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«Minutes of a Meeting of the Finance and Performance Committee Held on Tuesday, 22 March 2016 in the Boardroom, Blackpool CCG Present: David ...»

Approved 26 April 2016

Minutes of a Meeting of the Finance and Performance Committee

Held on Tuesday, 22 March 2016 in the Boardroom, Blackpool CCG

Present: David Edmundson, Lay Member (Chairman)

Roy Fisher, CCG Chairman

David Bonson, Chief Operating Officer

Gary Raphael, Chief Finance Officer

Dr Marie Williams, GP Member

Dr Cruz Augustine, GP Member (arrived during Item 5)

In Attendance: Lesley Anderson-Hadley, Deputy Chief Nurse

Pat Crawford, Interim Deputy Chief Finance Officer Helen Lammond-Smith, Head of Commissioning Beth Goodman, Contract Management Locality Lead, M&LCSU Dr Mark Johnston, Deputy Chief Operating Officer (arrived during Item 7) Vikki Lockwood, QIPP Programme Officer Joanne Alexander, Information Governance Support Officer, M&LCSU (Item 5) Louise Talbot, Secretary to the Governing Body


1. Apologies for Apologies for absence had been received from Dr Amanda Doyle, Dr Absence Michelle Martin, Andrew Harrison and Allan Jude.

2. Declarations RESOLVED: That the interests declared by members of the Committee as of Interest listed in the CCG’s Register of Interests be noted. The Relating to the Register is available either via the Secretary to the

Items on the Governing Body or the CCG website at the following link:

Agenda http://blackpoolccg.nhs.uk/about-blackpool-ccg/whowe- are/our-governing-body

3. Minutes of the RESOLVED: That subject to some minor typographical errors to be LJT Meeting Held on corrected, the minutes of the meeting held 23 February 23 February 2016 be approved as a correct record.


4. Matters Issues covered within the reports listed on the agenda.

Arising Joanne spoke to a circulated report and informed colleagues that the CCG is

5. Information required to submit an Information Governance (IG) Toolkit on an annual Governance basis. Work had been undertaken throughout the year to gain evidence that Annual Report the CCG is adhering to IG and has implemented this into their policies, 2015/16 procedures and agendas.

The CCG’s IG Toolkit score for 2015/16 was 91% which was an increase of 5% from the previous year. This was the final position for the toolkit for 2015/16

–  –  –

6. 2015/16 and David spoke to a circulated report and informed members on the progress 2016/17 QIPP of the delivery of the QIPP Programme that had been identified to Programme contribute to the savings target for 2015/16 and 2016/17.

–  –  –

therefore, the only way to be able to agree a contract at this stage is to have a PbR based contract which would be set at 2015/16 outturn levels and then a QIPP to come out of that. David Bonson explained that we are planning to deliver a £6.4m QIPP. David Edmundson commented that we should have 2016/17 QIPP savings, the amount required by the provider for 2016/17 and, therefore, the amount to be taken out of the contracts. He asked how we were financing this. David Bonson commented that this would be generated through the QIPP and we would need to deliver the £6.4m. Gary made reference to discussions held earlier in the day with the Executives. The Trust does not think it can have an assured contract with effect from 1 April 2016 as they cannot implement it within the timescale, therefore the QIPP becomes the means by which an increase in activity levels above the 2015/16 is avoided. It would mean the risk is on commissioners to prevent the growth in activity.

David Edmundson sought clarification as to what the incentive is if the provider is to manage capacity within the PbR contract. David Bonson commented that the intention was to reduce activity levels. BTH has £10m transformational funding and will need to achieve all of their targets.

Roy commented that there are two types of savings, ie, the contract QIPP savings and reduction in GP referrals.

Fylde Coast QIPP Delivery Programme – David Bonson explained that meetings had been held with BTH and Fylde and Wyre CCG in order to have one Fylde Coast joined up QIPP Programme for 2016/17 instead of three separate programmes in order to maximise whole health economy savings and to ensure sustainability. Andrew Harrison had Chaired the meetings which had been very positive. The CCGs are working together and it was recognised that there is a real appetite for collaborative working to agree savings and to have a Fylde Coast footprint which would allow for more deliverable savings plans. It was recognised that Fylde and Wyre CCG is in the process of developing its QIPP plans in order to reduce their financial risks. David Edmundson asked to what extent the Fylde Coast QIPP would slow down the implementation or whether the schemes are different.

Helen gave an example of the paediatric services where previously differences in the approach of the two CCGs had delayed implementation.

We were now sharing the PID information with Fylde and Wyre CCG with a view to having a consistent approach. She anticipated that the service would change and that savings could be made.

Right Care – David Bonson explained that NHS England and Public Health England are progressing with the Right Care approach to ensure that it becomes embedded within the new commissioning and public health agendas for the NHS. The Fylde Coast has been assigned a Right Care delivery partner who would help facilitate identification of focus and subsequent implementation. An initial meeting had taken place in early March with representatives from Fylde and Wyre CCG and two areas common to both CCGs were identified which were gastrointestinal and circulatory diseases. More detailed information packs in these areas were being developed. David explained that further discussion around Right Care would be held at the Governing Body Development Session on 5 April 2016.

David Edmundson asked if we could implement it in-year and David Bonson responded that it would depend on what it is. For example, for 3 Approved 26 April 2016

–  –  –

Gary was currently having discussions with Andrew regarding Vanguard funding. It was important that we ensure any money spent for Vanguard is correctly accounted for.

It was noted that there is a high overspend at the Acute Trust as the Trust continues to prescribe expensive drugs. Melanie would be asked to liaise with Trust colleagues.

Reference was made to Appendix 1 within the report in respect of exception reporting. Gary would liaise with Andrew to clarify the change in information provided for the Committee.

RESOLVED: That members note the report and the ongoing discussions.

(b) Performance Business Report – Month 10 – January 2016 – Beth tabled a revised report as it included the latest IAPT figures. Discussion ensued and DB/GR/AH

Beth highlighted the following:

BCCG had not met one of the RTT targets (patients waiting more than 52 • weeks) for January 2016 for incomplete pathways. The breach related to ENT treatment at LTH. Beth explained that the patient now has a TCI date. Marie commented that this was appalling and needed to be flagged up as an issue.

The A&E target had been breached for January. A Lancashire and • Greater Manchester escalation process with daily and weekly updates was being followed and in addition, there were local and regional teleconferences in place. A recovery plan was being developed. It was commented that whilst BTH was achieving the target for this week, the BG Q4 target would fail and, therefore, fail for the year.

Cancer Waits – The 62 day Cancer wait was below target. There were • 11 patient breaches which were made up of six complex cases, four late referrals and one delay in investigations due to the Christmas and New Year period. The Trust was working on a delivery plan. Gary sought clarification as to what constitutes a complex case and asked for a definition around this. Beth would make enquires. The target did improve but was now on a downturn again Eliminating Mixed Sex Accommodation – There had been zero reported • breaches for the CCG in January. There was one breach in January recorded for BTH.

Healthcare Associated Infection – Lesley provided an update:

• MRSA Bacteraemia – There were no cases in January at the CCG or BG BTH. Year to date there was one breach for the CCG and six for the Acute Trust.

• C.Difficile – BTH had recorded six new cases in January 2016. The Trust had breached for the year.

IAPT – Helen explained that the figures appeared to be poor as we were • trying to ensure the long waiters were in the system and treated. Helen confirmed that this had now happened and new patients were being seen very quickly. The local data states that the target is being met.

Helen had confidence that we would deliver and achieve the target by year end.

–  –  –

RESOLVED: That members receive the performance business report.

(c) Contract Business Report Summary – Month 10 – January 2016 – Beth

highlighted the following:

Community Contract – A meeting with community services had taken • place to look at community data flows. BI colleagues were also meeting with Fylde and Wyre CCG in an attempt to emulate the reports they have developed. The Quality and Performance Team at Blackpool is now in receipt of data to help monitor KPIs and in addition to this work, commissioners are working with the provider BTH to develop a smaller number of specifications for children’s specialist services. Three draft specifications for elements of children’s services are being considered by commissioners in both Fylde and Wyre and Blackpool CCGs with clinical input from GPs. The service specifications would be added to the Risk Register and a process would be put in place when reviewing the document. It was anticipated that from April, reporting strategies would contain more information.

Audit at Spire – The audit was complete in respect of activity and the • formal report was awaited from MIAA. Initial findings would suggest further clinical review was required to understand why, in some instances, when compared against all providers, the average cost at Spire was higher than other providers. Beth explained that there was no immediate evidence of miscoding but there may be some questions about clinical practice that would need to be addressed.

Contract Penalties – Following guidance from NHS England, the CCG • contract for penalties assigned to providers for non-achievement of constitutional standards are now published on the CCG’s website.

Information in respect of Q3 would be published on the CCG’s website at the end of March and it was recognised that there will be an impact on our numbers.

Referral Management – Beth explained that the first meeting of the • Referral Management Group had met in March with the intention that two business cases would be formulated to look at short term and longer term schemes to help manage demand. Beth explained that we had seen a drop in referrals and the map of medicine roll out appeared to be making a difference. Marie commented that the map of medicine had not been fully rolled out across all practices. Mark commented that the Clinical Leadership Team had agreed the map of medicine and it is within GP Plus from 1 April 2016. He reminded colleagues that if GPs do not use the map of medicine, they will not be paid. A meeting would be held to look at the quick wins and the longer term business cases.

(i) GP Referral Report – Month 10 – January 2016 – The reported was noted. David commented that information on all referrals had been included.

(ii) Contract Performance Dashboard – Noted.

(d) Lancashire Ambulance Performance Report – January 2016 – David provided a verbal update following on from the January report issued to


• Activity remained higher than expected.

–  –  –

11. Any Other There were no issues.


12. Declaration That with the exception of any agreed items to be submitted to the CCG of Governing Body meeting held in public, all other items should be regarded Confidentiality as confidential.

13. Date, Time The next meeting would be held on Tuesday, 26 April 2016 at 1.00 pm in the and Venue of Boardroom, Blackpool CCG.

Next Meeting


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