½ a side Short paragraphs All paragraphs numbered Clearly referenced documents 2 – 3 sides at the most plus supporting documents Plain English No acronyms Font Arial 11

Page 3 of 3

Section A: Key Financial Performance Dashboard Year to date rating

1. Headline financial indicators NHS Ashton, Leigh & Wigan 01

Revenue The Locality PCT (The PCT) is forecasting a planned surplus of £2.8m in 2012/13.

02

Capital The PCT is forecasting to achieve financial balance against its Capital Resource Limit in 2012/13.

03

Cash The PCT is drawing down cash in accordance with plans.

Year-end rating

2 Summary financial position at Month 03 NHS Ashton, Leigh & Wigan Year to Date

Forecast

CCG

107,464

u

G

443,372

Variance (favourable) / adverse £000s 443,372 -

u

G

NCB

29,518

29,518

-

u

G

121,603

121,603

-

u

G

5,628

5,628

-

u

G

22,660

22,660

-

u

G

789

789

-

u

G

3,428

3,428

-

u

G

Total Budgets

143,399

143,399

-

u

G

591,063

591,063

-

u

G

Allocation

144,101

144,101

-

u

G

593,870

593,870

-

u

G

702

702

-

u

G

2,807

2,807

-

u

G

Budget £000s

Local Authority Estates & Facilities

Surplus

Variance Actual (favourable) £000s / adverse £000s 107,464 -

Trajectory

RAG rating

3 Surplus – current position against full year plan

1

Budget £000s

Forecast £000s

Trajectory

RAG rating

Section B: NHS ALW Overall Financial Position Overview As reported last month the Board were informed that NHS Greater Manchester wrote to Directors of Finance suggesting that for consistency CCG finances are reported in a set format across Greater Manchester. This request features in this report as a series of appendices that are cross referenced to the appropriate elements within section ‘C’, Wigan Borough CCG Budgets.

Summary PCT Position At month 03 the locality PCT (CCG/NCB/LA) is forecasting to achieve its statutory duties in 2012/13, and achieve a surplus of £2,807k. The Year to Date (YTD) surplus (£702k) is in line with the projected planned surplus. Detailed financial positions are given in: Section C: Wigan Borough CCG budgets; Section D: NCB budgets; Section E: Wigan MBC budgets; and Section F: Section 75 Single Commissioning Agency budgets. The current position on the capital budget is given in Section G. Appendix 1 shows the allocations received by the locality PCT (CCG/NCB/LA) this month. Appendices 2 to 7 show detailed information for the CCG budgetary position this month. Key Message 1 – QIPP As previously reported to the Board, the locality PCT (CCG/NCB/LA) is planning to deliver £18.1m QIPP savings in 2012/13. Successful delivery of this target is critical to the achievement of the agreed control total surplus and all QIPP scheme owners must be committed to achieving their in-year targets. It was reported at month 02 that there was a shortfall of unidentified QIPP schemes totalling £2.4m required to achieve the £18.1m target. The Board should consider the impact of the Estates and Community related QIPP schemes not delivering the expected savings envisaged during the financial planning round. The combination of the underperformance of these schemes and the unidentified element places a significant financial risk against QIPP delivery. The details and risks are shown in the separate QIPP report. The Board should therefore consider the application of planned programme slippage as an option to offset the financial risks identified in the QIPP report. Key Message 2 – Non recurrent revenue funding The locality PCT (CCG/NCB/LA) financial plan for 2012/13 includes non-recurrent funding of £11.2m. This is 2% of the total revenue funding, which will be applied as follows:

2

1% (£5.6m) is being used for the NHS Greater Manchester (NHS GM) Safe and Sustainable programme; 0.6% (£3.4m) is being held for NHS GM transition costs to support non-recurrent pressures in the system. The PCT has previously agreed with the NHS GM Director of Finance (DoF) to utilise £2.5m as a payment to Wrightington, Wigan and Leigh FT (WWLFT) to support their voluntary redundancy programme. It is recognised that this is a large commitment against this allocation; and 0.4% (£2.2m) remains for local Safe and Sustainable funding, which is non-recurrent funding to support system change and closedown within the locality. The NHS GM DoF has indicated that due to current financial projections across NHS GM, the CCG undertake a review that would enable the £2.5m currently allocated to WWLFT from the 0.6% top-slice to be funded from within locality resources. This would enable the full £3.4m of the top-slice to be applied purely to NHS GM transition costs. A feasibility review will be undertaken to examine the options available. However, given the QIPP financial issues identified in ‘Key Message 1’, this will not be an easy task to accomplish. This matter was discussed at Finance and Performance Committee and a paper will be placed before the same committee in August.

Looking Towards Month 4 Month 04 reporting will see greater visibility on both secondary care and prescribing costs as two months data will be available. This should indicate any negative trends regarding potential over performance and the impact on the delivery of the localities surplus control total. It is therefore important that budget holders identify any areas of budget slippage in a timely manner to support the financial risks associated with QIPP and NHS GM transition.

3

Section C: Wigan Borough CCG budgets 1. Summary financial position at month 03 Year to Date Budget £000s


Actual £000s

Forecast

Trajectory

RAG rating

Budget £000s


Forecast £000s

Trajectory

RAG rating

Acute Services

66,137

u

G

269,088

u

G

Mental Health

7,340

7,340

-

u

G

29,360

29,360

-

u

G

Community

8,352

8,352

-

u

G

35,457

35,457

-

u

G

Other Commissioning

3,126

3,126

-

u

G

5,800

5,800

-

u

G

14,132

14,132

-

u

G

56,529

56,529

-

u

G

180

180

-

u

G

721

721

-

u

G

CHC/FNC

4,894

4,894

-

u

G

19,578

19,578

-

u

G

Corporate

3,203

3,303

100

u

G

12,198

12,597

399

u

G

Reserves

100

0 -

100

u

G

14,643

14,244 -

399

u

G

107,464

107,464 -

0

u

G

443,372

-

u

G

Prescribing Primary Care

Total CCG Budgets

443,372

2. Key financial performance issues in June Acute Services: The locality PCT has received month 01 freeze data and month 02 flex data from Wrightington Wigan & Leigh FT. The data is showing an over-performance at month 02, but it includes errors for incomplete spells that were agreed as part of the 2011/12 year end settlement and the profiled activity is very low for April; Acute Services: The month 02 contract monitoring information also shows a non-elective overperformance (£400k). This is currently being challenged, as hospital admission avoidance schemes that were transferred to WWL FT from Bridgewater under Transforming Community Services, may not be operating effectively leading to an increase in emergency admissions. These identified issues are being challenged and until these issues are resolved with the Trust, the position reported on this contract is in line with the agreed budget; Acute Services: Central Manchester and Salford have both reported problems with their data, and so the position reported on these contracts is also in line with the agreed budget until the data issues have been resolved by the Trusts; Corporate: There is a £399k over performance on corporate budgets due to a non-recurrent increase in the NHS GM Board costs. This has been funded from CCG reserves; and Prescribing: April’s GP prescribing information was not available in time for this report. When it becomes available, the CCG will continue to utilise the PPA forecast, which is consistent with the approach taken at the year-end. 3. Risks All: Non-delivery of CCG owned QIPP Schemes (see separate QIPP report); Acute Services: Acute services in-year contract over performance. 2012/13 activity plans are based on the purchase of 2011/12 forecast outturn, so activity this year needs to be tightly controlled to stay at that level and to make sure that all contracts are delivered in line with the agreed budgets and activity plans. It is expected that Acute Services Contracts will be subject to significant monitoring by NHS GM and NHS North; and Prescribing: In-year over performance – 2012/13 prescribing budgets are based on 2011/12 forecast outturn, the Medicines Management Team have to keep expenditure at that level and deliver £2.7m of QIPP savings (see separate QIPP report). Supporting information regarding the CCG position at month 03 is attached as Appendices 2 to 7. 4

Section D: National Commissioning Board budgets 1. Summary financial position at month 03 Year to Date Budget £000s Primary Care

18,801

Variance Actual (favourable) £000s / adverse £000s 18,801 -

Forecast

Trajectory

RAG rating

u

G

75,199


Budget £000s

Forecast £000s

Trajectory

RAG rating

u

G

Specialist

7,301

7,301

-

u

G

32,332

32,332

-

u

G

Other Commissioning

1,148

1,148

-

u

G

4,590

4,590

-

u

G

Public Health

2,068

2,068

-

u

G

8,272

8,272

-

u

G

201

201

-

u

G

805

805

-

u

G

-

-

-

u

G

405

405

-

u

G

29,518

29,518

-

u

G

121,603

121,603

-

u

G

Corporate Reserves Total NCB Budgets

As previously reported these budgets will transition to NCB control (NHS GM) during the year, but will still be accounted for in the locality PCT/CCGs accounts. The NCB has stated that the locality is still expected to manage these budgets on behalf of the NCB during 2012/13. 2. Key financial performance issues in June All: There are no significant financial performance issues this month; Specialist: North of England Specialised Commissioning Group continues to migrate services from NHS Trust contracts into its portfolio and this is expected to continue throughout 2012/13. These migrations should have a neutral impact on PCT/CCG budgets; and Primary Care: Primary Care budgets are being monitored closely by NHS GM and reported to the Direct Commissioning Board on a monthly basis. 3. Risks All: Non-delivery of QIPP Schemes – (see separate QIPP report); and Primary Care: Control over budgets reported through the locality PCT/CCG but managed externally by NHS GM.

5

Section E: Wigan MBC budgets 1. Summary financial position at month 03 Year to Date

Forecast

Public Health

4,583


u

G

18,265

Social Care

1,045

1,045

-

u

G

4,179

-

-

-

u

G

5,628

5,628

-

u

G

Budget £000s

Reserves Total LA Budgets

Actual £000s

Trajectory

RAG rating

Budget £000s


Forecast £000s

Trajectory

RAG rating

u

G

4,179

-

u

G

216

216

-

u

G

22,660

22,660

-

u

G

2. Key financial performance issues in June All: The locality PCT/CCG and Local Authority (LA) Public Health finance teams are working together to monitor performance against the 2012/13 shadow LA budget during this transition year; and All: There are no significant financial performance issues with the shadow budget this month. Update on finance issues for Public Health transition: Local Authority ring fenced allocation The DH have recently published ‘Healthy Lives, Healthy People: Update on Public Health Funding’ (14th June 2012), which sets out interim recommendations on the Public Health resource allocation formula. The NW will receive 15% of the total funding available with Wigan receiving 4.6% of this, which is the 5th highest share. This equates to 0.69% of the national total, which would be in line with the Local Government distribution formula for Adult Services. When compared to the share per 100,000 population, Wigan would receive 0.22% of the national allocation, which is line with the northwest average; The recommendations are now out for consultation, and the DH would welcome feedback on the assumptions that the resource allocation formula is based upon; and The final allocation for 2013/14 is currently expected towards the end of quarter 3, but DH will attempt to bring it forward if possible as they recognise the importance of the information for financial planning in 2013/14. Baseline spend A further DH baseline spend exercise has just been completed, analysing the locality’s expenditure between the future commissioning responsibilities of LAs, CCGs and NCB. The key changes to the LA’s funding are the inclusion of the entire pooled drug treatment budget (previously only the preventative part had been included) and taking out the NWSCT non specialist PH services expenditure (£551k) which has now been allocated to the CCG as part of the NHS CB and Clinical Network costs (£300k). Staffing structure and costs Two new structure options have been costed and both are within the current public health staffing financial envelope. 3. Risks All: Non-delivery of Public Health QIPP Schemes - (see separate QIPP report); and All: Agreement of allocations and staffing to be transferred to the LA.

6

Section F: Section 75 Single Commissioning Agency 1. Summary financial position Further information will be presented on the Section 75 Single Commissioning Agency in month 04. This area is currently under review by the Directors of Finance from both Wigan MBC, and NHS Ashton, Leigh & Wigan/Wigan Borough Clinical Commissioning Group.

7

Section G: Capital 1. Summary financial position at month 03 The Locality PCT has not incurred any expenditure on capital yet as the two main schemes included within the Capital Resource Limit (CRL) has not yet been formally agreed. 2. Sales The locality PCT is planning to make four sales in 2012/13, all of which have been carried over from 2011/12; and Two of these are in the process of being sold (College Street and Incefield House). Offers have been accepted and the sale will complete this year. One relates to Atherton, which the GP in the adjoining property has indicated that he would like to purchase and the sale is currently being negotiated. The other relates to Beech Hill clinic as the local NHS Trust has put in an offer to buy the clinic, recently declared surplus. 3. Expenditure Expenditure included within the plan includes the refurbishment of LIFT clinics to accommodate the relocation of outpatients. Costs are not finalised at this stage but £1.2m has been assumed for this, based on initial plans provided by the PCTs LIFT Co. A further scheme has been included relating to refurbishing a LIFT clinic, in order that the ophthalmology suite from WWLFT can move in to the site at Frog Lane Clinic. WWLFT are planning to close the existing ophthalmology suite as part of their next phase of their site development. To allow this, ophthalmology services must be relocated, and space is available within Frog Lane LIFT site. However, it requires significant refurbishment at an approximate cost of £1.2m (full plans are available if required). On relocation WWLFT would hold a sub-lease for the space used within the LIFT clinic and rental revenue will be generated, hence the scheme will generate an on-going saving; As part of WWLFTs capital development of the hospital site, the paediatrics service also requires relocation. Discussions on this are at a very early stage, but relocation to a LIFT site may also be an option for this. However, nothing has been included in the plans for this as the plans are at a very early stage. If this progresses, possible capital funding may be sought at a later date. The locality is sending business cases to NHS GM/ NHS North to get agreement to the CRL requested for these schemes so that work can get underway; An estimate of £150k has been included for the financial investment in Ashton LIFT if the scheme is given approval. If so the financial close would be in 2012/13 and the investment would be required at that time; A car park scheme at Platt Bridge Clinic, deferred from 2011/12 has been included within the plan; and Costs of life cycle on LIFT clinics of £415k have also been included.

8

Appendix 1: Allocations Allocation Update June 2012

Allocation

Total

£000

£000

Opening allocation 2012/13

593,337

No allocations received in month 02

PCT allocation at month 02

593,337

Allocations received in month 03 2012/13 Pooled Treatment Budget & Drug Interventions Programme

38

Child & Adult Vaccination - routine vaccs programme for HPV vaccine

46

GM Cats 2011/12 contract under utilisation

(51)

2012/13 Transformational pool WWLFT

450

2012/13 Transformational pool Bridgewater Community Trust Sub total allocations received in month 03

50 533

PCT allocation at month 03 (included in FIMS submission to SHA)

.

9

593,870

Appendix 2: CCG Detail – Key Financial Indicators Key Financial Indicators

1

Operate within Delegated Expenditure Budget(£000s) Plan

2

107,464

107,464

0

Year end forecast

443,372

443,372

0

Key

Result

Trend

Result

Trend

Result

Trend

Result

Trend

Top 2 contracts (cumulative year-to-date) Plan

Actual

42,792

42,792

0

4,510

4,510

0

Plan

Actual

Variance

Cumulative to date

4,894

4,894

0

Year end forecast

19,578

19,578

0

Plan

Actual

Variance

Royal Bolton NHS FT

4

Variance

Cumulative to date

Wrightington, Wigan & Leigh NHS FT

3

Actual

Variance

Continuing Health Care Expenditure

GP Prescribing Cumulative to date

14,132

14,132

0

Year end forecast

56,529

56,529

0

Symbol

Target Result Actual better than plan Actual meets the plan Actual fails to meet the plan

Symbol

Performance Trend Getting better (Actual v Target) from last period to current period No change (Actual v Target) from last period to current period Getting worse (Actual v Target) from last period to current period

10

Appendix 3: CCG Detail – Year to Date position Cumulative year-to-date expenditure Cumulative year-to-date expenditure MONTH

Plan £000

Actual £000

Variance £000

500,000

APRIL

36,948

36,948

0

MAY

73,895

73,895

0

JUNE

107,464

107,464

0

JULY

147,791

(147,791)

AUGUST

184,739

(184,739)

SEPTEMBER

221,686

(221,686)

OCTOBER

258,634

(258,634)

150,000

NOVEMBER

295,582

(295,582)

100,000

DECEMBER

332,529

(332,529)

JANUARY

369,477

(369,477)

FEBRUARY

406,425

(406,425)

MARCH

443,372

(443,372)

450,000 400,000

350,000

£000

300,000 250,000 200,000

50,000 -

Plan £000

Key

Symbol

Target Result Actual better than plan Actual meets the plan Actual fails to meet the plan

Symbol

Performance Trend Getting better (Actual v Target) from last period to current period No change (Actual v Target) from last period to current period Getting worse (Actual v Target) from last period to current period

11

Actual £000

Appendix 4: CCG Detail – Top 5 Acute Contracts

Acute provider

Point of delivery A&E Elective: inpatients and day cases

Wrightington, Non-elective admissions Wigan & Outpatients Leigh All other (PbR excluded, non activity services)

Activity (year to Date) Activity (over) / Variance Activity under as % of plan plan plan

Finance (year to Actual (over) / under Budget budget

Date) Variance as % of budget

Finance (forecast outturn) Actual (over) / Variance under as % of Budget budget budget

17,144

0

0%

1,751,953

0

0%

7,007,812

0

0%

9,330

0

0%

8,315,105

0

0%

33,260,420

0

0%

9,715

0

0% 12,439,211

0

0%

49,756,844

0

0%

85,297

0

0%

9,096,717

0

0%

36,386,868

0

0%

1,554,558

0

0% 11,188,677

0

0%

47,588,056

0

0%

Items outside Slam (including making it better) Total A&E Elective: inpatients and day cases Non-elective admissions Royal Bolton Outpatients All other (PbR excluded, non activity services)

1,676,044

0

0%

42,791,663

0

0%

174,000,000

0

0%

3,093

0

0%

316,087

0

0%

1,264,348

0

0%

588

0

0%

675,540

0

0%

2,702,160

0

0%

1,996

0

0%

2,372,278

0

0%

9,489,112

0

0%

5,442

0

0%

652,675

0

0%

2,610,700

0

0%

234

0

0%

493,449

0

0%

1,794,316

0

0%

Items outside Slam (including making it better) Total

11,353

0

0%

4,510,029

0

0%

17,860,636

0

0%

A&E

730

0

0%

87,680

0

0%

350,720

0

0%

Elective: inpatients and day cases

220

0

0%

441,636

0

0%

1,766,544

0

0%

Non-elective admissions

246

0

0%

407,513

0

0%

1,630,052

0

0%

3,135

0

0%

411,785

0

0%

1,647,140

0

0%

841

0

0%

1,108,305

0

0%

4,581,771

0

0%

Salford Royal Outpatients All other (PbR excluded, non activity services) Items outside Slam (including making it better) Total

5,172

0

0%

2,456,919

0

0%

9,976,227

0

0%

A&E

453

0

0%

41,775

0

0%

167,100

0

0%

Elective: inpatients and day cases

413

0

0%

555,135

0

0%

2,220,540

0

0%

169

0

0%

237,029

0

0%

948,116

0

0%

3,093

0

0%

386,140

0

0%

1,544,560

0

0%

2,914

0

0%

784,639

0

0%

2,327,509

0

0%

Non-elective admissions Central Outpatients Manchester All other (PbR excluded, non activity services) Items outside Slam (including making it better) Total A&E

0

0%

2,004,718

0

0%

7,207,825

0

0%

56

0

0%

4,917

0

0%

19,668

0

0%

260

0

0%

133,762

0

0%

535,048

0

0%

77

0

0%

57,407

0

0%

229,626

0

0%

Outpatients

733

0

0%

86,877

0

0%

347,508

0

0%

All other (PbR excluded, non activity services)

663

0

0%

547,181

0

0%

2,188,724

0

0%

Elective: inpatients and day cases Non-elective admissions UHSM

7,042

Items outside Slam (including making it better) Total Total

1,789

0

0%

830,144

0

0%

3,320,574

0

0%

1,701,400

0

0%

52,593,473

0

0%

212,365,262

0

0%

12

Appendix 5: CCG Detail – Summary financial position Annual Budget £000

YTD YTD Forecast Budget YTD Spend variance Forecast variance £000 £000 £000 £000 £000

Acute services NHS

261,315

64,204

64,204

0

261,315

0

Private providers

5,676

1,419

1,419

(0)

5,676

0

NCA

2,096

515

515

0

2,096

0

269,088

66,137

66,137

0

269,088

0

24,579

6,147

6,147

0

24,579

0

4,261

1,063

1,063

0

4,261

0

0

0

0

0

0

0

520

130

130

0

520

0

Total Mental Health

29,360

7,340

7,340

0

29,360

0

Prescribing

56,529

14,132

14,132

0

56,529

0

Community

35,457

8,352

8,352

0

35,457

0

5,800

3,126

3,126

0

5,800

0

Total Acute services Mental Health Mental Health - NHS Mental Health - Private providers Mental Health - NCA LD

Other Commissioning Primary Care

721

180

180

0

721

0

CHC / FNC

19,578

4,894

4,894

0

19,578

0

Corporate

12,198

3,203

3,303

100

12,597

399

0

0

0

0

0

0

CSS recharge Reserves

14,643

100

(0)

(100)

14,244

(399)

Other CCG

144,925

33,987

33,987

0

144,925

0

TOTAL

443,372

107,464

107,464

0

443,372

0

13

Appendix 6: CCG Detail – Corporate financial position Annual Budget £000

YTD Budget £000

YTD Spend £000

YTD Forecast variance Forecast variance £000 £000 £000

Corporate Chief Executive

2,294

591

691

100

2,693

399

Commissioning & Partnerships

2,075

519

519

0

2,075

0


3,992

1,117

1,117

0

3,992

0

554

138

138

0

554

0

2,416

604

604

0

2,416

0

PBC Management Allowance

18

18

18

0

18

0

Premises -Wigan Life Centre

850

216

216

0

850

0

12,198

3,203

3,303

100

12,597

399

0

0

0

0

0

0

12,198

3,203

3,303

100

12,597

399

Quality IM&T

Total Corporate CSS recharge

TOTAL

14

Appendix 7: CCG Detail – Risk Analysis Worst

Best

Most Likely

£000

£000

£000

443,372

443,372

443,372

4,000

0

2,000

0

(1,200)

(600)

447,372

442,172

444,772

Overspend against secondary care contracts will increase.

3,000

0

1,500

Failure to control prescribing spend and deliver efficiency

1,000

0

500

Continuing Care

250

(250)

0

Additional restructuring costs

250

0

125

0

0

0

451,872

441,922

446,897

Risk

Current forecast outturn, including most likely risks Under/(Over) achievement of QIPP plans Support available from reserves Adjusted delegated budget expenditure

Overspend against non NHS contracts will increase Risk Adjusted Delegated Expenditure

15

Wigan Clinical Commissioning Group

Quality, Innovation, Productivity and Prevention Dashboard & Scorecard 2012-2013

Month 3 (June 2012)

Mike Tate Locality Director of Finance, Contracting and Performance Management Director of Finance Wigan Borough Clinical Commissioning Group

Wigan CCG

1

Month 3 QiPP Report

Executive Summary – Month 3 The PCT is planning to deliver £18,169k QIPP savings in 2012/13 and it is currently expected that this level of saving will be made in aggregate. The achievement of QIPP savings in this report is also built into the Forecast Outturn of this month’s Finance Board report. Specific Points for Month 3 1. Expected savings in month 3 were £680k, compared to actual savings reported as £663k, thus a non-material difference of £17k. The cumulative savings expect as at month 3 are £2,945k compared to actual savings of £2,813k, a difference of £134k. 2. Forecast savings remain at £18,169k, however we still need to identify further QiPP schemes to the value of £2,088k to meet this forecast. Work is currently been undertaken with the locality business leads and Commissioners to identify these schemes. As individual schemes “slip” in year the value of schemes yet to be identified will likely increase, hence this area is reported as high risk. 3. Where possible QiPP values have been removed from the initial baseline budget at the start of the financial. Monitoring will continue via the budget cost centre, and should any of these budgets over perform this will have an adverse effect on the QiPP saving. Where savings have been realised at the start of the year via improved procurement etc. These have been removed from the baseline budget and the schemes are now classed as finished. 4. In addition to the schemes yet to be identified we currently have £1,060k of Secondary Care savings in the QiPP listing. The savings have been phased from August onwards due to the time lag in receiving data from the Trusts. This area has been classed as medium risk. 5. Medicines management - During May, June and July all Practices were invited to attend a peer review meeting with the Senior Medicines Management Team and their appropriate Locality GP Prescribing Lead. Each meeting involved between 5 to 6 practices and will be a component of their quality and outcomes framework payment. All 65 Practices booked to attend the peer review meetings. The final meeting will be held on 18.07.12 and it is anticipated that all Practices will have attended. The QIPP plan was discussed fully at these meetings. Practices prior to the meetings were provided with RAG rated data for their individual Practice for the QIPP prescribing areas. The peer review discussed and compared the individual Practices. Best practice was shared between the clinicians on how to make the appropriate prescribing changes to allow the CCG to achieve its Medicines Management QIPP plan. By 30.07.12 all Practices will have selected the 3 prescribing areas that they will review fully before 31.03.13. 6. Estates- LIFT – Outpatients scheme - all though any anticipated savings are not expected until the final quarter of the financial year this scheme has been classed as high risk. This due to the fact prior to utilisation of the buildings an

Wigan CCG

2

Month 3 QiPP Report

extensive piece of capital work needs to be carried out expected to cost in the region of £1.25m. We are currently awaiting confirmation of this funding from the SHA. Furthermore any slippage in the scheme does not allow time to introduce compensating schemes to bridge any gap. Two of the minor schemes, both in relation to car parking charges have now been classed as high risk due to potential shortfall in delivery. 7. Bridgewater Services Review – High risk -This individual scheme carries the highest value within the QiPP programme (£3.2m). A lead commissioner has been identified and extensive communication with the Community Health provider regarding potential areas the provider has been challenged to deliver QiPP savings is now underway. A draft work plan is currently being produced and will be presented to the Finance & Performance Committee Month 3.

General Points 1. The NHS Greater Manchester Director of Finance has emphasised the need for Locality PCTs to concentrate their efforts on the significant QIPP programmes rather than the minor schemes. 2. Non-achievement of the CCG’s QIPP savings target represents a significant risk to the CCG. This would be with regard to the delivery of its statutory financial duty. The risk is reported in the monthly FIMS return to the Strategic Health Authority (SHA).

Wigan CCG

3

Month 3 QiPP Report

QIPP Programme Dashboard Schemes by Categories M03 Jun-2012 Secondary Care Primary Care Public Health Medicines Management Estates

Monthly RAAG

Monthly £000s Planned 101 124 57 208 25

Community Care (BW) Community Health Other Total

Actual 97 124 58 215 16

0

0

0 165 680

0 153 663

Trajectory      

AG G G G AR Scheme Yet To Commence

  

Cumulative RAAG

Cumulative £000s

G AG AG

Planned 303 549 172 1025 300

Actual 291 549 172 966 276

0 100 496 2945

0 100 459 2813

AG G G AG AG Scheme Yet To Commence

G AG AG

Cumulative Actual Against Full Year Plan - £000s £18,169k

1

£2,812k

£0k

£2,000k

£4,000k

Full Year Plan YTD Actual

£6,000k

£8,000k

£10,000k

£12,000k

£14,000k

£16,000k

£18,000k

£20,000k

YTD Forecast Against Full Year Plan - £000s - RAAG Rated Full Year Plan, £2,594k

Secondary Care Current Forecast, £2,582k Full Year Plan, £2,866k

Primary Care Current Forecast, £2,866k Full Year Plan, £687k

Public Health Current Forecast, £688k Full Year Plan, £2,700k

Medicines Management

Current Forecast, £2,641k Full Year Plan, £1,862k

Estates Current Forecast, £1,837k Full Year Plan, £3,320k

Community Care (BW)

Community Health

Current Forecast, £3,320k Full Year Plan, £100k Current Forecast, £100k Full Year Plan, £2,085k

Other Current Forecast, £2,048k

Mike Tate Locality Director of Finance, Contracting and Performance Management Director of Finance Wigan Borough Clinical Commissioning Group Wigan CCG

4

Month 3 QiPP Report

QIPP Programme Scorecard Schemes by Categories M03 Jun-2012 Pathology Testing (Contract) Local Pricing (nursing)(Contract) Blood Transfusions - Local Pricing (Contract) Recommissioning Dermatology Alcohol related admissions 'Frequent Fliers' Other Secondary Care Savings

Monthly £000s Scheme Kim Godsman Kim Godsman Kim Godsman Paul Carroll Carol lyons

Planned Actual Variance Current Status 50 36 11 4 0

0

36

No Material Concerns 100% of Milestone Achieved

11


0

-4

Significant Concerns < 60% Of Milestone Achieved

0

Scheme Yet To Commence Scheme Yet To Commence

0 0

0

Secondary Care Sub-Total

Secondary Ca 101

97

-4

Orthodontic Pathway Redesign

Jackie Forshaw

0

0

0

Budget Top slice 8.2%

Jackie Forshaw Jackie Forshaw Primary

124

124

0

0

124

124

57

58

57

58

5

0

Darzi Reduction Primary Care Sub-Total Budget Top slice 1.59%

TBC

Care Kate Ardern

Public Health Sub-Total Increase low cost Statin prescribing to top quartile BCBV indicator Linda Scott Increase low cost PPI prescribing to top quartile BCBV indicator Linda Scott Decrease prescribing of unlicensed specially formulated products Linda Scott (specials) Increase prescribing of generic products that do not require to be Linda Scott brand prescribed Increase review of patients prescribed inhaled corticosteroid - to ensure step down from high doses following BTs Linda Scott and NICE guidance Review Blood Glucose Monitoring prescribing with the aim to educate patients in the management of their LTC and to decrease the use of these products, following NICE guidance Linda Scott Angiotensin Drugs - increase low prescribing of the low cost drugs GM Do Not Prescribe List - reduce prescribing

Linda Scott Linda Scott

Scriptswitch - implement across NHS ALW following ULC pilot* Linda Scott Ezetimibe - decrease prescribing; following locally agreed guidance Linda Scott Product formulation changes optimum pricing SIP Feeds Analgesics Individual Prescribing Reviews

Linda Scott Linda Scott Linda Scott Linda Scott

Meds Management Sub-Total LIFT out patients

Julie Southworth

Move from Bryan House to WLC

Andrea Lythgoe

Utilities recharge in LIFT and Clinics Recharge 5BPs at WLC 66a Standishgate Beech Hill SLAs for Fire and Security Incefield House College Street Clinic Wigan Road Ashton

Wigan CCG

Andrea Lythgoe Julie Southworth Julie Southworth Andrea Lythgoe Tracie Smith Andrea Lythgoe Andrea Lythgoe Tracie Smith

0

50


0

YTD Plan 150 108 33 13 0

£000s YTD Variance Current Status Actual

£000s Full Year Current Variance Plan Forecast

Actual Risk

150


600

600

Low

108


430

430

Low

33


130

130

Low

0


50

38

0

Scheme Yet To Commence

324

324


1060

1060

2594

2582

-13

-13

High Medium

0

0

303

291

Scheme Finished

177

177


177

177

Low


372

372


1489

1489

Low


0

0


549

549

172

172

172

172

0

105

83

-22


-13

0 No Material Concerns 100% of Milestone Achieved

1200

1200

2866

2866

Medium

-13

Medium

0

687

688

687

688

0

Material Concerns 60%+ Of Milestone Achieved

150

128

-22

Medium

150

135

-15

Medium

-5


60

45

-15


Low

10

2

-8


20

46

26


70

96

26


250

276

26

Medium

4

3

-1


39

36

-3

79%+ of Milestone Achieved

75

72

-3

Medium

5

2

-3


55

54

-1


100

99

-1

Medium

5

0

-5


30

19

-11


75

64

-11

Medium

15

19

4


45

41

-4


100

96

-4

Medium

31


17


400

417

17

Medium

30


103


300

403

103

Medium

-13


-23


200

177

-23

High

-16


-43


200

157

-43

High

-13


-38


150

112

-38

High

-25


100

75

-25

High


450

431

-19

Medium

-59

40 22 18 18 13 8

71 52 5 2 0 0

-8

25

13

208

215

7

0

0

0

0 10 4

0 10 4

-12

Significant Concerns < 60% Of Milestone Achieved Significant Concerns < 60% Of Milestone Achieved


206

-19

1025

966

-59

2700

2641

0

0


1250

1250

High

200


200

200

Low

30


125

125

Low

12


50

50

Low

0

0

40

40

Low

0

0


20

20

Low

17


17

17

Low

0


13

13

Low

0


10

10

Low

10


10

10

Low


0

225


0

0

1

0 0

0

26

0


0

0

38

11

0

0

0

54

31

Scheme Finished

0

0

54

207


0

0

104

137

0


0

120

0

Scheme Finished

0


0


0

Scheme Finished

5

200 30 12

17 0 0 10

Month 3 QiPP Report

QIPP Programme Scorecard Schemes by Categories M03 Jun-2012 Leigh LIFT parking return Potential Car Park Charges

Monthly £000s Scheme Julie Southworth Andrea Lythgoe

Planned Actual Variance Current Status 4

2

-2

Significant Concerns < 60% Of Milestone Achieved Significant Concerns < 60% Of Milestone Achieved

6

0

-6

Estates Sub-Total

25

16

-9

Commissioning of a Home Oxygen Service

0

0

0


Bridgewater Services Review

Linda Scott Kim Godsman

Community Care Sub-Total Development of an Integrated Specialist Palliative Care Service Community Health Sub-Total

Sally Forshaw

Running costs

All

Independent Sector contracts

TBC Peter Jenkinson

NPfIT CBS Infrastructure

0

0

0

0

0

0

0

0

0

0

0

0

34

34

0

70

70

0

42

42

0

8

8

0

0

0

0


-13


TBC

PBR Excluded drugs Anti Depressant LDAP

Kim/Umesh John Marshall

13

0

Scheme Finished

No Material Concerns 100% of Milestone No Material Concerns 100% of Milestone Achieved No Material Concerns 100% of Milestone Achieved No Material Concerns 100% of Milestone Achieved

YTD Plan 13

£000s YTD Variance Current Status Actual 6

52

45

-7

High


75

57

-18

High

1862

1837

-25

50

50

3270

3270

3320

3320

-18

300

276

-25

0

0


0 0

100

100

100

100

103

103

209

209

125

125

23

23

0

0 0

38

0 No Material Concerns 100% of Milestone Achieved

High

0

100

100

100

100

411

411

Low

834

834

Low

500

500

Low

90

90

Low


100

100

Medium


150

113

0 No Material Concerns 100% of Milestone No Material Concerns 100% of Milestone Achieved No Material Concerns 100% of Milestone Achieved No Material Concerns 100% of Milestone Achieved

-38

High

Low

0

-38

Other

165

153

-13

496

459

-38

2085

2048

-38

Sub-Total

680

663

-18

2945

2812 0

-134

16214 1955

16081 2088

-134

18169

18169

Schemes Yet To Be Identified Total

680

663

Risk

-7

0

0

Actual


18

0

£000s Full Year Current Variance Plan Forecast

-18

High

High

Value of Forecast by Risk £000s

Wigan CCG

6

Low

£

5,934

Medium

£

4,804

High

£

7,431

Month 3 QiPP Report

QIPP Programme

Index

Plan Activity

Recommissioning Dermatology Sponsor: Trish Anderson

Paul Carroll

Owner: Description:

Recommissioning Dermatology

QIPP Data Revised Forecast

Target To Date 38

Actual

13

0

Trend

RAAG Status

Period



Significant Concerns - < 60% Of Milestone Achieved

M03 Jun-2012

Trend Analysis Monthly £000s Month

Planned

M01 Apr-2012 M02 May-2012 M03 Jun-2012 M04 Jul-2012 M05 Aug-2012 M06 Sep-2012 M07 Oct-2012 M08 Nov-2012 M09 Dec-2012 M10 Jan-2013 M11 Feb-2013 M12 Mar-2013 Total

Cumulative Performance £000's

4 4 4 4 4 4 4 4 4 4 4 4 50

Cumulative Forecast Plan 4 0 8 0 13 0 17 4 21 8 25 13 29 17 33 21 38 25 42 29 46 33 50 38 50 38

RAAG

Actual

R R R

0 0 0 0 0 0 0 0 0 0 0 0 0

Variance - Actual to Plan -4 -8 -13 -13 -13 -13 -13 -13 -13 -13 -13 -13

Cumulative Actual Against Full Year Plan - £000s 1

£50k Planned

£0k

Actual

£0k

£10k

£20k

£30k

£40k

£50k

£60k

Cumulative Actual Against YTD Forecast- £000s 1

£38k Forecast

£0k

Actual

£0k

£5k

£10k

£15k

£20k

£25k

£30k

£35k

£40k

Action Plan to get to green Agreed action in place

N/A

Action plan on target

N/A

High

Associated Quality Indicator

TBC

Quality & Risk Current risk rating

No agreement to proceed with savings. Way forward to be discussed with CCG business managers on 6.6.12 , advised initial meeting was cancelled, no progress currently being made on this project.

Wigan CCG

7

Month 3 QiPP Report

QIPP Programme

Index

Plan Activity

Product formulation changes - optimum pricing Owner: Description:

Sponsor: David Valentine

Linda Scott

Product formulation changes - optimum pricing


Target To Date

157

Actual

54

Trend

RAAG Status

Period




M03 Jun-2012

11


Planned


Cumulative Plan 18 36 54 72 88 104 120 136 152 168 184 200 200

RAAG

Actual

18 18 18 18 16 16 16 16 16 16 16 16 200


6 3 2 0 0 0 0 0 0 0 0 0 11

R R R

Forecast 6 9 11 29 45 61 77 93 109 125 141 157 157



£200k Planned

£11k

Actual

£0k

£50k

£100k

£150k

£200k

£250k


£157k Forecast

£11k

Actual

£0k

£20k

£40k

£60k

£80k

£100k

£120k

£140k

£160k

£180k


N/A


N/A

High


TBC


Whilst this area is currently slipping against the agreed plan, savings in this area continue to be made under the Scriptswitch scheme which is currently over performing.

Wigan CCG

8

Month 3 QiPP Report

QIPP Programme

Index

Plan Activity

SIP Feeds Owner: Description:

Sponsor: David Valentine

Linda Scott

Reduction of SIP feed costs primarily within the nursing home environment.


Target To Date

112

Actual

38

0

Trend

RAAG Status

Period




M03 Jun-2012


Planned



13 12 13 12 13 12 13 12 13 12 13 12 150


RAAG

Actual 0 0 0 0 0 0 0 0 0 0 0 0 0

R R R



£150k Planned

£0k

Actual

£0k

£20k

£40k

£60k

£80k

£100k

£120k

£140k

£160k


£112k Forecast

£0k

Actual

£0k

£20k

£40k

£60k

£80k

£100k

£120k


N/A


N/A

High


TBC


A briefing is currently being prepared for the CAO to feed into the clinical forum in order to establish a way forward. Watching brief required to flag up any further in year slippage.

Wigan CCG

9

Month 3 QiPP Report

QIPP Programme

Index

Plan Activity

Analgesics Sponsor: David Valentine

Linda Scott

Owner: Description: Analgesics


Target To Date 75

Actual

26

1

Trend

RAAG Status

Period




M03 Jun-2012


Planned


Cumulative Plan 9 18 26 34 42 50 58 67 76 84 92 100 100

RAAG

Actual

9 9 8 8 8 8 8 9 9 8 8 8 100


1 0 0 0 0 0 0 0 0 0 0 0 1

R R R

Forecast 1 1 1 9 17 25 33 42 51 59 67 75 75



£100k Planned

£1k

Actual

£0k

£20k

£40k

£60k

£80k

£100k

£120k


£75k Forecast

£1k

Actual

£0k

£10k

£20k

£30k

£40k

£50k

£60k

£70k

£80k


N/A


N/A

High


TBC


This area is currently being reviewed by the technicians, scheme owner is confident that the planned savings will be achieved in year.

Wigan CCG

10

Month 3 QiPP Report

QIPP Programme

Index

Plan Activity

LIFT out patients Sponsor: Julie Southworth

Julie Southworth

Owner: Description:

Currently have 8 LIFT developments spread throughout the Borough. It is believed that these are underutilised. It is proposed that all outpatient services be delivered from LIFT buildings and that the TLC, current outpatient site be closed. Providing a capital return to the trust WWL and a recurrent return to the PCT through either a reduced OP tariff for community based services or recharge for the use of LIFT space.


Target To Date

1250

Actual

0

0

Trend

RAAG Status

Period




M03 Jun-2012


Planned


RAAG

Actual

0 0 0 0 0 0 0 0 0 417 417 417 1250


0 0 0 0 0 0 0 0 0 0 0 0 0



Variance - Actual to Plan


0 0 0


£1,250k Planned

£0k

Actual

£0k

£200k

£400k

£600k

£800k

£1,000k

£1,200k

£1,400k


£1,250k Forecast

£0k

Actual

£0k

£200k

£400k

£600k

£800k

£1,000k

£1,200k

£1,400k


N/A


N/A

High


TBC


Following the utilisation review we have received a schedule of improvements to improve the use of LIFT buildings, estimated costs are £1.25m which will be capital expediture (subject to bid for increase in CRL), hence the scheme remains high risk until confirmation of the funding is available.

Wigan CCG

11

Month 3 QiPP Report

QIPP Programme

Index

Plan Activity

Leigh LIFT parking return Sponsor: Julie Southworth

Julie Southworth

Owner: Description:

Leigh LIFT parking return


Target To Date 45

Actual

13

Trend

RAAG Status

Period




M03 Jun-2012

6


Planned


Cumulative Plan 4 8 13 17 21 25 30 34 38 43 47 51 52

RAAG

Actual

4 4 4 4 4 4 4 4 4 4 4 4 51


R R R

2 2 2 0 0 0 0 0 0 0 0 0 6

Forecast 2 4 6 10 14 19 23 27 32 36 40 45 45



£51k Planned

£6k

Actual

£0k

£10k

£20k

£30k

£40k

£50k

£60k


£45k Forecast

£6k

Actual

£0k

£5k

£10k

£15k

£20k

£25k

£30k

£35k

£40k

£45k

£50k


N/A


N/A

High


TBC


The income currently being generated by the schemes is currently running at 50% of the expect value, if this was to continue through out the year, there would be a shortfall of £26k against our QiPP target.

Wigan CCG

12

Month 3 QiPP Report