AGENDA Body Meeting... · 2020-04-08 · NHS Halton CCG & NHS Warrington CCG Joint Meeting of the...

NHS Halton CCG & NHS Warrington CCG Joint Meeting of the Governing Body Agenda – 8th April 2020

NHS HALTON CCG AND NHS WARRINGTON CCG

JOINT MEETING OF THE GOVERNING BODY TO BE HELD ON WEDNESDAY 8TH APRIL 2020 AT 2.20 P.M. – 3.50 P.M.

VIRTUALLY VIA MICROSOFT TEAMS

AGENDA

Agenda Item No

Timings (approx.)

A 2:20 p.m. Apologies for Absence: Eileen O’Meara

All

B Declarations of Interest in Agenda Items A conflict of interest is defined as “a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”

All

C Chair's Remarks and Questions from the Public (members of the public have been asked to raise any questions in relation to today’s agenda in advance of the meeting)

Chair Verbal

D Minutes of the Joint HCCG and WCCG Governing Body Meeting held on 11th March 2020 (for approval)

E Matters Arising

F Clinical Chief Officer Report (to note and endorse)

Andrew Davies Enclosure

Quality & Patient Experience:

033/20 Chief Nurse Report (to receive assurance)

Michelle Creed Enclosure

Corporate Business & Governance:

034/20 Financial Report (including Corporate Performance Report)

• Financial and Operational Performance Overview – Month 11

• 2020/21 Financial Outlook (to note)

Bryan Webb Enclosure

NHS Halton CCG & NHS Warrington CCG Joint Meeting of the Governing Body Agenda – 8th April 2020

035/20 Any Other Business

All

036/20 Date and Time of Next Meeting: Wednesday 13th May 2020

Public Halton CCG and Warrington CCG Joint Governing Bodies Meeting

Wednesday, 11 March 2020 4.00pm to 5.30pm Large Conference Room, The Gateway, Sankey Street, Warrington WA1 1SR

Halton CCG Members in Attendance:

Name Position Organisation

Ruth Austen-Vincent Lay Member NHS Halton CCG

David Cooper Chief Finance Officer NHS Halton and NHS Warrington CCG

Dr David Wilson (present for Items A, B and 002/20 only)

GP Member - Federation Representative NHS Halton CCG

Gareth Hall Lay Member NHS Halton CCG & NHS Warrington CCG

Dr Claire Forde (present for Items A, B and 002/20 only)

General Practitioner Governing Body Member

NHS Halton CCG

Dr Julie Langton Secondary Care Doctor NHS Halton CCG & NHS Warrington CCG

Leigh Thompson Chief Commissioner NHS Halton CCG

Dr Andy Davies Chief Clinical Officer NHS Halton CCG and NHS Warrington CCG

Warrington CCG Members in Attendance:


Dr Ian Watson (IW) Chair NHS Warrington CCG

Gareth Hall Lay Member (Chair) NHS Halton CCG & NHS Warrington CCG

Dilys Quinlan Lay Member NHS Warrington CCG

David Cooper Chief Finance Officer NHS Halton and NHS Warrington CCG

Dr Julie Langton Secondary Care Doctor NHS Halton CCG & NHS Warrington CCG

Dr Andy Davies Chief Clinical Officer NHS Halton CCG and NHS Warrington CCG

Dr Lalit Sakhi (LS) General Practitioner Governing Body Member

NHS Warrington CCG

Dr Sangeetha Steevart (SS) General Practitioner Governing Body Member

NHS Warrington CCG

Dr Aparna Rao GP Governing Body Member NHS Warrington CCG

Dr Golam Chowdhury GP Governing Body Member NHS Warrington CCG

In Attendance:


Stacy Evans Head of Quality and Safety (deputising for Michelle Creed)

NHS Halton CCG

Suzanne Barker Chief of Corporate Services NHS Halton CCG and NHS Warrington CCG

Maria Austin Chief of Public Affairs and Engagement NHS Halton CCG and NHS Warrington CCG

Louise Murtagh Senior Committee Administrator NHS Halton CCG

Colin Scales (present for Items A, B and 002/20 only)

Chief Executive Bridgewater Community Healthcare NHS Foundation Trust.

Professor Simon Constable (present for Items A, B and 002/20 only)

Chief Executive Warrington and Halton Teaching Hospitals NHS Foundation Trust

Apologies:

Shahzad Tahir Lay Member NHS Halton CCG

David Merrill Interim Chair NHS Halton CCG

Kevin Goucher Governing Body Member NHS Warrington CCG

Nick Atkin Lay Member NHS Warrington CCG

Dr Latha Meda GP Member - Federation Representative Widnes Highfield Health Ltd

Michelle Creed Chief Nurse NHS Halton CCG and NHS Warrington CCG

Eileen O’Meara Director of Public Health Halton Borough Council

Kath Parker Healthwatch Chair Healthwatch Halton

Minutes:

A. Welcome and Introductions

Introductions were made and the Chair welcomed all present to the meeting. It was noted that the Warrington CCG Governing Body meeting was quorate. Halton CCG Governing Body was not quorate. Any decisions made by Halton CCG Governing Body members present would be recorded and an email would be sent following the meeting to those not present asking for their decision in respect of relevant agenda items. ACTION: Louise Murtagh to email Halton CCG Governing Body members following the meeting requesting a response to item 001/20 Outline Proposal for Mid Mersey Merger. Following Apologies and Declarations of Interest, report 002/20 was considered first followed by 001/20 and 003/20.

B. Apologies

Apologies were received from those listed above.

C. Declarations of Interest

The Chair reminded attendees of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of the CCG. For the purposes of this meeting, a conflict of interest was defined as “a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”. Declarations made by members of the Governing Body were listed in the respective CCGs’ Registers of Interests. The Registers were available on the CCGs’ websites. Dilys Quinlan highlighted that she was a Lay Member at NHS Wirral CCG and the Director of Healthwatch St Helens. Gareth Hall reported that he was a Lay Member at Health Education England and a

Board Member at MSV Housing.

001/20 Outline Proposal for Mid Mersey Merger

Members were reminded that Warrington CCG Governing Body was quorate and therefore could take a decision on the proposal. Votes would be recorded from Halton CCG Governing Body members however, the any decision would not be binding at this point. An email would be sent following the meeting to those not present asking for their decision. Dr Andy Davies presented a paper, prepared jointly with Professor Sarah O’Brien, Executive Director People Services/Clinical Accountable Officer, St Helens CCG. In this report, members were asked to provide approval to the Management Teams to explore the potential of merger to establish a single NHS strategic commissioner for the Mid-Mersey region. To start the process Governing Bodies were also asked to confirm the establishment of project support arrangements to oversee this work through the appointment of a Senior Responsible Officer (SRO) and required project infrastructure arrangements. Members discussed Halton specifically in that its population was split into two distinct areas of Runcorn and Widnes and considered the flows of patients in respect of hospital treatment. Discussions moved on to the proposed merger and how this would fit with providers in the area who were also considering merger options. Attendees agreed that exploring potential options and considerations would address a number of issues but that a very clear communications and engagement stakeholder plan was required to support all of this work. Warrington CCG Governing Body and Halton CCG Governing Body members present agreed the following:

• Approved that the Management Teams explored the potential of merger to establish a single NHS strategic commissioner for the Mid-Mersey region.

• Supported the establishment of project support arrangements to oversee this work through the appointment of a Senior Responsible Officer (SRO) and required project infrastructure arrangements.

• Noted the requirements to receive further information in respect of this matter at a Governing Body Meeting to be held in April 2020 (most likely to be held on 8th April 2020)

Approval by Shahzad Tahir, David Merrill, Dr Latha Meda, Michelle Creed and Eileen O’Meara would be sought in writing following the meeting.

002/20 Intention to Progress an Acquisition of Bridgewater Community Healthcare NHS Foundation Trust by Warrington & Halton Teaching Hospitals NHS Foundation Trust

Colin Scales (CS) and Professor Simon Constable (SC) attended the meeting to discuss the collaboration between Bridgewater Community Healthcare NHSFT and Warrington and Halton Teaching Hospitals NHSFT. Members were reminded that in August 2019, representatives attended a Joint Governing Body meeting to advise of partnership arrangements that were in place at the time. This presentation provided information on the progress of these discussion since August 2019.

SC set the context of working together with the primary driver being that both served the same populations across Halton and Warrington. These patients needed to be looked after in a more integrated way across community and hospital settings. The case for change had been presented to NHS England & Improvement and it had supported the Trusts to move to a more formal working relationship. This case highlighted the proposed benefits including improved quality services, greater opportunities for innovation and financial efficiencies. The wider context on how a formal collaboration satisfied the requirements of the NHS Long Term Plan were also referred to. CS moved on to talk about the primacy of place and the move towards an Integrated Care System. For ease of the ‘transaction’ the proposal made to NHS England & Improvement was for the acquisition of Bridgewater Community Healthcare NHSFT by Warrington and Halton Teaching Hospitals NHSFT. However, both were adamant that this was not a take-over of a community provider by an acute trust. Recent progress included:

• Joint working with PCNs. This was developing across both boroughs but Halton was further on than Warrington currently.

• Integration collaborative with adult and children’s social care, community and acute services. CS noted that there was a greater focus needed on children’s services.

• Clinical services reconfiguration n e.g. Long Term Conditions. This would provide a great opportunity to drive on improvements

• Planned contribution to system financial recovery. The ‘system’ was already working well to achieve this.

To assist with the acquisition the Trusts were using an NHS timeline template to help plan key milestones. Members were advised that these were not set in stone and could be altered to fit in with specific requirements for this transaction. Discussions moved on to consultation and engagement with stakeholders with the staff themselves being key to this process. CS and SC confirmed that discussions had been on-going for over 18 months. Comments received included the tie-in of the Engagement and Involvement Group at Halton and to avoid any events or deadlines over the Christmas period. Maria Austin confirmed that the Communications Plan had been shared with the CCGs and would come to the CCGs Quality Committees and to the Engagement and Involvement Group. Members commented that there was a need to develop two models as Halton and Warrington were very different boroughs. An example of this was that Halton did not have an acute hospital. The focus needed to remain as provision over the two places. Following discussion Governing Body Members noted the presentation.

003/20 Any Other Business

None to report.

AGENDA ITEM NO: F

1

GOVERNING BODY MEETING:

Joint Governing Body Meeting of NHS Halton CCG and NHS Warrington CCG

DATE OF MEETING:

8th April 2020

REPORT AUTHOR AND JOB TITLE:

Dr Andrew Davies, Clinical Chief Officer, NHS Halton CCG and NHS Warrington CCG

REPORT TITLE:

Clinical Chief Officer Report

STRATEGIC OBJECTIVES:

Please tick which strategic objectives the paper relates to

Improve quality of services

X

Sustained financial balance

Build an effective and motivated whole system workforce

X

Sound governance arrangements

X

Ensure integration and joint working arrangements

X

OUTCOME REQUIRED (tick)

Approval

Assurance

✓

Discussion

✓

Information

✓

EXECUTIVE SUMMARY

The purpose of the report is to provide members of the Governing Body with:

• An update on any key corporate issues that members need to be appraised and aware of

• An update on any key national and local issues relevant to the CCG

• A summary of key activities that support delivery of the CCGs strategic objectives (not referred to elsewhere in the Governing Body papers)

Please note this is a summary paper to provide relevant update and assurance to the Governing Body on key matters during the COVID-19 pandemic period.

AGENDA ITEM NO: F

2

RECOMMENDATIONS

The Governing Body is asked to:

• Note the contents of this report and support the handling arrangements in respect of COVID-19.

Outline any engagement – staff, clinical, stakeholder and patient / public

Not applicable

Are there any conflicts of interest which may be associated with this paper?

Not applicable

Does this paper address any existing risks which are included on the Assurance Framework or Risk Register?

Not applicable

Have the following areas been considered whilst producing this report?

Yes

N/A

Equality Impact Assessment (if yes, attach to paper)

✓

Quality Impact Assessment (if yes, attach to paper)

✓

Regulation, legal, governance and assurance implications (reference in the report if applicable)

✓

Procurement process (reference in the report if applicable)

✓

Document development

Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation

Not Applicable

AGENDA ITEM NO: F

3

1. Purpose

The purpose of this report is to provide Members of the Governing Body with:

• information in respect of relevant local and national initiatives and priorities

• information on key issues that may have not been covered elsewhere in an individual report

Please note this is a summary paper to provide relevant update and assurance to the Governing Body on key matters during the COVID-19 pandemic period. This is in line with national guidance in respect of revised governance arrangements during the current period. Therefore, this report does not include the usual review of meetings attended or overview of recent national communications. 2. Updates for Governing Body

a) Update on Mid-Mersey Integrated Working

In March 2020, the Governing Body approved plans for the Integrated Management Team to explore potential options for CCG integrated working on a mid-Mersey footprint and also appoint a Senior Responsible Officer to lead the development of this work. However, with the absolute focus on supporting the NHS to tackle the COVID-19 pandemic, NHS England has decided to suspend CCG merger work programmes during Quarter one with a review at the end of this period. The newly appointed Senior Responsible Officer (Paul Sly) has with the agreement of the two Accountable Officers and NHS England significantly scaled back the planned work in April, May and June to ensure there is no impact on the COVID-19 response. Background work on developing the High Level Project Plan, Case for Change and the Communication and Engagement Plan will continue, and fortnightly touch points with the Accountable Officers have been scheduled to review progress. Communications (1-2-1 calls) with Governing Body members will be arranged with the SRO to help shape the next phase of integrated working between the three CCGs, and the development of the Case for Change. It is recognised however that calls with GP Governing Body members and other Governing Body clinicians will not be scheduled during the first phase of this work.

b) Chief Finance Officer Arrangements To support the robustness of our arrangements during the COVID-19 period, discussions have taken place in respect of resourcing requirements for the Incident Coordination Centre to ensure effective leadership, experience and resilience. As a result of these discussions, it has been agreed that David Cooper, Chief Finance Officer will be seconded to the ICC for a three month period (with regular reviews of requirements) with effect 1st April 2020. During this period, Bryan Webb, Deputy CFO will formally act up into the position of Chief Finance Officer for NHS Halton CCG and NHS Warrington CCG.

AGENDA ITEM NO: F

4

c) Response to Coronavirus (COVID-19) CCG Approach The CCG Incident Co-ordination Centre (ICC) was established on Monday 9th March 2020 to oversee and co-ordinate the response for NHS Halton CCG and NHS Warrington CCG. Led by the Clinical Chief Officer, the control room is supported by dedicated staff undertaking the roles of Incident Director, Incident Manager, Incident Administrator and Action Handler. The ICC is now operational 7 days a week with extended hours and with two Incident Control Room teams working a rotational shift system.

The ICC is supported by various members of the IMT taking a lead across sector issues including Primary Care, Acute, Community, Mental Health & Learning Disability and Care Homes. This is also supported by underpinning infrastructure workstreams in respect of Communications, Workforce (inc Health and Wellbeing), Finance, Quality & Safety and IT & Estate.

A daily call is in place with colleagues in Primary Care across Halton and Warrington to understand current issues and risks.

Robust command and control procedures have been established which enable the co-ordination of efforts from a health perspective to ensure that patients and core services are being protected. There are three levels within the command and control structure, from strategic/tactical, to system-wide and local internal incident management. System Working NHS Halton Clinical Commissioning Group (CCG), NHS Warrington Clinical Commissioning Group (CCG), Halton Borough Council and Warrington Borough Council are working closely with local NHS providers, Public Health England (PHE), NHS England and other partner organisations in order to co-ordinate our approach in dealing with the pandemic.

A strategic system response group has also been established with meetings taking place on a weekly basis. The membership of the group contains senior representatives from NHS Halton CCG, NHS Warrington CCG, Warrington Borough Council, Halton Borough Council, Public Health and our main NHS providers.

The purpose of this group is to support the coordination of the local health and social care response in the Halton and Warrington area, in the event of an epidemic or pandemic involving infectious disease, being declared.

Handling of Communications

A Halton and Warrington System Communications Group has been established with representatives from all health and social care organisation. This group is working collaboratively to co-ordinate and support all communication and media activity The group meets virtually every Monday and Friday. Local media outlets have been engaged and have responded positively in terms of supporting communications with the public. A dedicated COVID page has been established through the local media. All media and social media activity has been significantly increased to ensure consistent and timely public messages across all communities.

AGENDA ITEM NO: F

5

In line with supporting our new interim working arrangements in response to COVID-19, we have reviewed and implemented a number of internal processes to support internal communication and staff engagement, these include;

• Virtual staff brief via TEAMs – every Monday (3pm) and Friday (10am)

• Daily staff COVID brief

• Weekly Round-Up (single brief for staff, Governing Body members and external stakeholders)

Staffing We have established a number of workstreams to ensure we effectively manage workforce issues during this period and also support the health and well-being of our staff at this time. This includes work in respect:

• Supporting and equipping our staff to work from home effectively and also mechanisms to keep in touch and connected with each other

• Supporting staff with changes to childcare and caring responsibilities

• Identifying, supporting and making any required adaptations in respect of staff in higher risk groups

• Staff Skills Scans to support any potential re-deployment activities

• Strengthened reporting of absence and attendance to support our duty of care and national requirements to track staff absence

• Implementation of a range of staff communications mechanisms and initiatives both at team and CCG level

• Information for staff both verbally and on-line including opportunities for questions and provision of FAQs to address pertinent questions

• Implementation of a range of staff engagement and support mechanisms to ensure staff receive the necessary emotional and wellbeing support during this period. This is also supported by the continuing work of the Staff Engagement Group at this time to ensure staff remain connected, involved and supported.

Current Position In light of the changing position and priorities in respect of COVID-19, a detailed verbal update will be provided to Governing Body members at the meeting on the 8th April 2020 in respect of current issues and handling arrangements. Information and guidance: The latest from the UK Government can be found here: www.gov.uk/coronavirus Detailed NHS information is available at: www.nhs.uk/coronavirus

d) Reducing burden and releasing capacity to NHS Providers and commissioners to manage the COVID-19 Pandemic

The CCG has received further guidance from NHSE to direct and enable organisations to free up management capacity and resources to support and prioritise the COVD-19 response. This guidance is focussed on 3 key areas of activity:

• Governance and Meetings

• Reporting and Assurance

• HR and staff related activities

http://www.gov.uk/coronavirushttp://www.nhs.uk/coronavirus

AGENDA ITEM NO: F

6

IMT Leads have reviewed the respective areas and ensured current activities, arrangements and priorities are in line with this guidance. Particular areas to note for the Governing Body include:

• Streamlined requirements for GB Meetings in terms of key issues and meetings held virtually

• Streamlining or temporary cessation of other Committees

• Continued requirement in respect of Annual Accounts and Audit

• Anticipation that the Annual Report may be streamlined but waiting further guidance – draft due to be presented to Audit Committee on the 22nd April

• Review of decision making processes to allow for emergency decision making. Governing Body to consider the establishment of Urgent Issues Committee (to be discussed at the meeting on the 8th April 2020).

• Amendments and changes to requirements for monitoring of Constitutional Standards (some continuation of standards and others are temporarily suspended) – update to be provided as part of the Corporate Performance Report to Governing Body

• Amendments in respect of Quality and Safety reported as part of Chief Nurses report to Governing Body

• Suspension of CCG merger work programmes for 2020/21 during Quarter one with a review at the end of this period (as per brief above)

• CCG Governing Body GP to focus on Primary Care Provision

• Pause of Mandatory Training (unless essential in line with deployment) and Appraisals (unless exceptional circumstances) during this period.

e) Local Governance Arrangements and Actions

In light of the above guidance and previous correspondence, governance arrangements across both CCGs during this period are as follows:

• Governing Bodies to meet on a monthly basis in April, May and June 2020 (streamlined agenda in virtual meeting setting)

• Audit Committee to meet virtually in April and May (streamlined agenda in virtual meeting setting in line with the requirements of the Annual Report and Accounts)

• Remuneration Committee to be arranged virtually as required

• Primary Care Commissioning Committee, Quality Committee, Finance & Performance Committee and Performance & Finance Committee are all suspended on a temporary basis for three months (following reviews of work plans by Lead Officers – any urgent requirements for decision making will be handled as appropriate)

• The current composition of the two Governing Bodies remains in line with current constitutions and operating arrangements

• Extension to contracts of current GB Members to 30th June 2020 (as applicable) to ensure continuity and to minimise the requirements to engage with Primary Care and recruit into roles (particularly GP/Clinical Roles) at this time in light of COVID-19. This will be reviewed in early June 2020 and the usual engagement process will be enacted at an agreed future point

• Extension to contract of the Clinical Chair of NHS Warrington CCG Dr Ian Watson to 31st March 2020 in line with the outcomes of the Membership Ballot

AGENDA ITEM NO: F

7

• Dr Julie Langton, Secondary Care Doctor has agreed to extend her contract to 30th June 2020 to support the work of the two Governing Bodies and CCGs during this period

• Pause of the work in respect of the updates to the Constitution (reviewed by Governing Bodies in March 20) to enable finalisation of engagement with Member Practices, LMC and NHSE.

Following previous communications, the Governing Body of NHS Halton CCG is also asked to note that Shazhad Tahir, Lay Member left the Governing Body at the end of March 2020. We would like to extend our thanks to Shazhad for his commitment to the work of the Governing Body and NHS Halton CCG during his period of office. 3. Recommendations The Governing Body is asked to:

• Note the contents of this report and support the handling arrangements in respect of COVID-19.

Dr Andrew Davies Clinical Chief Officer 2nd April 2020

AGENDA ITEM NO: F

1



DATE OF MEETING:

8th April 2020


Suzanne Barker, Chief of Corporate Services

REPORT TITLE:

Urgent Issues Committee -Terms of Reference (for approve)







X



Approval

✓

Assurance

Discussion

✓

Information

EXECUTIVE SUMMARY

This document presents the draft terms of reference for the proposed Urgent

Issues Committee.

It is proposed, the Urgent Issues Committee (the Committee) is established as a

temporary committee arrangement to support any urgent decision making during

the current COVID–19 period. This predominately relates to matters previously

under the role and remit of the Quality Committee and Performance &

Finance/Finance & Performance Committee (committees currently suspended

during this period).

AGENDA ITEM NO: F

2

This proposal is in line with the national guidance in respect of “Reducing burden

and releasing capacity to NHS Providers and commissioners to manage the

COVID-19 Pandemic” where it is suggested that CCGs review decision making

processes to allow for emergency decision making.

A proposal to establish an Urgent Issues Committee as part of this response is referenced within the report of the Clinical Chief Officer to Governing Body on the 8th April 2020). Terms of Reference for an Urgent Issues Committee for NHS Halton CCG and NHS Warrington CCG are presented in this paper.

RECOMMENDATIONS

The Governing Body is asked to:

• Review and approve the draft terms of reference for the proposed Urgent Issues Committee.


Not applicable


Not applicable


Not applicable


Yes

N/A


✓


✓


✓


✓



Discussed and reviewed by the Integrated Management Team

1

URGENT ISSUES COMMITTEE Terms of Reference The Urgent Issues Committee (the Committee) is established as a temporary

committee arrangement to support any urgent decision making during the current

COVID–19 period. This predominately relates to matters previously under the role

and remit of the Quality Committee and Performance & Finance Committee

(Committees currently suspended).

Where decisions need to be taken as a matter of urgency, the Governing Body has

delegated authority to the Chief Clinical Officer to make decisions on behalf of the

CCG by convening an Urgent Issues Committee with membership as detailed

below.

The requirement for this Urgent Issues meeting to be held in private may be

determined by the Clinical Chief Officer by exception.

NHS Halton CCG and NHS Warrington CCG have each established their respective Urgent Issues Committees. However, the two CCGs have identified common areas and ways in which they will able to access joint knowledge and experience to support effective decision making. Accordingly, the CCGs have identified that there is merit in their respective Urgent Issues Committees meeting together as “Committees in Common”. Whilst each Committee will retain responsibility for its own functions and will remain accountable to its Governing Body, the CCGs believe that efficiencies may be achieved in establishing a “Committees in Common” approach, to share views and opinions on relevant issues and, where possible, to achieve consistency in decision making across the two CCGs. Each Urgent Issues Committee will have its own Terms of Reference (setting out the membership, remit & responsibilities and reporting arrangements), quorum and administrative arrangements. 1. Membership

• Chair of the Committee (Chief Clinical Officer or nominated deputy)

• Lay Member representative of the Quality Committee

• Lay Member representative of the Performance & Finance Committee

• Clinical Member of the Governing Body either GP Member or Secondary Care Doctor

• Chief Finance Officer (or nominated deputy)

• Chief Nurse (or nominated deputy)

• One other member of the Integrated Management Team

In attendance

• Chief of Corporate Services (or nominated deputy)

• Appropriate Representatives in line with Agenda items

• Committee Administrator

2

2. Quorum Four Members of the Committee including the Clinical Chief Officer or nominated deputy, a Lay Member, a clinician, Chief Finance Officer or Chief Nurse (or nominated Deputy). 3. Remit and responsibilities in Respect of Quality Committee The Committee shall meet to review any immediate and urgent concerns or issues in relation to service quality, safety, commissioning or provision and will provide the required assurance to the Governing Body on aspects of service quality within the CCG’s remit. This could include: 3.1 Clinical Effectiveness

• receive an update on any urgent quality issues for all providers of commissioned services

• review any urgent information, notification or advice received from NHS England, NHS Improvement, Quality Surveillance Groups, National Quality Board, CQC, or any external regulator which relates to or has a bearing on an NHS care provider’s provision

3.2 Safety

• prioritise and monitor urgent emerging actions to minimise risks across

Warrington and Halton CCG commissioned services

• receive and report on any Serious Incidents and/or reports or investigations of

Significant Events Analysis/audits

• receive and report on urgent issues in respect of infection, prevention and

control

• receive overviews and outcomes of any urgent independent investigation or

reviews carried out on any local providers and seek assurance that findings

and actions are in place to manage any issues identified

• seek assurance that there are appropriate arrangements in place in all

commissioned services in respect of Safeguarding as recommended by the

Quality Committee

• receive, review and advise on appropriate actions in relation to medicines

related incidents and medicines safety

3.3 Service User Experience

• consider any urgent service use feedback

4. Remit and responsibilities in Respect of the Performance & Finance

Committee The Committee shall meet to review any immediate concerns or issues in relation to

the:

• management of sudden financial pressures or risks.

3

• urgent decision of unplanned but essential immediate spend.

• immediate action in relation to possible financial mismanagement or probity

issue.

• any other aspects of the financial management of the CCG including risk

areas that requires urgent attention

5. Other urgent matters The Committee may also (in exceptional circumstances) review any immediate and urgent issues in relation to the following issues:

• matters in respect of Governance and Risk

• matters in respect of management risks

• matters in respect of Reputation and Communications

6. Administration The Committee will be supported by an appropriate administrator that will be responsible for supporting the Chair in the management of the Committees business. The administrator will take minutes and produce action logs as required. 7. Frequency and notice of meetings. The Urgent Issues Committee shall meet on an ad hoc basis as required in line with urgent business. IMT members may request a meeting of the Urgent Issues Committee to the Chair of the Committee if they consider one necessary in line with organisational requirements. 8. Reporting The ratified minutes of any Urgent Issues Committee will be submitted to the Governing Body (Public or Private dependent on the nature of Committee business). 9. Conduct All members are required to make open and honest declarations of the interest at the commencement of each meeting or to notify the Committee Chair of any actual, potential or perceived conflict in advance of the meeting. All members are required to uphold the Nolan Principles and all other relevant NHS Code of Conduct requirements. 10. Date and Review These Terms of Reference were reviewed by the Governing Body on 8th April 2020 Version No. [1] Review dates April 2021

1

URGENT ISSUES COMMITTEE Terms of Reference The Urgent Issues Committee (the Committee) is established as a temporary

committee arrangement to support any urgent decision making during the current

COVID–19 period. This predominately relates to matters previously under the role

and remit of the Quality Committee and Finance & Performance Committee

(Committees currently suspended).

Where decisions need to be taken as a matter of urgency, the Governing Body has

delegated authority to the Chief Clinical Officer to make decisions on behalf of the

CCG by convening an Urgent Issues Committee with membership as detailed

below.

The requirement for this Urgent Issues meeting to be held in private may be

determined by the Clinical Chief Officer by exception.

NHS Halton CCG and NHS Warrington CCG have each established their respective Urgent Issues Committees. However, the two CCGs have identified common areas and ways in which they will able to access joint knowledge and experience to support effective decision making. Accordingly, the CCGs have identified that there is merit in their respective Urgent Issues Committees meeting together as “Committees in Common”. Whilst each Committee will retain responsibility for its own functions and will remain accountable to its Governing Body, the CCGs believe that efficiencies may be achieved in establishing a “Committees in Common” approach, to share views and opinions on relevant issues and, where possible, to achieve consistency in decision making across the two CCGs. Each Urgent Issues Committee will have its own Terms of Reference (setting out the membership, remit & responsibilities and reporting arrangements), quorum and administrative arrangements. 1. Membership

• Chair of the Committee (Chief Clinical Officer or nominated deputy)

• Lay Member representative of the Quality Committee

• Lay Member representative of the Performance & Finance Committee

• Clinical Member of the Governing Body either GP Member or Secondary Care Doctor

• Chief Finance Officer (or nominated deputy)

• Chief Nurse (or nominated deputy)

• One other member of the Integrated Management Team

In attendance

• Chief of Corporate Services (or nominated deputy)

• Appropriate Representatives in line with Agenda items

• Committee Administrator

2

2. Quorum Four Members of the Committee including the Clinical Chief Officer or nominated deputy, a Lay Member, a clinician, Chief Finance Officer or Chief Nurse (or nominated Deputy). 3. Remit and responsibilities in Respect of Quality Committee The Committee shall meet to review any immediate and urgent concerns or issues in relation to service quality, safety, commissioning or provision and will provide the required assurance to the Governing Body on aspects of service quality within the CCG’s remit. This could include: 3.1 Clinical Effectiveness

• receive an update on any urgent quality issues for all providers of commissioned services

• review any urgent information, notification or advice received from NHS England, NHS Improvement, Quality Surveillance Groups, National Quality Board, CQC, or any external regulator which relates to or has a bearing on an NHS care provider’s provision

3.2 Safety

• prioritise and monitor urgent emerging actions to minimise risks across

Warrington and Halton CCG commissioned services

• receive and report on any Serious Incidents and/or reports or investigations of

Significant Events Analysis/audits

• receive and report on urgent issues in respect of infection, prevention and

control

• receive overviews and outcomes of any urgent independent investigation or

reviews carried out on any local providers and seek assurance that findings

and actions are in place to manage any issues identified

• seek assurance that there are appropriate arrangements in place in all

commissioned services in respect of Safeguarding as recommended by the

Quality Committee

• receive, review and advise on appropriate actions in relation to medicines

related incidents and medicines safety

3.3 Service User Experience

• consider any urgent service use feedback

4. Remit and responsibilities in Respect of the Performance & Finance

Committee The Committee shall meet to review any immediate concerns or issues in relation to

the:

3

• management of sudden financial pressures or risks.

• urgent decision of unplanned but essential immediate spend.

• immediate action in relation to possible financial mismanagement or probity

issue.

• any other aspects of the financial management of the CCG including risk

areas that requires urgent attention

5. Other urgent matters The Committee may also (in exceptional circumstances) review any immediate and urgent issues in relation to the following issues:

• matters in respect of Governance and Risk

• matters in respect of management risks

• matters in respect of Reputation and Communications

6. Administration The Committee will be supported by an appropriate administrator that will be responsible for supporting the Chair in the management of the Committees business. The administrator will take minutes and produce action logs as required. 7. Frequency and notice of meetings. The Urgent Issues Committee shall meet on an ad hoc basis as required in line with urgent business. IMT members may request a meeting of the Urgent Issues Committee to the Chair of the Committee if they consider one necessary in line with organisational requirements. 8. Reporting The ratified minutes of any Urgent Issues Committee will be submitted to the Governing Body (Public or Private dependent on the nature of Committee business). 9. Conduct All members are required to make open and honest declarations of the interest at the commencement of each meeting or to notify the Committee Chair of any actual, potential or perceived conflict in advance of the meeting. All members are required to uphold the Nolan Principles and all other relevant NHS Code of Conduct requirements. 10. Date and Review These Terms of Reference were reviewed by the Governing Body on 8th April 2020 Version No. [1] Review dates April 2021

AGENDA ITEM NO: 033/20

Chief Nurse Report NHS Halton CCG and NHS Warrington CCG Joint Governing Body Meeting 8th April 2020



DATE OF MEETING:

8th April 2020


Michelle Creed, Chief Nurse

REPORT TITLE:

Chief Nurse Report




X



X


X


X


Approval

Assurance

✓

Discussion

Information

EXECUTIVE SUMMARY

The purpose of the paper is to provide assurance from the Chief Nurse to the Governing Body with regard to the quality, safety and patient experience in services commissioned by NHS Halton CCG and NHS Warrington CCG.

RECOMMENDATIONS

The Governing Body is asked to receive this report by way of assurance regarding the Quality, Safety and Experience of Commissioned Services during the Covid-19 pandemic period.




As detailed within the report


None


Yes


Yes

N/A


✓


✓


✓


✓



Not Applicable



1 PURPOSE The purpose of the paper is to provide assurance from the Chief Nurse to the Governing Body with regard to the quality, safety and patient experience in services commissioned by NHS Halton CCG and NHS Warrington CCG.

2 QUALITY, SAFETY AND EXPERIENCE

2.1 NEVER EVENTS AND SERIOUS INCIDENTS

At the time of writing this report there has been 1 Never Event in St Helens & Knowsley Hospital Trust in relation to a retained swab related to a Gynae operation in Halton CCG commissioned services.

2.2 SAFEGUARDING

On 24th February 2020 Halton Borough Council were notified of an ‘Inspection of Local Authority Children’s Services’ or ILACS. The inspection is now finished and there is a period of factual accuracy checks and they will then receive the final judgement. During Covid-19 the Chief Nurse has established weekly teleconference calls with the strategic partners in Halton and Warrington, those being CCG, Local Authority and Police to collate intelligence and identify any emerging themes and trends. Areas of concern identified to date:

• Children in Care

• Vulnerable children

• Domestic Abuse

2.3 CARE HOMES – Covid 19 support

• Warrington have established Care Home System call twice weekly with all are Care Homes, CCG, LA on Tues and Thursday. Daily email updates to be sent to all homes with any key information or new guidance. All homes to email in/phone with any additional issues that occur in between the twice weekly calls

• Halton homes – to phone in to the LA if there are any issues, daily email updates to be sent to all homes with any key information or new guidance. We are exploring teleconference calls in addition. All homes to email in/phone with any additional issues that occur in between the twice weekly calls

• Chief Nurse having weekly teleconference calls with CQC and LA.

• Several support initiatives are in place:

o Establishing a Tracker to monitor all Care Homes re Covid-19

o Weekly reports to Primary Care have now moved to daily.

o Supporting the use of video conferencing for primary care, either establishing current use or supporting the purchase of laptops/ipads.

o Establishing equipment needs (thermometers, BP machines, pulse oximeters)

• Checking Business Continuity Plans



• Ensuring the receipt and use of the correct Personal Protective Equipment (PPE)

• Establishing the use of the bed capacity tracker in al care homes across Halton and Warrington and Halton Haven and St Rocco’s Hospice.

2.4 INFECTION PREVENTION AND CONTROL (IPC)

The IPC team are experiencing high level of demand, both for interpretation of guidance issues and advice and guidance to the system. The team have moved to 7 day working and 2 members of the Quality Team have been redeployed to support the non-clinical issues of tracking and system communication.

3 REDUCING THE BURDEN AND RELEASING CAPACITY AT NHS

PROVIDERS AND COMISSIONERS TO MANAGE THE COVID-19 PANDEMIC During this challenging period NHS England and NHS Improvement (NHSE/I) are committed to supporting providers and commissioners in allowing them to free up as much capacity as possible and prioritise their workload to be focused on doing what is necessary to manage the response to the COVID-19 pandemic. A letter of guidance was issued on 28th March 2020 to support this. The elements relevant to the Quality & Safety agenda are as follows:

3.1 Quality Accounts

The deadline for quality accounts preparation of 30 June is specified in Regulations. NHSE/I have deferred this. However, the presentation of the accounts to system partners has been suspended for the 2019/20 Quality Accounts.

3.2 CQUIN Whilst the CQUIN guidance around Q1 2020/21 is very clear, there is ambiguity about Q4 2019/20 payments. Providers do not have to submit their evidence of compliance with CQUINs until 30th April 2020 and would usually gather this during April. However, there are to be no further uploads to the national CQUIN data collection template during the Covid-19 period. There are a number of indicators where the entire CQUIN or a considerable proportion is in Q4 so to use Q1-3 and estimate up from here would disadvantage the providers. Furthermore, the quality elements may have significantly improved but the provider will not be able to evidence in the data collection. A decision to pay all providers has been made. The quality of service will be monitored and be included in the recovery plan surveillance for quality and safety.

3.3 Quality Committee

Provider Trusts and CCGs are asked to review the committee structure and streamline all committees. However, Provider Trusts have been asked to continue with the Quality Committee.

3.4 Friends and Family test Is suspended



3.5 Continuing Healthcare CHC assessments have been suspended. Capacity tracker, currently mandated for care homes, is now also mandated for hospices and intermediate care facilities. NHS will pay for all hospital discharge care during Covid-19 period

3.6 Clinical Audit

All national clinical audit, confidential enquiries and national joint registry data collection, including for national VTE risk assessment, can be suspended. Analysis and preparation of current reports can continue at the discretion of the audit provider, where it does not impact front line clinical capacity. Data collection for the child death database and MBRRACE-UK-perinatal surveillance data will continue as this is important in understanding the impact of COVID-19.

3.7 Appraisal and Revalidation

Recommendation that appraisals are suspended from the 28th March 2020, unless there are exceptional circumstances agreed by both the appraisee and appraiser. This should immediately increase capacity in our workforce by allowing appraisers to return to clinical practice. The GMC has now deferred revalidation for all doctors who are due to be revalidated by September 2020. NHSE/I requested that all non-urgent or non-essential professional standards activity be suspended until further notice including medical appraisal and continuous professional development (CPD) The Nursing and Midwifery Council (NMC) is to initially extend the revalidation period for current registered nurses and midwives by an additional three months and is seeking further flexibility from the UK Government for the future.

3.8 CCG Clinical Staff

A review of internal need has been undertaken in order to retain a skeleton staff for critical needs and the remainder of the staff have been redeployed to support

• Primary Care

• Care Homes

• Infection Control

• Serious Incident Management/Never Events

• Safeguarding

• Community Services. CCG Governing Body GPs to focus on primary care provision

4 PROVIDER QUALITY SURVEILLANCE

Agreement reached at C&M Quality Surveillance Group was to move to:

• Light touch quality surveillance for providers with Outstanding or Good CQC ratings and establish an escalation process for concerns.

• Continue with video conference CPQG for Providers in Requires Improvement or Inadequate. For NHS Halton and Warrington CCG, the focus remains on:

o Bridgewater CHFT o Halton Haven Hospice o Care Homes



5 CONCLUSION

The governing body should be assured that the system surveillance process is in place to identify best practise and sport early warning signs of system failure. However, this system and process will need to be reviewed in light of changing organisational forms, the financial recovery climate and engagement and involvement public requirements. This report has focused on business critical quality and safety oversight during Covid-19 period.

The Chief Nurse will submit a monthly report to the Governing Body for consideration and challenge during this current period.


Financial & Operational Performance Overview – Month 11 NHS Halton CCG and NHS Warrington CCG Joint Governing Body Meeting 8th April 2020



DATE OF MEETING:

8th April 2020


Bryan Webb, Acting Chief Finance Officer

REPORT TITLE:

Financial and Operational Performance Overview – Month 11





X



X



Approval

✓

Assurance

✓

Discussion

Information

EXECUTIVE SUMMARY

The purpose of this paper is to:

i. Provide an overview of the financial performance of both CCGs at period 11 of the 2019/20 financial year and the corresponding financial outturn projections;

ii. Advise on the going concern status for each CCG to inform the content of the financial statements for 2019/20; and

iii. Provide an overview of operational performance against national standards for periods to date during 2019/20.



RECOMMENDATIONS

The Joint Governing Body is asked to:

• Note the Financial positions for each respective CCG at month 11; and • Note the Financial Outturn projections for each CCG; • Note the financial risks that could impact on these outturn projections; • Approve the recommended “going concern” status for each CCG; and • Note the operational performance for the locality for period to date in 2019/20.


Not Applicable


Not Applicable


NHS Halton CCG: BAF 36, 43, & 41 NHS Warrington CCG: B1 to B5


Yes

N/A


✓


✓


✓


✓



Not Applicable



Purpose

1. The purpose of this paper is to update the Joint Governing Body on the financial positions of NHS Halton CCG and NHS Warrington CCG at period 11 (February 2020), and the financial outturn projections for, the 2019/20 financial year.

2. An overview of the operational performance for the Warrington & Halton locality is also included.

Month 11 Financial Position – NHS Halton CCG

3. The financial position at month 11 is a deficit position of £6.8m against the planned expenditure budgets. All available reserves have been utilised to support non delivery of QIPP for periods to date. The CCG forecasts an outturn position against planned expenditure budgets of £7.3m deficit position, which against the CSF resource unsecured (£1.3m) during this financial year culminates in a reported deficit of £8.6m within the financial statements. The CCG has been tasked with improving this reported position to support collective reporting across the Cheshire and Merseyside Health & Care Partnership, however this is deemed less and less feasible with the controls introduced as part of the COVID-19 response, with the agreement of contractual financial settlements encouraged with providers to reduce administrative burden and provide financial stability during this period. CCGs have been asked to assume no slowdown in Elective PbR activity as a consequence of the provider responses to COVID-19. These arrangements place risk against the existing CCG assumptions included within the month 11 forecast outturn, which will need to be managed through the completion of the accounts.

4. Non delivery against the outlined level of efficiency (QIPP) required to support the financial plan is a key contributor to the reported position both year-to-date and within the forecast outturn for the CCG. The projected delivery, against a planned requirement of £9.7m, is £2.6m.

5. A detailed account of the financial performance is included within Appendix 1.

Month 11 Financial Position – NHS Warrington CCG

6. The financial position at month 11 is an adverse position to planned expenditure of £14.6m. The CCGs projected outturn for 2019/20 remains at £16.1m. Other elements are consistent with prior period reporting. National instructions aligned to the COVID19 response for contractual management may impact on some the assumptions for local provider contract positions, with agreeing early financial settlements encouraged to reduce administrative burden and provide financial stability during this period, and this may present an element of risk during the completion of the 2019/20 accounts. This risk this is expected to be managed in line with the forecast outturn position communicated to the regulators during period 11.

7. Non delivery against the outlined level of efficiency (QIPP) required to support the financial plan is a key contributor to the reported position both year-to-date and within the forecast outturn for the CCG. The projected delivery, against a planned requirement of £16.4m, is £5.4m.



8. A detailed account of the financial performance is included within Appendix 2.

Going Concern Status – NHS Halton CCG and NHS Warrington CCG

9. The financial projections for both CCGs indicate reported deficits for the 2019/20 financial year. As part of the annual reporting cycle, the Governing Body is required to consider the going concern status of each respective organisation.

10. The basis of assessment for both CCGs has been outlined as per the following and this is recommended for inclusion with the reported financial statements:

The CCG’s financial accounts are prepared under a direction issued under the National Health Service Act 2006 (as amended). In the light of the 2019/20 deficit and the requirement to refer to the Secretary of State under Section 30 of the Local Audit and Accountability Act, the CCG has undertaken an assessment of its status as a going concern. The CCG has produced, alongside system partners, a long term financial plan that considers how the system will work collaboratively to manage the collective position into sustainable financial balance. These financial plans have been shared with NHS Northwest. For non-trading entities in the public sector, the anticipated continuation of the provision of a service in the future, as evidenced by inclusion of financial provision for that service in published documents, is normally sufficient evidence of going concern. Therefore, based on the above, the accounts will be prepared on a going concern basis recognising that:

i. Health care services will continue to be provided for residents of Halton/Warrington ii. The system has produced a longer-term financial plan which has been received by

NHS Northwest and the Cheshire and Merseyside Health & Care Partnership. iii. The CCGs have been notified of their financial allocations for the period of 2020-21

until the Financial year 2023-24.

Month 11 Operational Performance – Warrington & Halton locality

11. The March report, included as Appendix 3, details performance for January 2020 and February 2020 periods highlighting the following elements:

Urgent Care

12. Urgent care services are under severe pressure with all but one activity plans being exceeded for both NHS Warrington CCG and NHS Halton CCG. Most of the related performance standards are also not being met.

13. Notable performance improvement has been reported in relation to ambulance response times during recent periods, however the national standards are still not being achieved.



Planned Care 14. Warrington & Halton Teaching Hospitals NHS Foundation Trust is consistently performing well

against the national standards, outperforming the national average. However, capacity issues at multiple Merseyside based Trusts is impacting upon planned activity for both Halton and Warrington residents. These capacity issues have been addressed in the interim, however the backlog of patients remains an outstanding issue. Cancer

15. The Cancer standards are being achieved for periods to date with regards to Warrington & Halton Teaching Hospitals NHS Foundation Trust, however previous breast and dermatology capacity issues at St Helens & Knowsley Teaching Hospitals Trust have resulted in NHS Halton CCG failing both two week wait standards during this period. Mental Health

16. Performance against the Dementia standards remains strong for both CCGs. However, performance against IAPT standards is below the national standard and below that achieved last year for both CCGs.

Appendices

17. This report is supported by the following appendices:

• Appendix 1 - NHS Halton CCG Financial Position Period Ending 29th February 2020

• Appendix 2 – NHS Warrington CCG Financial Reporting 2019/20

• Appendix 3 – Joint Corporate Performance Report March 2020

Recommendations

18. The Joint Governing Body is asked to:

• Note the financial positions for each respective CCG at month 11; and

• Note the financial outturn projections for each CCG;

• Note the financial risks that could impact on these outturn projections;

• Approve the recommended “going concern” status for each CCG; and

• Note the operational performance for the locality for period to date in 2019/20.

NHS Halton CCG Financial PositionFinancial Monitoring Statements

Period Ending 29th February 2020 (Month 11)

Bryan WebbActing Chief Finance Officer

1 • Executive Summary

2 • Financial Plan Run Rate (Incl. CSF)

3 • Financial Outturn Scenarios

4 • Summary of Financial Position (Year to date & forecast)

5 • Sector Highlights

6 • Acute Trust performance

7 • QIPP Savings

8 • CCG Risks

9 • Conclusion

Contents

1. Executive Summary

The financial position at month 11 is a deficit position of £6.782m against the planned expenditure budgets. This is attributable to elementspreviously reported as risks now crystallising in the financial position, including acute based performance; non delivery of planned efficiencies(QIPP); and the financial consequences of the abandoned Urgent Treatment Centre procurement. All available reserves have been utilised tosupport non delivery of QIPP for periods to date. This position has been reported to NHS England and NHS Improvement through the SystemRecovery Plan and a revised forecast outturn trajectory has been reflected at Month 11 to reflect a planned year-end deficit of £7.3m.

Material financial impacts (greater than £0.250m) reflected in the outturn position in 2019/20 are as follows:

QIPP Savings: The latest forecast QIPP delivery is £2.5m against a target of £9.7m.

Acute Sector: The Warrington & Halton Hospitals NHS Teaching Foundation Trust Sustainability Contract performance is forecast to be aboveplan by £1.05m based on month 10 data, which is applied against the thresholds within the contract. The St Helens & Knowsley TeachingHospitals NHS Trust contract has an adverse position within month 10 data, which is largely attributable to the blended paymentarrangement for Non Elective care. The Royal Liverpool and Broadgreen University Hospitals NHS Trust contract has presented a more stableposition when compared to the month 9 reported position. All other contracts are cumulatively performing in line with planned levels. Nondelivery of planned QIPP against this sector continues to be the material financial risk against the delivery of the financial plan. Theabandoned Urgent Treatment Centre procurement has resulted in further non delivery of planned QIPP aligned to this with a corresponding£1.2m detrimental impact.

Mental Health : Inflation rates have been set by the council in respect of out of area mental health services, this has led to a pressure of circa£0.5m to the forecast outturn. Work has also been undertaken across the Mersey footprint to review rehab and ABI beds which has caused apressure for NHS Halton CCG during 2019/20.

Prescribing: Non delivery of planned levels of QIPP, impact of Category M price increases, NCSO impact and assumptions regardingPregabalin rebate are reflected within the outturn position.

Financial Position Overall Risk Rating : Red

2. Financial Plan Run rate (incl. CSF)

Overall Risk Rating : Red

• Cumulative Planned Deficit Profile

3. Financial Outturn ScenariosOverall

Risk Rating :

Red

• Financial Outturn Scenarios at month 11

-167-333

-500-667

-834-1,000

-1,167-1,335

-1,502-1,669

-1,836-2,000

-167 -333

-500 -467 -633 -800

-466 -633

-800

-366 -534

-

-6,782

-7,300

-5,216

-6,720

-7,382

-8,600

-10,000

-9,000

-8,000

-7,000

-6,000

-5,000

-4,000

-3,000

-2,000

-1,000

0

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

£'00

0

NHS Halton CCG 2019/20 Financial Outturn Scenarios

Plan Cumulative Defict Plan Revised Cumulative Deficit with CSF

Plan Net Risk Trajectory Reported Position

Risk Adjusted Financial Poistion Risk Adjusted Financial Poistion (incl loss of CSF)

Plan Net Risk Trajectory following CSF achieved

Q1&Q2 CSF £700k Q1-Q3 CSF £1,300k

Q1-Q4CSF £2,000k

4. Summary of Financial Position

• Financial Position

At month 11 the CCG reported a deficit position of £6.78m for periods to date against a planned deficit of £1.13m. Non Deliveryof QIPP is impacting on the planned position for the CCG with an adverse variance of £5.3m for periods to date, a detailedbreakdown of this is reported separately within section 7 “QIPP Position”.

• Key Highlights

Areas of Financial Deterioration

Acute Sector Performance £5.4m: QIPP Non Delivery £2.6m

WHHFT £1.1m YTD adverse positionSTHKT £0.6m YTD adverse (NEL Blended)

Mental Health £1.2m:High Cost packages of care / placements

Impact of new ABI contract arrangements

Prescribing £0.9m:Revised forecast expenditure to capture

Category M price concession impact, continued NCSO, and QIPP non delivery.


Plan Actual Variance Variance

£m £m £m %

Acute Services (ISFE) 112.82 118.22 (5.40) -4.8%

Mental Health Services (ISFE) 20.01 21.23 (1.22) -6.1%

Community Health Services (ISFE) 17.06 17.08 (0.02) -0.1%

Continuing Care Services (ISFE) 9.94 10.00 (0.06) -0.6%

Primary Care Services (ISFE) 5.25 4.89 0.36 6.8%

Prescribing 21.14 22.40 (1.26) -6.0%

Primary Care Co-Commissioning (ISFE) 17.36 17.36 0.00 0.0%

Other Programme Services (ISFE) 11.38 10.59 0.79 6.9%

TOTAL COMMISSIONING SERVICES 214.95 221.76 (6.82) -3.2%

Running Costs (ISFE) 2.75 2.72 0.03 0.0%

TOTAL CCG NET EXPENDITURE 217.69 224.48 (6.78) -3.1%

IN YEAR UNDERSPEND / (DEFICIT) (1.13) (7.92) (6.78) -3.1%

CCG EXPENDITURE ANALYSIS

Year to Date Net Expenditure

5. Sector Highlights

Acute

• Highlights: There is a an adverse variance of £5.4m across the Acute sector at month 11. This includes £2.6m ofQIPP non delivery against planned levels, the remaining balance relates to over performance on local acutecontracts including Warrington & Halton Hospitals NHS Teaching FT and St Helens & Knowsley Hospitals TeachingTrust. The short stay admissions audit has reached a conclusion and the CCG has profiled £0.521m of the adverseimpact into the position in this period. This adverse position to plan has been offset by savings delivered througha review of discretionary budgets in the same period.

• Key Impacts: Adverse variances to planned levels / cost of activity, particularly at St Helens & Knowsley HospitalsTeaching Trust, with the impact of the blended tariff arrangements for urgent care. Under delivery of QIPPschemes. UCC procurement abandonment has contributed to adverse performance against contract plans.

Mental Health

• Highlights: Pooled budgets including Section 117 have been set based upon last years budget plus inflation,pooled budget contributions are agreed. In 2019/20 rehab (incl. Acquired Brian Injury (ABI)) activity is paid forsolely based on usage. NHS Halton CCG has commissioned additional capacity and seen an increase in utilisationwhich is causing a cost pressure.

• Key Impacts: Inflation rates on out of area Mental health placements higher than anticipated, and activity inrespect of rehab and acquired brain injury beds (ABI).

Primary care

• Highlights: The CCG is reporting a year to date adverse position to plan of £0.901m, with a projected outturnadverse variance of £0.978m due to increase Cat M costs, NCSO and profiling of QIPP schemes on prescribing.

Continuing Care

•Highlights: Currently reporting an over performance of £0.064m which is net of the pool budgets overperformance against savings with CHC assessment support team (staff vacancies) and lower than expectedchildren's CHC activity. The latest financial forecast from Council has identified increased costs in CHC, work is on-going to verify the data provided.

•Key Impacts: Inflation on CHC higher than budgeted and additional packages of care in year higher thananticipated.

Community

•Highlights: Slight over performance of £0.018m due to an overspend on Hospices as a result of a long staypatient.

Other

•Highlights: Slight under performance against plan due to delayed recruitment of clinical leads and staff vacancieswithin the safeguarding team.

Running Costs

•Highlights: Running costs is currently on plan but there is still an outstanding credit budget of £0.131m withinreserves which is anticipated to be cleared by the end of the financial year.

5. Sector Highlights

6. Acute Trust Performance

The collective reported financial position for acute contracts at month 11 is an adverse variance to plan of £5.4m.This performance is determined based on 10 months worth of data. These figures now include a profiled impact of the prior yearactivity challenges and non delivery of planned QIPP. The month 11 position has profiled unidentified QIPP into the position. TheQIPP profiled during quarter 4 is not anticipated to be delivered and therefore is factored into the outturn projections for theCCG.

Key Highlights

Plan Actual Variance Variance

£000's £000's £000's %

Warrington & Halton FT 46,473 47,609 (1,135) -2%

St Helens and Knowsley Trust 44,440 45,071 (631) -1%

Royal Liverpool & Broadgreen and Aintree Trust 5,691 5,748 (57) -1%

Royal Liverpool & Broadgreen Trust 2,235 3,697 (1,462) -65%

Countess of Chester FT 1,390 1,347 44 3%

Liverpool Womens FT 1,239 1,186 53 4%

Aintree Hospitals FT 3,456 2,051 1,405 41%

Alder Hey 1,329 1,470 (141) -11%

Wirral 218 218 (1) 0%

WWL 285 271 13 5%

LHCH 696 874 (178) -26%

Other Acute Trusts (inc AQP) 4,879 5,186 (307) -6%

Non NHS Acutes 2,168 2,843 (675) -31%

QIPP Achievement (2,660) (24) (2,635) 99%

Other Acutes 1,351 1,086 264 20%

Ambulance 5,327 5,341 (14) 0%

TOTAL COMMISSIONING SERVICES 112,825 118,225 (5,400) -5%

Expenditure analysis

Year to Date Net Expenditure

7. QIPP Position

• QIPP Position

Acute sector QIPP achievement is based on activity available up to month 9 projected up to month 11.Overall QIPP savings reported at month 11 are £2.531m which is resulting in an adverse variance of £5.307m against theplanned level of QIPP of £7.838m. A £7.121m adverse position is the forecast against all schemes. Acute contract activity isbelow planned levels in recent periods, which could have a positive impact on QIPP position going forward. Non electiveactivity is under-performing against planned levels with blended payment impacting on this under performance. A number ofthe Acute Sector schemes were due to impact during the latter half of the financial year but due to this not materialising thishas been reflected within the forecast outturn.

Key Highlights


£m £m £m % £m £m £m %

UTC procurement 0.514 0.033 (0.481) 6% 0.610 0.033 (0.577) 5%

CHC fully funded 0.466 0.465 (0.001) 100% 0.508 0.507 (0.001) 100%

Prescribing savings 2.559 1.383 (1.177) 54% 2.804 1.383 (1.421) 49%

Acute Trust savings 2.593 0.189 (2.405) 7% 2.830 0.189 (2.642) 7%

Running Costs 0.125 0.121 (0.003) 97% 0.136 0.133 (0.003) 98%

High Intensity users (A&E avoidance) 0.011 0.007 (0.004) 64% 0.014 0.009 (0.005) 64%

Short stay at STHK 0.511 0.153 (0.358) 30% 0.557 0.153 (0.404) 27%

Unidentified Programme 1.059 0.181 (0.879) 17% 2.118 0.181 (1.938) 9%

Unidentified Running Costs - - - 0.131 - (0.131) 0%

7.838 2.531 (5.307) 32% 9.708 2.586 (7.121) 27%

CCG EFFICIENCY PLANS

Year to Date Forecast

Plan Actual Variance%

AchievedPlan Actual Variance

%

Achieved

8. CCG Risks

• Risks


(0.80)

(0.60)

(0.40)

(0.20)

-

0.20

0.40

0.60

0.80

£m

Risks Mitigations Net Risk (Unmitigated Risk)

Risks are limited at month 11 considering the majority of risks are now factored into the position. The CCG is still reporting £1.3mas a risk which is a combination of acute over performance alongside potential pooled budget overspends, these are over andabove what is factored into the forecast outturn position. The CCG expects this risk to be fully mitigated therefore no impact isanticipated within the overall outturn position reported.

9. Conclusion

The development of financial plans, across the North West footprint, for the 2019/20 financial year to meet both theexpectations outlined within planning guidance and to secure the designated control totals proved a collectivechallenge. There was also the emphasis on commissioners supporting providers to access all of the availablesustainability resources (FRF/PSF/MRET) to optimise the system position.

For NHS Halton CCG, this resulted in a financial plan being submitted with outlined risks of £5.6m against thedelivery of the control total of £2.0m planned deficit. The largest proportion of the risk outlined at the planningstage was in relation to the level of QIPP that had been included (£9.8m, or 8.4% of amenable budgets) with asignificant level unidentified at the planning stage. In consideration against that target, the Sustainability Contractarrangement has partially prohibited the application of cashable savings with Warrington & Halton Hospitals NHSTeaching Foundation Trust where the arrangements do not also reduce the cost of provision (i.e. win-win scenarios).

Most system based opportunities are aligned to pathway redesign (RightCare / GIRFT / Model Hospital) and thesystems’ agreed priorities have recently been outlined as Frailty; Coronary Heart Disease; Chronic Pain; and LiverDisease. These prioritised schemes are not anticipated to deliver cashable savings to the commissioner(s) within thefirst year of the programme.

The Joint Governing Body is asked to:

• Note the financial position at the end of February 2020; and• Acknowledge the forecast outturn position that was submitted at Month 11;• Acknowledge the contributing factors within position, in particular the non delivery of QIPP savings; and• Note the application of the NHS Northwest protocol for deviations from assigned control totals during the

month 11 reporting period.

Financial Reporting

2019/20

April 2020

Contents

1 • Executive Summary

2 • Financial Position

3 • Financial Outturn Trajectories

4 • QIPP Position

5 • Risks and Mitigations

6 • Conclusion

1. Executive Summary

The financial position at month 11 (February) is an adverse variance to planned expenditure of £14.642m. A breakdown of thisexpenditure can be found in Appendix 1. The CCGs forecast outturn position for 2019/20 remains at £16.1m. The CCGs unidentifiedQIPP budgets continue to be the main internal contributor to the adverse performance against the planned position to date and theforecast outturn for the 2019/20 financial year. The CCG shall continue to work with System Partners to manage the collectivefinancial position to minimise the time to achieve system financial recovery.

Material financial performance issues are identified as:

• Acute Sector: Activity risk reserves have been fully utilised however with agreed collaborative sustainability adjustments theposition has shifted to an adverse variance of £3.982m year to date. The adjustments will help alleviate the financial pressureswithin the System. Independent Sector providers continue to cause a cost pressure, with £0.435m adverse variance year todate. Non Contracted Activity is creating an adverse variance to month 11 of £0.731m, largely attributable to NHS trusts in theNorth West of England and North Wales.

• Community: A year to date adverse variance of £1.766m due to the agreed collaborative sustainability adjustment.

• Primary Care (including Prescribing): PMD prescribing expenditure was lower than anticipated in December 2019. In yearallocations for Flash Glucose, recharges to NHS England for Flu, prescribing rebates, and February typically being a low valuemonth for prescribing have all helped improve the position year to date for prescribing to a favourable variance of £0.083m.Other includes spend such as Programme Projects (£0.290m adverse variance), Local Enhanced Services (£0.084m adversevariance) and Clinical Leads (£0.030m adverse variance).

• Continuing Care: The pressures within Free Nursing Care are mostly attributable to prior year costs and the monthlyexpenditure on Acquired Brain Injury patients almost doubling from April 2019.

• Better Care Fund: Collectively reconciles to budget, however in month an accrual went to Joint Funded MH rather than JointFunded Care Packages that will be rectified in the next reporting period. Joint Funded MH packages of care costs in excess ofthe pooled budget arrangements were anticipated, with a planned reserve, and therefore managed within available budgets.

• Unidentified QIPP: The QIPP plan for 2019/20 is £16.366m, however there is unidentified QIPP amounting to £11.750m.Reporting to NHS Northwest reflects the non delivery against the Unidentified QIPP target to date of £10m and forecast nondelivery in excess of £11m.

YTD Risk Rating : Red

FOT Risk Rating : Red

2. Financial Position YTD Financial Position Rating:

Red

Key Headlines

The financial position at month 11 is an adverse variance to the planned control total of £14.642m.Unidentified QIPP (£11.750m budget) within the financial plan is phased into the position equally acrossthe year. This equates to a negative budget within “Other Programme” of £10.083m for periods to date.

The areas of most significant adverse variances, excluding unidentified QIPP, are with Independent Sector,Non Contract Activity and collaborative sustainability adjustments within Acute. Within Community thecollaborative sustainability adjustment is driving the variance. Programme Projects and prior year FreeNursing Care pressures are also material.

RESOURCE LIMIT (YTD) 308.617

SECTOR REPORTING (ISFE) PLAN YTD ACTUAL YTD VARIANCE YTD VARIANCE

£m £m £m %

ACUTE SERVICES 165.067 168.910 -3.843 -2.3%

MENTAL HEALTH SERVICES 31.587 32.345 -0.758 -2.4%

COMMUNITY SERVICES 25.150 27.023 -1.873 -7.4%

CONTINUING CARE 17.177 17.933 -0.755 -4.4%

PRIMARY CARE 39.218 39.232 -0.013 0.0%

DELEGATED COMMISSIONING 25.634 25.359 0.275 1.1%

OTHER PROGRAMME 0.464 8.310 -7.846 -1691.3%

TOTAL COMMISSIONED SERVICES 304.298 319.110 -14.812 -4.9%

RUNNING COSTS 4.319 4.149 0.170 3.9%

TOTAL CCG POSITION YTD 308.617 323.259 -14.642 -4.7%

-833

-1,667

-2,500

-3,333

-4,167

-5,000 -5,833

-6,667

-7,500

-8,333 -9,167

-10,020

-1,889 -2,563

-3,174 -3,740

-4,421 -5,998 -6,740

-13,389

-14,745

-16,100

-14,745

-16,100

-18,000

-16,000

-14,000

-12,000

-10,000

-8,000

-6,000

-4,000

-2,000

-

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

£'0

00

NHS Warrington CCG 2019/20 Outturn Trajectories

Plan Net Risk Net Risk Trajectory Control Total System Recovery Trajectory

3. Financial Outturn Trajectories YTD Financial Position Rating:

Red

4. QIPP Position

The QIPP plan for 2019/20 is £16.366m,however unidentified QIPP accounts for£11.750m of this efficiency target.

The reporting profile to NHSE is different tothe profiling within the ledger, quarterlyversus monthly. Therefore within financialreturns to NHSE the YTD Unidentified QIPPvariance is £9.126m, however within theCCG financial position the YTD UnidentifiedQIPP variance is £10.083m.

The QIPP delivery against the Prescribingschemes tapered at month 10 based uponthe latest reports from the MedicinesManagement Team and expenditureperformance during 2019/20.

YTD Risk Rating : Red

FOT Risk Rating : Red

£m £m £m %

Acute Services 0.462 0.462 - 100.0 %

Mental Health Services 0.891 0.891 - 100.0 %

Continuing Care Services 0.444 0.444 - 100.0 %

Community Health Services 0.627 0.627 - 100.0 %

Primary Care Services 1.349 0.811 (0.538) 60.1 %

Other - 0.600 0.600 0.0 %

Unidentified QIPP 9.188 - (9.188) 0.0 %

TOTAL QIPP 12.961 3.835 (9.126)

Service Segment

Year to Date

Plan Actual Variance % Achieved

5. Risks and Mitigations

All known risks and mitigations are included within the forecast outturn position for February reporting.

This approach has been employed to support the national reporting requirements, with revised outturn targets being agreed and managed locally.

No further risks or mitigations have been included within reporting to NHS Northwest.

Since February reporting there have been significant national developments in relation to Coronavirus. Guidance from NHS England and Improvement are being issued to steer both Providers and Commissioners during this unprecedented time.

6. Conclusion

The development of financial plans, across the North West footprint, for the 2019/20 financial year to meet both theexpectations outlined within planning guidance and to secure the designated control totals proved a collective challenge.

For NHS Warrington CCG, this resulted in a financial pl

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