Part Two of the Governing Body

There will be a part two of the Governing Body meeting today which will discuss a report from the Remuneration Committee on primary care joint committee lay member remuneration. This report contains sensitive information not yet in the public domain.

The minutes of the confidential discussion will be published in the next CCG Governing Body papers.

MEETING: Islington Clinical Commissioning Group Governing Body

DATE: 11 November 2015

TITLE: Integrated Quality, Finance and Performance Report LEAD COMMITTEE

MEMBER:

Ahmet Koray

Chief Finance Officer

AUTHOR: Anthony Browne - Head of Finance

Nick Cabon – Head of Performance and Information CONTACT

DETAILS:

[email protected] [email protected] SUMMARY:

Finance: As at Month 6 (September 2015), the CCG has achieved the year-to-date surplus target of £3.2m and remains on course to meet the 2015/16 full year planned surplus of £6.5m. Acute over-performance and primary care prescribing continue to present the main financial risk to the CCG.

 Forecast acute over-performance stands at £1.2m against plan. When compared to the previous month the acute overspend has reduced, however, the CCG acute demand reserves are still required to balance the overall position.

 Moorfields over-performance makes up a third of the overall acute pressure.

The full year £0.4m overspend at the Trust is driven by elective, outpatient and A&E activity above the plan. The CCG has issued an activity query notice to the Trust due to the material level of over-performance across all CCGs in North and East London. The Royal Free contract is also forecasting a significant pressure at year end (£0.3m) due to critical care and elective activity above plan. Work continues with both Trusts to ensure appropriate counting and coding of chargeable activity.

 UCLH is forecast to break-even at year end following a reduction in projected elective activity as referral to treatment (RTT) backlogs are cleared. The Whittington Health contract, operating under a cap and collar block contract in 2015/16 is also expected to break-even at year end. Fluctuations in low volume high cost activity such as critical care still present a risk to the CCG at both Trusts.

 Non-acute is currently projecting a £0.6m overspend due a pressure in prescribing costs (£0.9m). The prescribing overspend is the cumulative impact of increased usage of new NICE approved high cost drugs and changes to Category M drug pricing. This is partially offset by a review of care continuing healthcare accruals for care package costs which will not be realised (£0.3m).

 To balance the position over the first six months, budgeted reserves of £934k have been released. The forecast assumes £1.8m of acute demand reserves Appendix: 3.1

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will be required by year-end, leaving a balance of £0.5m for the remainder of the year. There is unlikely to be any significant opportunities in non-acute this this year due to pressures on the prescribing budget.

 In response to the financial pressures, and to ensure the CCG remains on target to deliver its planned £6.5m surplus, a financial management plan has been produced. The financial management plan aims to provide support to existing QIPP schemes as well as identify further QIPP opportunities to mitigate against further risks over the remainder of the year. A detailed analysis and scrutiny of contractual performance (deep dives) has also been incorporated in to the management plan. Progress against the financial management plan will be reported to the Strategy and Finance Committee.

 The CCG is currently forecasting slippage of £0.3m against its QIPP programme (see section 6). This is a result of three specific programmes (community gynaecology, referral management and reductions in non-elective admissions). Through the financial management plan, a review is currently underway with commissioning managers to identify new opportunities.

 The risks and opportunities assessment (see section 7) has identified a small amount of headroom (£0.3m) above forecast.

Performance: The following targets are currently the most concern.

Constitution targets:

 Access targets and in particular those relating to:

o The overall A&E standard across the CCG is achieving the 95% 4-hour target, however performance at the Whittington remains challenging (94.3%) and more recently at UCLH where performance has deteriorated;

o Diagnostic waits and in particular at the Whittington (3.3% vs a 1%

threshold)

o The following cancer indicators:

a) 31-day 1^st treatment target (95.0% vs a target of 96%) b) 62-day screening service target (81.8% vs a target of 90%)

o Red 1 and Red 2 category A (8 minutes) ambulance calls (70.5% and 67.9% vs thresholds of 75%)

o 18-week Referral to Treatment targets:

a) Admitted (89.8% vs a threshold of 90%) Other targets:

 Islington CCG had the highest dementia diagnosis rate across all London CCGs, achieving 86.0% in August 2015

This report contributes to: Delivering high quality, efficient services within the resources available.

Prior consideration by Committees and other partners: None specific Patient & Public Involvement (PPI): None specific

Equality Impact Assessment: None specific

Risks: This report is one element used to monitor the Clinical Commissioning Group’s financial performance in terms of adherence to core statutory duties.

RECOMMENDED ACTION:

The Governing Body is asked to:

 CONSIDER the contents of this report

SUPPORTING PAPERS:

Appendix A: Islington CCG detailed year to date actual and full year financial position Appendix B: QIPP Summary (September 2015, Month 6)

Appendix C: Performance summary

Please note that a detailed CSU pack of performance is available to Governing Body members on request.

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1. Introduction

1.1 This paper presents to the Governing Body of Islington Clinical Commissioning Group the integrated finance and performance position as at September 2015.