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Agenda – Wirral Governing Body Meeting PUBLIC SESSION – 2ND May 2017 Page 1 of 3

GOVERNING BODY MEETING – A meeting in public

Tuesday 2nd May 2017

Old Market House, Nightingale Room

1pm - 4pm

AGENDA

Ref No.

No Time Item Action Papers

GB17-18/0005 1. 1.00pm PRELIMINARY BUSINESS/ADMINISTRATIVE

ITMES (Chair)

1.1 Apologies for Absence 1.2 Chair’s Announcements To Note 1.3 Declarations of Interest 1.4 Welcome and

Comments/questions from members of the public (10 mins)

1.5 Minutes and Action Points of Last Meeting – 7th March 2017 Action Points

To Approve

2. DRAFT GB Minutes PUBLIC MEETING 07.03

3. MASTER - CORPORATE ACTION L

1.6 Matters Arising To Approve

1.7 Patient Story (Lorna Quigley)

To Note Presentation

1.8 Chief Officer’s Update (Simon Banks)

To Note Verbal

GB17-18/0006

2. 1.20pm RISK MANAGEMENT 2.1 Risk Register

(Paul Edwards) To

Discuss 4. MASTER Risk

Resgister -May GB me GB17-18/0007

3. 1.30pm FINANCE 3.1 Chief Financial Officer’s

Report (Mike Treharne)

• Finance Committee

To Note

To Note

5. Finance report cover sheet - May GB 2

6. Finance Report 16-17 - May GB 2017.d

7. Appendix 1 Governing Body - Finan

8. Finance Committee 21 March 2017 Chairs


Ref No.


Chair’s Report (Lesley Doherty)

• Turn Around Group Update Report (Mike Treharne)

To Note

9. Turnaround Group update reportGB.docx

GB17-18/0008

4. 1.50pm PERFORMANCE AND COMMISSIONING

4.1 Director of Commissioning’s Report (Nesta Hawker)

• Primary Medical Care Co-Commissioning Committee Chair’s Report

(Linda Roberts)

To Note

To Note

10. Cover Sheet Director of Commission

11. Director of Commissioning Report

11A. Copy of Copy of Operational Plan Dash

12. PMCCC Chair report 14.3.17.docx

GB17-18/0009

5. 2.20pm QUALITY & PATIENT SAFETY 5.1 Director of Quality &

Patient Safety’s Report (Lorna Quigley)

• Quality and Performance Chair’s Report

(Linda Roberts)

To Note

To Note

13. Director of Quality Cover sheet - May GB

14. Director of Quality and Patient Safety Rep

15. Wirral - Final NHSE return for 2016 E

16. wirral E+I annual report 2016.docx

17. Quality and Performance Chair rep

GB17-18/0010

6. 2.50pm GOVERNANCE AND ENGAGEMENT

6.1 Director of Corporate Affairs’ Report (Paul Edwards)

• Integration between NHS Wirral CCG and Wirral Council Commissioning

To Note

To Approve

18. Corporate Affairs Report cover sheet.doc

19. Director of Corporate Affairs Repo

20. Integration cover sheet.docx

21. Integration Update.docx


Ref No.


functions

• Governing Body Assurance Framework

• Audit Chair’s Report (Alan Whittle)

To Approve

To Note

22. Integration diagram.pdf

23. BAF cover sheet.docx

24. AF May Body narrative.docx

25. Wirral CCG Assurance Framework

26. Audit Committee Chairs Report 20 April

GB17-18/0011

7. 3.10pm MEDICAL 7.1

7.2

Medical Director’s Report (Dr Paula Cowan) Clinical Senate Chair’s Report (Dr Paula Cowan)

To Note

To Note

27. Medical Director GB Report - May 2017

28. Clinical Senate Chair Report GB May 2

GB17-18/0012

8. 3.30pm COMMITTEE REPORTS 8.1 Committee Meeting

Minutes

• Quality and Performance Minutes from January & February 2017

• Clinical Senate

Meeting of 14th February 2017 & 14th March 2017

• Audit Minutes from 26th January 2017

To Note

To Note

To Note

29. RATIFIED QP Minutes 31.01.2017.do

30. RATIFIED QP Minutes 28.02.2017.do

31. ratified clinical sentate minutes 14 2 1

32. RATIFIED Clinical Senate minutes 14.03

33. Ratified audit minutes 26 1 17.docx

GB16-17/0013

8.0 3.40pm ANY OTHER BUSINESS

Date and time of Next meeting: Tuesday 6th June 2017 – 1pm – 4pm Nightingale Room OMH Please forward any apologies to [email protected]

mailto:[email protected]

Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 7th March 2017 Page 1 of 7

WIRRAL CLINICAL COMMISSIONING GROUP GOVERNING BODY BOARD MEETING

Minutes of Meeting – Public Session

Tuesday 7th March 2017 1pm

Nightingale Room, Old Market House Present: Dr Sue Wells (SW) Chair Dr Paula Cowan (PC) Medical Director Jon Develing (JD) Chief Officer Mike Treharne (MT) Chief Financial Officer Nesta Hawker (NT) Director of Commissioning Paul Edwards (PE) Director of Corporate Affairs Lorna Quigley (LQ) Director of Quality & Patient Safety Dr Sian Stokes (SS) GP Lead – Long Term Conditions Dr Helen Downs (HD) GP Lead – Unplanned Care Dr Laxman Ariaraj (LA) GP Lead – Planned Care Dr Simon Delaney (SD) GP Lead – Primary Care Lesley Doherty (LD) Registered Nurse Alan Whittle (AW) Lay Member (Audit & Governance) Graham Hodkinson (GH) Director of Health and Care Richard Sturgess (RS) Secondary Care Doctor Mike Sowden (MS) Healthwatch In Attendance: Allison Hayes (AJH) Corporate Officer

Ref No. Minute

Action

GB16-17/0038

Preliminary Business 1.1 Apologies for absence Apologies were received from: Richard Williams, James Sowery, Linda Roberts and Fiona Johnstone.

1.2 Chairs Announcements/Opening Remarks Chair welcomed Dr Helen Downs, GP Lead for Unplanned Care and Dr Richard Sturgess, Secondary Care Doctor as new members of Governing Body. She also welcomed the members of the public to the meeting. 1.3 Declarations of Interest Chair reminded the Governing Body members of their obligations to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of Wirral Clinical Commissioning Group. Declarations declared by members of the Governing Body are listed in the CCGs Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: https://www.wirralccg.nhs.uk/Downloads/AboutUs/WhosWho/Register%20of%20Interes

https://www.wirralccg.nhs.uk/Downloads/AboutUs/WhosWho/Register%20of%20Interests%20Version%20Updated%20June%202016.pdf


Ref No. Minute

Action

ts%20Version%20Updated%20June%202016.pdf The following update was received at the meeting:

• With reference to business to be discussed at the meeting, LA declared that he works in Wirral University Teaching Hospital Foundation Trust as a GP with Special Interest in Endoscopy but that there were no decisions on the agenda that this represented a direct conflict with.

1.4 Comments/questions from members of the public There were 2 members of the public who attended the meeting. Mr D Stieber, Customer Liaison Manager with a provider organisation, addressed the Governing Body with regards to proactively identifying key areas of support that they could supply to the CCG. It was agreed that LQ would contact Mr Stieber after the meeting. 1.5 Minutes & Action Points from previous meeting held on 7th February 2017 The minutes of the previous meeting held on 7th February 2017 were agreed as a true and accurate record notwithstanding grammatical/typographical errors which will be rectified. Action Points: Members noted that the outstanding action. 1.6 Matters Arising There were no matters arising. 1.7 Patient Story In light of Prostate Cancer week, LQ read a transcript from a patient who had suffered with prostate cancer and the treatment he had received. Members recognised the positive aspects of the patient’s journey. Chair thanked LQ for the patient story. 1.8 Chief Officer’s update JD advised the Governing Body of discussions which have recently taken place with regard to the membership for the Healthy Wirral Partners Board and advised that the membership has now been amended to reflect Primary care, Children’s Services and Federations. JD reported that an independent chair has not yet been identified and therefore Clare Fish, Strategic Director at Wirral Borough Council, will act as the interim chair. JD reported that the CCG have received a ‘directions’ letter from NHS England (NHSE) as a result of the CCGs current and forecast financial position and advised that a response will be required within four weeks, incorporating an Improvement Plan and a Financial Recovery Plan. JD advised that a Turn Around Group has been established with Lay member support and it is expected these arrangements will improve the overall governance and grip around the recovery process and formalise the key

LQ

https://www.wirralccg.nhs.uk/Downloads/AboutUs/WhosWho/Register%20of%20Interests%20Version%20Updated%20June%202016.pdf


Ref No. Minute

Action

linkages to operational performance and wider improvement. JD also advised that the CCG has received a letter from NHS England offering support in relation to Quality, Innovation, Productivity and Prevention (QIPP) and that the CCG will be looking to take up this offer. JD reported that the first Joint Health and Wellbeing Board across Cheshire and Wirral has taken place and was very successful. Members of the Governing Body noted the Chief Officer’s update.

GB16-17/0039

2.0 Risk Management 2.1 Risk Register PE highlighted the main risks recently reviewed at the Quality and Performance Committee and the Governing Body noted the updated to the risks and accepted the recommendation to keep the scores as they were. He suggested that the key risk for focus in relation to today’s agenda was the CCGs financial position.

GB16-17/0040

3.0 Finance 3.1 Chief Financial Officer’s Report MT introduced the finance report for the period 1st April 2016 to 1st January 2017. MT drew members’ attention to the following headlines:

• £11.366 YTD deficit against Resource Limit • The CCG forecast outturn remains at £12.00m deficit, but there remains risk of

£0.5m attached to this forecast. The risk relates to expenditure on prescribing. • The risk attached to the forecast has reduced by £1.0m compared to month 9

due to some favourable contract movements, in particular Spire. • The QIPP required to achieve this forecast will be full year £3.779m consistent

with the M9 reported figure. With regards to non NHS contracts MT stated that there is a contract over performance of £253k at the end of month 10 which represents a favourable movement in the position of £234k when comparing to the month 9 position. MT reported that the CCGs QIPP challenge started at £17.6m. However, since the start of the year, the forecast outturn has been revised from a surplus of £0.4m to a deficit of £12m and advised that the QIPP forecast has been reduced to £3.779m. As at month 10, the remainder of schemes are delivering against forecast and all schemes have started In conclusion MT asked the Wirral Governing Body to note the Month 10 Operational overspend of £11.366m and the current full year forecast outturn of £12m with £0.5m of net risk attached. Members of the Governing Body noted the financial update. 3.2 Chair of Finance Committee Report LD provided a brief from the Finance Committee held on 31st January 2017. Significant topics discussed at the meeting included the following:


Ref No. Minute

Action

• Month 9 Financial position • 2017/18 Financial Plan • Audiology service procurement options appraisal • Continuing Health Care (CHC)/Joint packages improvement plan • Establishment of the Turn Around Group

Members of the Governing Body noted the Finance Committee Report.

GB16-17/0041

4.0 Performance and Commissioning 4.1 Director of Commissioning’s Report NH reported the key activities undertaken by her and her team. Particular focus was given to:

• NHS RightCare programme • November’s performance data

NH advised that Wirral CCG has adopted the NHS RightCare improvement methodology which is used to maximise value and reduce variation, both from an individual patient perspective and at population level. NH reported that through using this methodology, opportunities to increase value, improve outcomes and reduce spend have been identified within the following areas:

• Cardiovascular Disease (CVD) • Gastroenterology • Neurology

NH reported that task and finish groups with key stakeholders and clinical involvement have met to begin to redesign local pathways. NH went on to report the performance against the NHS constitutional standards for November 2016 and highlighted to members the following:

• The 4 hour A&E target – continues to be challenged and performance has not achieved the 95%.

• Ambulance standards continue to be a challenge, with a weekly average ‘time to clear’ of 33 minutes which is above the 30 minute standard.

• The referral to treatment (RTT) 18 week wait for incomplete pathway was not met in November and the CCG has not met the 92% standard since December 2015.

• In terms of IAPT (Improving Access to Psychological Therapies) the implementation of the action plan for recovery is continuing and additional action plans and scrutiny have been implemented in order to improve performance and meet the trajectories.

Members noted the Director of Commissioning’s report.

GB16-17/0042

5.0 Quality & Patient Safety 5.1 Director of Quality and Patient Safety’s Report LQ provided a report updating Governing Body members of the activities that have been undertaken by the Quality and Patient Safety team. Key areas of focus included:


Ref No. Minute

Action

• Performance against quality indicators (December) – Health Care Acquired Infections

• Mixed Sex Accommodation Breaches • Friends and Family • Serious Incidents • Care Quality Commission activities (CQC)

LQ asked Governing Body members to note the contents of the report and to be assured of the rigour in the process in relation to quality in nursing homes and domiciliary providers via the CQC inspection regime. 5.2 Quality and Performance Chair’s Report In the absence of LR, LQ provided a brief from the Quality and Performance Committee held on 20th December 2016. Significant topics discussed at the meeting included the following:

• Review of Risk Register • Performance of Wirral University Teaching Hospital Foundation Trust (WUTH)

in relation to the Constitutional Standards • Safeguarding Annual Report • Personal Health Budgets

Members of the Governing Body noted the Quality and Performance Report presented today.

GB16-17/0043

6.0 Governance and Engagement 6.1 Director of Corporate Affairs Report PE reported the key activities undertaken by the Corporate Affairs team and asked the Governing Body to note the following:

• Emergency Preparedness, Resilience and Response Core Standard Assurance – PE reported that the statement of compliance level was submitted as full compliance and this has now been confirmed by NHS England.

• Statutory and Mandatory training – PE reported that the target compliance rate for all training is 90% and overall the CCGs compliance rate is 94%.

• PE drew attention to the wide range of engagement activity undertaken recently. Members of the Governing Body noted and acknowledge the report and work carried out by the Director of Corporate Affairs. 6.2 Audit Chair’s Report AW provided a brief from the Audit Committee held on 26th January 2017. Significant topics discussed at the meeting included the following:

• Annual Audit Committee effectiveness review • CCG Annual Report 2016/17 – Month 9 Governance Statement Report • Conflicts of Interest quarterly assessment, January 2017 • Losses and Special payments • Review risks and controls around financial management • Review Information Governance compliance progress report • Review progress on implementation of internal Audit Report recommendations


Ref No. Minute

Action

• Review Counter Fraud Progress report • Receive progress reports from internal audit and external audit

AW drew members’ attention to the internal audit review of Quality, Innovation, Productivity and Prevention (QIPP) leadership arrangements within the CCG, which had been designated as providing limited assurance. However, recent changes, such as the formation of the Turn Around Group, should improve this. Members supported AW suggestion that Governing Body should commend to each subcommittee that an annual effectiveness review should be conducted in line with the approach taken to review the effectiveness of the Audit Committee. AW also stated that the CCG’s external auditor has written to the Secretary of State in relation to the CCG’s breach of financial duty. Members of the Governing Body noted the Audit Chair’s report.

GB16-17/0044

7.0 Medical 7.1 Medical Director’s Report PC provided the Governing Body with an update on the clinical leads and delegated duties of the Medical Director. Members noted the update provided by the Medical Director. 7.2 Clinical Senate Chair’s Report PC provided a brief from the Clinical Senate Committee of 17th January 2017. Areas included:

• Antimicrobial Resistance • Medical Optimisation Pathway • 2 week referral for suspected Upper Gastrointestinal Cancer • Procedures of Low Clinical Priority

PC advised that the medical optimisation pathway is a process so that patients who have a raised Body Mass Index (BMI) and/or who are smokers be given the opportunity to optimise and improve their surgical outcomes. PC went on to report that the 2 week referral pathway for Upper Gastrointestinal Cancer has recently changed with a direct to scope pathway now in place. PC also advised members that the Clinical Senate were given further updates on additional areas for consideration within the Procedures of Low Clinical Priority (PLCP). The Governing Body noted the Clinical Senates update.

GB16-17/0045

8.0 Committee Reports

• Quality and Performance Minutes from 20th December 2016 • Clinical Senate Meeting of 8th November 2016 and 11th Jan 2017 • Audit Committee of November 2016 • Finance Committee meeting of 20th December 2016

Members agreed for the Turn Around Group to submit a regular monthly update from


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Action

April onwards to the Governing Body. JD

GB16-17/0048

9.0 Any Other Business 9.1 Risk Register With regards to the financial position highlighted within today’s Finance report, members agreed that the risk rating remain the same on the Risk Register.

Date and Time of Next Meeting (informal meeting)

Tuesday 4th April 2017 1pm – 4pm Nightingale Room, OMH, Please forward any apologies to [email protected]

Board meeting ended at: 14:20pm.

mailto:[email protected]

Action Date of meeting Title of Item Agenda Ref ID Action Lead(s) Deadline Progress Update

1 10.01.2017 HWPB NA NA JD advised that the HWPB Change of membership details will need to be approved by the Governing Body in March

JD Mar-17 JD to update Governing Body as part of his Chief Officer's Report in March

4 10.01.2017 Director of Commissioning Report GB16-17/0028 4.1 NH to present final operational plan to Governing Body NH Jun-176 10.01.2017 Director of Quality Report GB16-17/0029 5.1 LQ to present more information on avoidable infections in

reports LQ Mar-17 Complete

7 07.02.2017 Service Review Report GB16-17/0036 4.1 NH to progress implementation of Service Review decisions NH Apr-17 Complete 8 07.03.2017 Comments and Questions from Public GB16-17/0038 1.4 LQ to contact Customer Lliasion Manager MHC LQ Apr-17 Complete 9 07.03.2017 Committee Reports GB16-17/0045 8 Turn Around Group to submit a regualr monthly update from

April onwards to GB MT/SB Apr-17 Complete

GB Formal Meetings Action Log

2017 Actions - GB Public Meeting

Master 16-17

Page 1 of 3

Risk ID Date added Source Division Risk Description Organisational Objectives (reference to detail)

Consequence

Likelihood

Matrix Score

Key Control Established Key Gaps in Control (reference to evidence)

Assurance on Controls (reference to evidence)

Gaps in Assurance (reference to evidence)

Consequence

Likelihood

Previous Risk

Rating

Owner Date of next review

Date of last review Last review Change narrative

Target Impact Target Likelihood Target Score Target Deadline

Risk Appetite

9

9

By end of quarter 1 - 2017

By end of March 2016.

3

3

3

4 4

5 20.00 On-going monitoring Target not being met by Wirral economy & rated high risk by NHS England and Monitor

Target continues to not be met.

414-15G Jun-14 CCG

14-15P January QPF CCG 3Minutes & monitoring of GB / QPF / Finance

Committee / QIPP Plan / Financial recovery plan.

Timeliness of reporting / ability it implement action

plans directly.

Ability to influence activity trends.

4Gov Body A&E 4 hour Target, including quality of care & standards provided to patients

Quality / Financial / Patient Safety

4

QPF Financial risk to CCG in achieving the planned circa £12 million deficit.

Financial 4 4 16.00 Regular financial reporting through QPF & GB.

Further detailed monitoring of contractual prescribing

& other commissioning expenditure areas as appropriate. Finance

Committee. QIPP Plan. Financial recovery plan.

16.00 NH April 2017 QP

Feb 17 QP - Additional narrative re quality review visits agreed.

Updated action plan reviewed at October QPF - Wirral economy is part of phase 1 ECIP and first meeting took place on 20th October 2015. Next due for review at QPF in January 16.Updated AP to be reviewed at Jan 16 QPF as weekly monitoring of the target continues.

Updated AP reviewed at Jan 16 QPF and agreed for the risk scores to remain the same. Noted that the ECIP report will be reviewed at Governing Body in March 16. Therefore action plan next due for review at March 2016 QPF.

Updated AP received for review at March QPF.

Reviewed at March 16 QPF and agreed that for 2015/16 the 4 hour target would not be achieved. QPF members recognised, however, that a range of measures are in place to address this risk and it was envisaged that performance would improve in quarter 1 2016/17.

Further update to be provided at QPF in April 2016.

Reviewed at April QPF and members agreed they would request specific assurances from the Systems Resilience Group around implementation of action plans and tangible improvement milestones.

Update provided at May QPF together with a review of the performance report and action plan to support patient flow. Next due for review at June QPF.

Some improvement following SAFER, new Chief Operating Officer appontment and improved internal processes. Score left as is to assess sustainablilty of improvement.

Reviewed at July 16 QPF - Agreed for next review at August 16 QPF. Agreed for scores to remain the same.

Current position and verbal update to be provided by NH at QPF in October 2016.

Discussed at QPF in October 2016 in line with the performance pack and agreed for the scores to remain the same. ECIP report to be received at the next QPF together with a verbal updae from NH in December 16.ECIP report presented at December 16 meeting. Recovery plan within the report to be closely monitored but scores to remain the same until tangible improvement is seen in performance.

Feb 17 - NH advised that performance has deteriorated and a formal letter is to be sent to WUTHsharing the concerns of the CCG. Assurance will be requested regarding the quality impact of the performance.

Feb 17 QPF - LQ reported that in light of repeated performance of below 80% quality review visits will be arranged to assure CCG that the actions outlined in correspondence have been undertaken.

Verbal update due for April QP meeting.

Oct 16 - Update provided from MT (plan lead) to update of the latest position for month 6 - Schemes are needed for £5 million to deliver the control deficit of £9 million. Scheme identified to the tune of £7.2 million which is a combination of new saving schemes and managing back operational overspend.

Oct 16 QPF - Noted financial position remains the same. Scores agreed to remain the same. Due for next review at Nov 16 QPF.

November 16 - Update from MT to advise that the risk to control decrease is estimated of £9 million is currently estimated at £3.5 million with known actions to mitigate further risk.

Finance Committee to provide report to QPF on a monthy basis until the approval of the Finance Committee as a sub-committee of Governing Body. Next due at QPF to be held in January 2017.

Jan 2017 - Year end planned deficit has now been moved, with agreement by NHS England, to circa 12 million. As a result, the Governing Body had increased confidence in achieving this position and hence reduced the likelihood score from 4 to 3.

Jan 17 QPF - Financial issue remains - Month 10 should provide a clear indication re position. Spire and Prescribng remain the two main issues

Feb 17 - Update from MC to advise that the full year forecast outturn remains at £12m, and there remains risk attached to this of £0.5m which has been discussed with NHSE. The risk will be reassessed for month 11 reporting.

March 17 QP - QP members agreed to increase the lieklihood score from 3 to 4.After Finance Committee consideration, it was felt that some of the potential financial risk was likely to materialise before year end,.Further verbal update to be provided at QP in April 17.

16.00 MT April 2017 QP

March 2017 QP 10th January 2017 - Year end planned deficit has now been moved, with agreement by NHS England, to circa 12 million. As a result, the Governing Body had increased confidence in achieving this position and hence reduced the likelihood score from 4 to 3.

February 2017 QP

Master 16-17

Page 2 of 3

16-17A Jul-16 CCG QPF Number of significant issues raised by MIAA report into Personal Health Budgets.

Commissioniong 3 3 9.00 Head of Partnerships to develop plan based on the management responses within the MIAA report.

Action plan still not developed.

Monitoring of action plan once in agreed and in

place.

Monitoring framework still not established.

3 3 9.00 LQ April 2017 QP

January 2017 QP Action Plan to be collated for review at July 2016 QPF.

Paper included within the agenda for July 16 QPF with MIAA Personal Health Budget Arrangements Advisory Report 2015/16 which also includes action plan. Agreed to leave risk on the register with the same scores.

Current position and verbal update to be provided by LQ at December 2016 QPF.

LQ deferred report until QPF in January 2017.

Verbal update to be provided in relation to the report at January 2017 QPF.

Jan 17 QPF - LQ advised that the report has not yet been received - LQ to follow this up via the joint CHC Committee and provide an update at QPF in February 2017 QPF.

Feb 17 - Update from LQ to advise that the need to increase PHB’s is a national drive for 2017/18, a system will be developed in order to achieve this which will fulfil the actions required in the MIAA report. Achievement against targets set will be reported upon via Q&P Committee.

LQ to provide verbal update at QP in April 17.

2 2 4 By end of quarter 1 - 2017

16-17C Nov-16 CCG QPF Increase in potential patient safety issues leading to moderate or severe harm at acute provider organisation.

Quality / Patient Safety 4 3 12.00 Monthly Serious Incident Review Group, of which

minutes are also reviewed at QPF Committee.

Awaiting outcome of the reviews.

Minutes of Serious Incident Review Group.

Potential patient safety issues.

LQ April 2017 QP

February 2017 QP Scores to be agreed at QPF to be held in December 2016.

08/12/2016 - Updates provided in relation to actions being taken in relation to this:

- 72 hour concise reviews being undertaken- External review of the Opthalmology service- Serious Incidents reported on the national reporting system (StEIS)- Contract meetings with provider organisation

Discussed at December 16 QPF and scores agreed as 4 for consequence and 3 for likelihood.

Next due for review at QP in February 2017.

Feb 17 - Update from SS to advise that the report from the external review of the Opthalmology Servuce was reviewed at Serious Incident Review Group and further questions were raised for clarification with WUTH - Therefore, awaiting action plan from the Associate Director of Risk at WUTH.

Feb 17 QP - Updated that all lists have now been suspended. Further verbal update to be provided at QP in April 2017.

Scores agreed as 4 for consequence and 3 for likelihood. TBC TBC TBC TBC

16-17D Feb-17 CCG QP Potential breach of Referral to Treat (RTT) targets

Quality / Patient Safety / Commissioning

3 5 15.00 NHS England have allocated funds for data validation which is being

monitored

Awaiting outcome of the data validation which is also in conjnction with

NHS Improvement

Data to be monitored and action plan to be

developed.

Potential patient safety issues.

NH April 2017 QP

February 17 QP April 17 - Data validation and cleanse being undertaken - Expecting for the situation to worsen before an improvement is seen. Action plan is to also be developed following the data cleanse exercise.Further update to be provided at May 2017 QP.

9 Update to be provided by the end of quarter 1 - 2017

3353Dec-15 CCG14-15U QPF Improving Access to Psychological Therapy (IAPT) service will not meet the targets related to access and treatment and performance will not improve with additional resource and will deteriorate with any claw back of resource by NHS England.

Quality / Patient Safety / Financial / Contracts

3 April 17 QP March 17 QP4 12.00 Wirral CCG Improving Access to Psychological Therapy (IAPT) Recover Plan 2015/16 in place.

15.00 The Recovery Standard has trajectory to be achieved by September 2016 (reported to NHS England in Feb 16 as part of the recovery planning). Currently on 45% from 40%, and the standard is 50%.

Risk to remain on the register until recovery standard is met, then all IAPT standards will be compliant (access, 6 and 18 week waiting times and recovery).

Update re IAPT performance provided at July and August 16 QPF - Noted (as above) to remain on the register until the recovery standard is met then all IAPT standrads will be compliant (access, 6 and 16 week waiting times and recovery).

Oct 16 QPF - Reviewed in line with the performance pack and noted that IAPT are not meeting the 6 weeks or recovery times. It was agreed for scores to remain the same but with close attention paid to improving performance. It was additionally noted that this risk was potentially affected by a local third sector provider' sustainability, but assurance was given by NH that contingencies were in place. Due for review further update at December 16 QPF.

LQ provided an update at December 16 GB to advise that a meeting will be held on 23rd December to discuss in depth the on-going risks associated with IAPT non-delivery. Scores to be re-assessed in January 2017.

Jan 17 - Verbal update to be provided and scores to be re-assessed in January 2017.

Jan 17 QPF - Update provided that IAPT is noted under performance at the contracy meetings. Noted no trends accross Cheshire and Merseyside. NHS England are supporting a Quality Meeting - currently awaiting date for this and following the meeting will outline the key lines of enquiry. CQC have held a meeting with the main provider but the CCG have received no feedback to date. Recovry has deteriorated 10% since last reporting period. Therefore, will continue to bemonitored / scrutinised.Further update to be provided at Feb 17 QPF.

Feb 17 - Update from SS to advise that a date has now been sent for 24th February 2017 to undertake the Quality Risk Profile with NHS England and further feedback will be provided once this has been completed.

March 17 QP - Update from SS at QP to advise that a quality risk profile has taken place in conjunction with NHS England resulting in an interim action plan, that will be monitored on a weekly basis.

Verbal update to be provided at April 17 QP.

NH

Master 16-17

Page 3 of 3

16-17E Mar-17 CCG Commissioning Introduction of primary care streaming mandated by NHSE – prescribed model is likely to have financial implications for the CCG

Commissioning 3 4 12.00 Whole system approach being adopted with

providers working together to develop economically

viable proposal

This is a recent directive so funding not identified

within CCG financial plan for 17/18

Agreement from all stakeholders to develop

sustainable solution

Level of financial risk currently unknown until

provider proposals submitted and reviewed

NH April 2017 QP

Not applicable April 17 - Awaiting submission of provider proposals.

Insert Rows Above This Line Only

Impact ValuesNegligible 1 Minor 2Moderate 3Major 4Catastrophic 5

Probability Values

Rare 1Unlikely 2Possible 3Likely 4Almost Certain 5

Green/Yellow/Red Threshold ValuesGreen - maximum score 4Yellow - minimum score 5Yellow - maximum score 12Red - minimum score 15

1/2

GOVERNING BODY REPORT COVER SHEET

Risk Please indicate Detail of Risk Description

High Medium Low YES

The figures in this report are subject to external audit but it is expected that the risk of any changes is low.

Clinical engagement taken place N

Patient and public involvement taken place N

Equality Analysis/Impact Assessment completed N

Quality Impact Assessment N

Chief Finance Officer’s Report Agenda Item: 3.1 Reference GB17-18/0007 Public / Private Public Meeting Date 2nd May 2017 Lead Officer/Author of paper

Mike Treharne, Chief Finance Officer

Contributors Mike Cunningham, Deputy Chief Finance Officer Emma Edwards, Senior Reporting and Planning Accountant

For Decision For Information Yes For Discussion Yes Executive Summary Financial performance as at 31st March 2017 (full year outturn subject to external

audit as referenced in the introduction section of the paper), and high level identification of risks for 2017/18.

Recommendations The Governing Body is asked to: • Note the contents of the report • Note the risks identified in the report

2/2

Strategic Themes To empower the people of Wirral to improve their physical, mental health and general well being Y

To reduce health inequalities across the Wirral Y

To adopt a health and well-being approach in the way services are both commissioned and provided Y

To commission and contract for services that:

• Demonstrate improved person centred outcomes • Are high quality and seamless for the patient • Are safe and sustainable • Are evidenced based • Demonstrate value for money

Y

To be known as one of the leading Clinical Commissioning Groups in the country Y

Provide systems leadership in shaping the Wirral health and social care system so as to be fit for purpose both now and in five years time

Y

This section gives details not only of where the actual paper has previously been submitted and what the outcome was but also of its development path i.e. other papers that are directly related to the current paper under discussion.

Governance route prior to Governing Body

Meeting Date Objective/Outcome

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1) INTRODUCTION

1.1 This report sets out the headline financial position for NHS Wirral Clinical Commissioning Group (Wirral CCG) as at the end of March (Month 12) 2016/17. As this is a yearend position, all figures quoted are subject to a satisfactory audit of the statutory accounts. The 1% headroom which the CCG has been required to maintain during the year has been released reflecting a yearend position. Therefore performance is measured against a forecast outturn deficit of £7.130m (calculated as £12.000m less 1% headroom of £4.870m). The main headlines are;

• £7.128m full year actual outturn deficit compared to forecast outturn deficit of £7.130m. This means that the CCG has achieved its forecast outturn in line with NHSE expectations.

• The QIPP delivery was as forecast at £3.779m.

2) FINANCIAL POSITION

2.1 As at the end of March, NHS Wirral CCG has a reported deficit of £7.128m. The year to date operational overspend is shown below:

Wirral CCG Financial Position as at 31st March 2017 (Month 12)

Expenditure Area M12 YTD

variance £'000

M11 YTD

variance £'000

Movement £'000s

NHS 1,284 1,295 (11)Non NHS 487 581 (94)Prescribing (591) (503) (88)Commissioned out of Hospital

4,377 4,050 327

Primary Care (405) (178) (227)Better Care Fund (321) (175) (146)QIPP (incl reserves/ contingency)

2,909 7,546 (4,636)

Running costs (218) (222) 4Operational performance

7,522 12,394 (4,872)

Surplus (394) (361) (33)CCG YTD overall 7,128 12,032 (4,905)

Report Title Chief Finance Officer’s Report Lead Officer Mike Treharne, Chief Finance Officer Recommendations To note contents of M12 report and delivery of the CCG’s forecast

outturn in line with NHSE expectations.

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2.2 This deficit position reported includes full year QIPP achieved of £3.779m, and a number of operational overspends as discussed (starting at paragraph 2.3) below. A full breakdown of the CCG position by contract and spend area is within Appendix 1.

NHS Contracts

2.3 NHS contracts £1,284k overspent which represents a favourable movement of £11k when compared to the month 11 YTD position. Of the £1,284k overspend; £193k is attributable to the Countess of Chester Hospital. This is predominantly due to critical care which is overspending by £319k, offset by underspends in electives and non-electives.

2.4 The Liverpool Heart and Chest Hospital contract also over performed by £255k for the year predominantly due to day cases including a biventriculuar pacemaker, percutaneous interventions and perc complex ablations.

2.5 Wirral Community Trust over performed by £278k. This was predominantly due to

physiotherapy overspending by £200k and an increase in CTS attendances.

2.6 Royal Liverpool & Broadgreen University Hospital over performed by £253k for the year which was predominantly due to non-achievement of QIPP.

2.7 The remaining overspend of £305k was due to increased performance across all other

NHS contracts.

2.8 The weekly activity management group (AMG) continues to look into significant contract variances and there is an activity log to monitor actions which is reviewed and task and finish groups set up to report back on items identified.

Non NHS Contracts

2.9 Non NHS contract over performance was £487k for the full year. This represents a favourable movement in the position of £94k when comparing to the month 11 YTD position.

Spire Murrayfield was £665k over the planned level of spend for the full year which represents a favourable movement of £141k when compared to Februarys YTD position. This is due to activity data having been received at the predicted lower levels. This overspend was partially offset by under performance against planned levels at Peninsula (£107k) and one to One Midwifery (£110k).

2.10 Monthly practice visits continue to take place in order to attempt to address the issue of over performance.

Prescribing 2.11 The month 12 financial position for prescribing has been informed by February’s data.

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This shows a year to date position of £591k underspent, (favourable movement of £88k) of which £579k relates to practice prescribing, £39k against central drugs, but a pressure of £29k against Air Liquide.

Continuing Healthcare

2.12 As at the end of March, Joint/ Fully Funded and Children’s packages were overspent by £4,377k. This is an adverse movement of £327k when compared to the month 11 position. Of this, approximately £125k is the result of the FNC rate increase approved by government. The remaining pressure has been caused by a number of new packages, existing package price increases and also the impact of QIPP non delivery £92k.

2.13 The main movements however this month include the following:

Continuing Healthcare

• 26 new CHC eligible packages have been agreed totalling an estimated value of £496k (note this value also includes the impact of all YTD new packages), with an increase in existing package costs totalling £100k. 16 packages have ceased totalling £266k. We have also seen a number of new PHB packages with a total cost of £28k.

Joint Funded/Complex Care

• 12 new Complex Care packages have been agreed totalling an estimated value of £520k (note this value also includes the impact of all YTD new packages), with an increase in existing package costs totalling £79k. 8 Complex Care MH packages have ceased totalling £397k.

Funded Nursing Care

• The impact of the weekly rate increase has seen an in month impact of £125k.

Better Care Fund 2.14 BCF has reported a full year underspend of £321k, an improvement of £146k compared to the £175k underspend reported at month 11. This position reflects slippage on a number of schemes.

Running Costs

2.15 Running cost budgets were underspent by £233k for the full year. This reflects some pay & non pay underspends relating to vacancies and some staff not currently being part of the NHS pension scheme.

2.16 The savings referred to in 2.15 more than offset the non-recurrent expenditure which the

CCG has incurred as part of its financial recovery. 2.17 The outturn position includes costs pressures identified in earlier reports relating to

Property Services Limited for the vacant space within Old Market House. This relates to the space that the Community Trust used to occupy, as host tenant, the CCG is liable for the charges until the space is occupied.

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3) QIPP

3.1 The CCGs QIPP challenge started at £17.6m (excluding BCF £0.6m). However since the start of the year the forecast outturn was revised from a surplus of £0.4m to a deficit of £12m. The QIPP requirement was consequently revised. The actual QIPP outturn for the year was £3.779m in line with the forecast made in recent months.

4) UNDERLYING POSITION

4.1 Due to the sizeable challenge the CCG faces, it must be noted that the underlying position

of the CCG finances is a significant deficit.

Wirral CCG Underlying Recurrent Position 2017/18 Revenue Resource Limit 493,944 Programme Costs 495,207 Running costs 7,099 Contingency - Total Application of Funds 502,306 Underlying Surplus /(Deficit) (8,362)

4.2 £8.4m deficit would mean contingency and headroom have been utilised. In order to

return to business rules (1% surplus/ 1% headroom and 0.5% contingency (£12.4m)), the underlying position could be closer to £21m deficit.

5) RISKS

5.1The risks previously identified pertaining to 2016/17 have been managed within the overall

position to achieve the forecast outturn. 5.2 However moving into 2017/18 the key risks facing the CCG include achievement of a QIPP

plan of £12.3m and ensuring operational/contract expenditure is managed in line with the financial plan set.

6) CASH MANAGEMENT

6.1 The recorded CCG cash book balance at the end of March was £16k. This is in line with

current NHSE guidance that CCGs aim towards 1.25% month end cash balance of the drawdown.

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6.2 In total there is £1,778,450 of outstanding debt at 31st March 2017. The ageing profile is shown in the graph below.

6.3 The top 3 debtors by value greater than 30 days amount to £78,671.

Customer £ Invoice Date Comments NHS MIDLANDS AND LANCS CSU 29,308.53 11/02/2017 Update required. WIRRAL UNIVERSITY TEACHING HOSPITAL 25,719.74 11/02/17

Clarity sought on what further back up information is required 16/03..

WIRRAL METROPOLITAN BOROUGH COUNCIL 23,642.40 various Payment date requested 30/03

6.4 The BPPC monitors public sector organisations on the timeliness of its financial payments in terms of both volume and value. Guidance recommends 95% of payments within 30 days, the CCG performance was 99.32% for March. The following table shows the number of invoices paid against target.

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6.5 Expenditure incurred above £25k is collected monthly and published on the CCG website.

7) CONCLUSION

7.1 The Governing Body is asked to note: • Full year actual outturn deficit £7.128m compared to forecast deficit of £7.130m (after

release of 1% headroom).

• QIPP actual outturn £3.779m.

• Risks pertaining to 2017/18 – achievement of QIPP plan £12.3m, and the need for vigorous control of operational/contractual expenditure in line with the agreed finance plan.

Month Period Number

Paid Year

Total Number

of Invoices

Paid

Total Paid

Within Target

No.

%age Total Value of Invoices Paid £

Value paid w ithin Target £

%age

APRIL 01 16 866 860 99.31% 33,456,211.22 33,444,805.71 99.97%MAY 02 16 1032 1014 98.26% 53,350,413.32 53,321,457.60 99.95%JUNE 03 16 1318 1298 98.48% 18,709,856.47 18,689,113.64 99.89%JULY 04 16 1031 1030 99.90% 40,173,367.99 40,120,156.39 99.87%AUGUST 05 16 1253 1244 99.28% 35,662,459.16 35,654,083.17 99.98%SEPTEMBER 06 16 1099 1090 99.18% 35,889,499.67 35,862,128.53 99.92%OCTOBER 07 16 1040 1033 99.33% 38,417,565.13 38,379,976.62 99.90%NOVEMBER 08 16 845 841 99.53% 33,905,551.55 33,843,665.90 99.82%DECEMBER 09 16 1264 1253 99.13% 37,471,119.61 37,450,927.03 99.95%JANUARY 10 17 1009 976 96.73% 39,241,694.88 38,871,692.69 99.06%FEBRUARY 11 17 1075 1061 98.70% 33,987,741.71 33,932,583.55 99.84%MARCH 12 17 1347 1295 96.14% 37,254,056.15 37,002,580.49 99.32%

13179 12995 98.60% 437,519,536.86 436,573,171.32 99.78%

Performance Against Better Payment Practice Code (BPPC) ALL

NHS Wirral CCG

APPENDIX 1 - Month 12 Breakdown of Expenditure By Contract & Spend Area

Cost Centre Expenditure Category Annual Budget Budget to Date

Spend to Date Variance Prior Mth YTD Variance

Change In YTD Variance

Prior Mth Forecast Variance Including

RiskWirral University Teaching Hospital NHS Foundation Trust Acute 228,177,000 228,177,000 228,162,153 (14,847) (15) (14,832) 0North West Ambulance Service Ambulance and Other 12,165,890 12,165,890 12,324,836 158,945 195,636 (36,690) 236,816West Midlands Ambulance Service Ambulance and Other 898,443 898,443 1,046,906 148,464 133,810 14,654 157,860Royal Liverpool & Broadgreen University Hospitals NHS Trust Acute 7,398,314 7,398,314 7,651,706 253,392 (27,353) 280,745 (9,592)Aintree University Hospitals NHS Foundation Trust Acute 2,786,886 2,786,886 2,966,097 179,211 122,548 56,663 145,038Countess of Chester NHS Foundation Trust Acute 4,214,294 4,214,294 4,406,827 192,533 316,767 (124,234) 311,892Liverpool Womens NHS Foundation Trust Acute 2,578,747 2,578,747 2,767,862 189,115 169,826 19,290 212,843Liverpool Heart & Chest NHS Foundation Trust Acute 1,297,932 1,297,932 1,552,941 255,009 223,770 31,239 244,106Alder Hey Childrens NHS Foundation Trust Acute 2,163,700 2,163,700 2,108,843 (54,857) (109,429) 54,572 (130,034)St Helen's & Knowsley NHS Trust Acute 1,046,464 1,046,464 880,589 (165,875) (141,546) (24,329) (166,924)CCC Diagnostics Other 168,188 168,188 123,664 (44,524) (36,737) (7,786) (41,940)Central Manchester University Hospitals NHS Foundation Trust Acute 223,955 223,955 284,094 60,139 49,218 10,921 60,139Warrington & Halton Hospitals NHS Foundation Trust Acute 96,821 96,821 97,683 862 7,002 (6,140) 7,401Wrightington, Wigan and Leigh NHS Foundation Trust Acute 147,347 147,347 124,931 (22,416) (13,456) (8,960) (16,388)University Hospital of South Manchester NHS Foundation Trust Acute 168,267 168,267 216,428 48,161 40,710 7,450 46,106Walton Centre NHS FT Acute 1,010,472 1,010,472 1,070,707 60,235 72,097 (11,862) 78,640Non Contracted Activity (various providers) Acute 2,660,510 2,660,510 2,507,065 (153,445) 1,336 (154,781) 0Cheshire & Wirral Partnership NHS Foundation Trust Mental Health 33,081,753 33,081,753 32,943,222 (138,531) (98,071) (40,460) (96,762)South Staffordshire and Shropshire Healthcare NHS Foundation Trust Mental Health 2,617,118 2,617,118 2,589,842 (27,276) (1,743) (25,533) (1,741)Greater Manchester West MH NHSFT - Military Vets Mental Health 30,000 30,000 30,302 302 (63) 365 0MH NCAs (Various Providers)/ Merseycare NHS Trust Mental Health 54,393 54,393 136,089 81,696 32,874 48,822 35,854Wirral Community NHS Trust Community 42,929,211 42,929,211 43,207,031 277,820 358,375 (80,555) 426,438Liverpool Community Health NHS Trust Community 47,897 47,897 47,376 (521) (473) (48) (521)Total NHS Contracts 345,963,602 345,963,602 347,247,193 1,283,591 1,295,083 (11,492) 1,499,231Spire - Murrayfield Acute 5,701,910 5,701,910 6,367,046 665,136 806,171 (141,035) 748,090Spa Medica Acute 1,447,599 1,447,599 1,382,649 (64,950) (50,203) (14,747) (47,017)One to One Midwifery Acute 934,426 934,426 824,792 (109,634) (114,818) 5,184 (124,945)Spire Liverpool Acute 86,765 86,765 136,386 49,621 20,145 29,476 21,971Extended Choice Network Acute 63,994 63,994 118,236 54,242 48,851 5,391 53,283Locally Commissioned Services - Minor Surgery (Wallasey&Bebington) Community 181,522 181,522 156,589 (24,933) (34,762) 9,829 (37,932)Peninsula Community 1,993,374 1,993,374 1,886,708 (106,666) (105,203) (1,463) (112,125)Locally Commissioned Services Community 2,867,508 2,867,508 2,908,919 41,411 23,868 17,543 34,431Stroke Association Other 135,829 135,829 135,829 0 1 (1) 0Specialist Care / IFR Panel Approvals Other 345,284 345,284 374,214 28,930 21,237 7,694 23,159Marie Curie Community 113,675 113,675 123,685 10,010 10,054 (44) 10,957End of Life Community 329,545 329,545 329,567 22 32 (10) 23St Johns Hospice (Wirral) Community 1,642,482 1,642,482 1,634,072 (8,410) (7,197) (1,212) (7,755)British Pregnancy Advice Service Community 196,327 196,327 225,237 28,910 31,381 (2,472) 34,230Patient Transport Other 37,706 37,706 18,994 (18,712) (15,606) (3,106) (17,039)Mental Health Services Mental Health 67,998 67,998 68,002 4 (928) 932 0Primary Care Advice Link Other 484,820 484,820 484,746 (74) (73) (1) 0CAMHS Mental Health 174,000 174,000 174,000 0 0 0 0Parenting & Prevention Other 87,500 87,500 30,000 (57,500) (52,711) (4,789) (57,500)Homeopathy Other 14,318 14,318 10,077 (4,241) (3,046) (1,195) (4,241)Looked After Children Other 0 0 3,372 3,372 3,583 (211) 2,000Total Non Acute Contracts 16,906,582 16,906,582 17,393,121 486,539 580,775 (94,236) 519,590Primary Care Prescribing Prescribing 59,201,241 59,201,241 58,621,870 (579,371) (522,848) (56,524) (716,930)Central Drugs Prescribing 1,728,388 1,728,388 1,688,547 (39,841) (29,030) (10,811) (23,619)Air Liquide Prescribing 527,608 527,608 556,204 28,596 49,214 (20,618) 56,446Total Prescribing 61,457,237 61,457,237 60,866,620 (590,617) (502,664) (87,953) (684,103)Continuing Healthcare/ Fully Funded Packages of Care Commissioned Out of Hospital 8,124,350 8,124,350 9,747,402 1,623,052 1,206,136 416,917 1,331,852Continuing Healthcare/ Fully Funded Packages of Care Personal Health Commissioned Out of Hospital 857,048 857,048 1,225,950 368,902 340,936 27,966 360,165Continuing Healthcare/ Joint Funded Packages of Care Commissioned Out of Hospital 19,242,408 19,242,408 20,132,870 890,462 836,228 54,234 1,219,641Continuing Healthcare/ Joint Funded Packages of Care Personal Health Commissioned Out of Hospital 0 0 40,918 40,918 38,716 2,201 39,022Children with Special /Safeguarding Needs Commissioned Out of Hospital 1,522,841 1,522,841 1,333,165 (189,676) 109,699 (299,375) 139,303CHC Childrens Personal Health Budgets Commissioned Out of Hospital 32,557 32,557 33,651 1,094 822 272 1,054Funded Registered Nursing Care Commissioned Out of Hospital 4,581,840 4,581,840 6,224,210 1,642,370 1,517,448 124,921 1,616,530Total Commissioned out of Hospital 34,361,044 34,361,044 38,738,167 4,377,123 4,049,986 327,137 4,707,567LES Budgets Other 2,260,691 2,260,691 1,924,585 (336,106) (130,694) (205,413) (142,907)Primary Care Development Other 170,000 170,000 163,165 (6,835) 0 (6,835) 0Think Pharmacy Other 200,000 200,000 125,894 (74,106) (65,527) (8,579) (74,103)WCCG Service Development Other 698,972 698,972 663,190 (35,782) (22,859) (12,923) (40,305)

Cost Centre Expenditure Category Annual Budget Budget to Date

Spend to Date Variance Prior Mth YTD Variance

Change In YTD Variance

Prior Mth Forecast Variance Including

RiskInterpreting Services Other 70,400 70,400 74,018 3,618 3,528 90 1,841Collaborative Fees Other 180,625 180,625 182,983 2,358 0 2,358 0Phlebotomy Other 121,029 121,029 168,253 47,224 43,067 4,157 31,920Prior approvals & exceptions (GPIT spend) Other 0 0 (703) (703) (703) 0 0PCTF Revenue Other 29,007 29,007 0 0 0 0Primary Care GPIT Other 860,000 860,000 855,589 (4,411) (4,485) 74 (4,492)Total Primary Care 4,590,724 4,561,717 4,185,981 (404,743) (177,672) (227,071) (228,046)Reablement Other 21,267,047 21,267,047 20,881,196 (385,851) (251,413) (134,438) (272,460)Acute Elderly Services Other 623,039 623,039 623,040 1 10 (9) 1Commissioning - Non Acute Other 127,057 127,057 127,057 0 12 (12) 0Community Services Other 48,633 48,633 33,914 (14,719) (13,674) (1,045) (14,925)Palliative Care Community 43,785 43,785 43,782 (3) 4 (7) 0Hospices Community 230,036 230,036 230,035 (1) 5 (6) 0Mental Health Services - Advocacy Other 16,521 16,521 53,415 36,894 33,224 3,670 36,243MH Services - Adults Other 471,996 471,996 471,996 0 8 (8) 0Dementia LES Other 53,000 53,000 72,587 19,587 17,960 1,627 19,587Dementia Other 221,290 221,290 221,292 2 11 (9) 0Intermediate Care Other 1,840,596 1,840,596 1,863,294 22,698 38,664 (15,967) 40,605Total BCF 24,943,000 24,943,000 24,621,608 (321,392) (175,189) (146,203) (190,949)Programme Projects (VANGUARD) Other 75,000 75,000 177,619 102,619 105,857 (3,238) 105,857CHC Admin Team Other 796,022 796,022 796,020 (2) 0 (2) 0CHC Admin Team - Other Other 187,374 187,374 187,378 4 () 4 0CSU MM Programme charges Other 873,125 873,125 873,122 (3) 1 (5) 0Winter Pressures (SRG) Other 198,684 198,684 134,493 (64,191) (3,535) (60,656) (64,191)Safeguarding Other 385,396 385,396 370,080 (15,316) (11,147) (4,169) (12,159)Safeguarding - other Other 194,082 194,082 191,562 (2,520) 96 (2,616) 0General Reserve - Programme Reserves 446,064 446,064 (1,572,301) (2,018,365) (1,719,867) (298,498) (2,091,961)Contingency Reserves 2,470,100 2,470,100 0 (2,470,100) (2,265,077) (205,023) (2,470,100)Rec QIPP Target Reserves (13,549,856) (13,549,856) 0 13,549,856 12,547,223 1,002,633 13,549,856Non recurrent Reserves Reserves 1,305,720 1,305,720 0 (1,305,720) (1,108,051) (197,669) (1,305,720)1% Headroom Reserves 4,867,000 4,867,000 0 (4,867,000) 0 (4,867,000) 0Total Other (1,751,289) (1,751,289) 1,157,973 2,909,262 7,545,501 (4,636,239) 7,711,582Total Programme Budgets 486,470,900 486,441,893 494,210,663 7,739,762 12,615,819 (4,876,056) 13,334,872Chair and Non Execs Running Costs 182,661 182,661 183,573 912 4,344 (3,432) 3,395CEO/ Board Office Running Costs 757,690 757,690 954,112 196,422 181,243 15,178 194,749Strategic Planning & Outcomes Running Costs 446,821 446,821 446,052 (769) (5,528) 4,759 (3,125)Clinical Governance Running Costs 469,954 469,954 345,177 (124,777) (123,062) (1,715) (134,723)Contracts Management Running Costs 552,422 552,422 423,755 (128,667) (123,629) (5,038) (130,513)Corporate Costs Running Costs 795,891 795,891 915,838 119,947 97,714 22,234 137,683CSU SLA Running Costs 444,580 444,580 411,895 (32,685) (30,089) (2,596) (32,685)Business Informatics Running Costs 445,218 445,218 423,212 (22,006) (14,242) (7,764) (21,850)Finance Running Costs 883,227 883,227 814,582 (68,645) (59,127) (9,518) (68,679)Commissioning Running Costs 553,767 553,767 564,519 10,752 6,935 3,817 2,152PALS Running Costs 34,000 34,000 34,000 0 2 (2) 0Reserves RC Running Costs 86,874 86,874 (81,740) (168,614) (156,731) (11,883) (169,150)Total Running Costs 5,653,105 5,653,105 5,434,975 (218,130) (222,170) 4,040 (222,746)

Total Wirral CCG Spend 492,124,005 492,094,998 499,645,638 7,521,633 12,393,649 (4,872,016) 13,112,126Surplus Offset 394,000 394,000 0 (394,000) (361,163) (32,837) (394,000)Total Wirral CCG Resource 492,518,005 492,488,998 499,645,638 7,127,633 12,032,486 (4,904,853) 12,718,126

* Running costs budget is vired non recurrently each year to cover programme spend - actual running costs expenditure against the original allocation is shown on the line below

Total Running Costs 7,099,000 7,099,000 6,865,555 (233,445) (233,314) (131) (234,905)

Wirral Clinical Commissioning Group

Briefing from the Deputy Chair of the Finance Committee, 21 March 2017

Purpose

The purpose of the committee is to provide assurance to the Governing Body in relation to the financial performance and plans of the CCG. This includes an assessment of the major risks to the delivery of the CCG’s statutory financial duties and the effectiveness of mitigating actions to manage the risks, the achievement of value for money in the use of resources, and the delivery of the annual Quality, Innovation, Productivity and Prevention plan, which is fundamental to the CCG’s ability to operate within the business rules determined by NHS England.

Significant agenda Items/Key topics discussed

• Month 11 Financial Position. The control total for the year of £12million deficit agreed by NHS England will be a major challenge to achieve, following a deterioration of £666,000 during Month 11.The committee focussed its discussion on the main areas of overspending, and efforts to improve performance.

• Cheshire and Wirral control total for 2017/18. NHS England has set a break-even control total for the CCG for next year, which will necessitate delivery of QIPP savings of over £12 million in the year, significantly more than the £3.8 million forecast achievement in 2016/17.

• Proposed Incentive Scheme for Primary Care Prescribing. The committee considered and supported a new prescribing incentive scheme, which if successfully implemented, will improve the quality, safety and cost effectiveness of prescribing, with shared benefit for the CCG and individual participating practices.

• Financial Recovery Plan. The committee reviewed the draft plan, which must be submitted to NHS England as part of the Capability and Capacity Action Plan, by 23 March 2017. Committee members made suggestions to strengthen the narrative of the plan, particularly in relation to proposals being considered to identify the full value of QIPP schemes required, and to address current overspending trends in key managed budgets such as Continuing Health Care and Physiotherapy Services.

Outcomes/actions/assurances/risks

• Based on the Month11 financial performance, there is a strong risk that the control total for 2016/17, set by NHS England may be breached. The CFO is reviewing all available options to avoid this position.

• In order to be released from formal Directions by NHS England in March 2018, the CCG must deliver a QIPP savings programme of over £1 2million in 2017/18, more than 3 times that achieved in 2016/17, as well as control spending within all managed operational budgets.

•

Any formal recommendations

The recommendations to the Governing Body from the meeting are as follows:-

• The Governing Body should take clear ownership for the successful delivery of the Capability and Capacity Action Plan, and in particular the Financial Recovery Plan.

Deputy Chair Name: Alan Whittle

Deputy Chair of Finance Committee

Date: 23 March 2017

1/2

1. INTRODUCTION 1.1 This report provides an update from the Turnaround Group meetings held on 28th February and the

21st March.

1.2 The Turnaround Group was established to improve the governance around Financial Recovery and to support the work of the Financial Recovery Group. The Turnaround Groups’ focus is on execution at Executive and Governing Body level, and it meets monthly to track the progress of the key programme themes and agree any mitigations or recovery activity necessary; it also tests the level of clinical ownership and confidence in the measures coming forward. Detailed scrutiny and development of individual QIPP projects takes place at the Financial Recovery Group, working to a new and more robust decision making process. The Finance Committee retains the key overview responsibility for financial recovery, to the Governing Body.

1.3 The terms of reference and scope of the Turnaround Group was approved at the Finance

Committee, and the first meeting was held on the 28th February.

2. KEY ISSUES / MESSAGES 2.1 The February meeting covered the following key areas:

• Agreement of terms of reference, scope of the group, and overall governance. • 2016/17 Financial plan and QIPP update. • 2017/18 Financial plan and QIPP update. • 2017/18 QIPP schemes requiring gateway review. • 2017/18/19 Operational plan. • Improvement Plan update.

2.2 The March meeting covered the following key areas:

• Requirements of the NHS England directions letter, • Discussion/Approval of the Improvement Plan, • Discussion/Approval of the Financial Recovery Plan 2017/18 – 2018/19.

2.3 The group strengthens the governance arrangements around the delivery of the QIPP programme

in terms of accountability, and provides a direct line of sight for governing body through the Accountable Officer who Chairs the meeting.

Report Title Turnaround Group Update Report Lead Officer Simon Banks, Accountable Officer

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2.4 The 2017/18 QIPP plan has currently around 83% in total identified and this represents a considerable improvement on last year where very little was identified at the planning stage. The delivery of schemes now needs to be the key focus in terms of execution, and this represents a key challenge for the Executive Team, and for the CCG as a whole.

2.5 The Business case approach to QIPP scheme approval improves the governance and rigour

around schemes, ensuring we take forward those schemes that deliver the best returns. However, the identification of the business case outcomes in terms of both change and financial savings need further focus in terms of scale and pace to support improved delivery. It is important that cases are honed in on the key deliverables to gain traction, and that sufficient resource is supporting delivery.

2.6 The operational plan will need to support the financial recovery and QIPP requirements once this is

completed in May. 2.7 The Improvement Plan shows progress to date in terms of the implementation of key

recommendations, however there remains a significant challenge in terms of supporting the changes required to deliver the new ways of working.

2.8 The Financial Recovery Plan meets the requirements to deliver a balanced plan in 2017/18 through

a £12,275m QIPP, the challenges remaining around delivery. 2.9 The CCG expects to receive feedback on both the Improvement plan and the Financial Recovery

Plan from NHSE as part of its directions.

3. IMPLICATIONS

3.1 The delivery of the financial plan for 2017/18 and the supporting QIPP is critical to the CCG

achieving the requirements laid out in its directions.

3.2 The Executive Directors will need to ensure they have the appropriate focus within their teams to assure delivery.

4. CONCLUSION

4.1 The Turnaround Group provides a key assurance to the Governing Body in holding to account on delivery of QIPP and wider transformation.

Simon Banks Chief Officer

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GOVERNING BODY BOARD REPORT COVER SHEET

Risk Please indicate Detail of Risk Description

High YES Medium Low

The exceptional performance is identified as a risk within the CCG Risk Register.

Clinical engagement taken place N

Patient and public involvement taken place N

Equality Analysis/Impact Assessment completed N

Quality Impact Assessment N

Director of Commissioning’s Report Agenda Item: 4.1 Reference GB17-18/0008 Public / Private Public Meeting Date 2nd May 2017 Lead Officer/Author of paper

Nesta Hawker, Director of Commissioning

Contributors Tricia Clitheroe, Assistant Director of Contracts and Delivery, Andrew Cooper, Assistant Director of Planned and unplanned Care, Anna Coyle, Programme Management Office Lead

For Decision For Information Yes For Discussion Executive Summary The report highlights key updates from the portfolio of the Director of

Commissioning.

Recommendations The Governing Body is asked to: • Note the contents of the report

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Strategic Themes To empower the people of Wirral to improve their physical, mental health and general well being Y

To reduce health inequalities across the Wirral Y

To adopt a health and well-being approach in the way services are both commissioned and provided Y

To commission and contract for services that:

• Demonstrate improved person centred outcomes • Are high quality and seamless for the patient • Are safe and sustainable • Are evidenced based • Demonstrate value for money

Y

To be known as one of the leading Clinical Commissioning Groups in the country Y

Provide systems leadership in shaping the Wirral health and social care system so as to be fit for purpose both now and in five years time

Y

This section gives details not only of where the actual paper has previously been submitted and what the outcome was but also of its development path i.e. other papers that are directly related to the current paper under discussion.

Governance route prior to Governing Body

Meeting Date Objective/Outcome

Report Title Director of Commissioning’s Report Lead Officer Nesta Hawker, Director of Commissioning

Recommendations • To note update on the implementation of the CCG Operational Plan

for 2016/17 • To note the update on the Better Care Fund to 2017/18 • Note the review of recent performance against constitutional

standards.

1 INTRODUCTION

This paper provides Governing Body with a report on the key strategic and operational issues and developments related to the delegated duties of the Director of Commissioning.

2 STRATEGY DEVELOPMENT AND REFORM IMPLEMENTATION

2.1 OPERATIONAL PLAN 2016/17

The CCG Operational Plan for 2016/17 had a number of milestones for achievement of the key priority areas of work. Against the key priority areas there were 115 milestones of which 73 have been achieved, 32 will be achieved during 2017/18 and 8 remain outstanding with mitigating actions identified against each of these. The detail of the milestones and achievements are shown in appendix 1 and the below is a summary of achievements against each of the priority areas.

2.1.1 Primary Care Transformation – notable achievements in this area include use of e-referral increasing to 78% from baseline of 56% and an increase to 90% of patients rating the experience of accessing GP service as very good or good. There is one unachieved milestone within this priority area related to the CCG achieving level 3 delegated commissioning for primary care. Further engagement work will continue during 2017/18 with our members with the aim of submit an application for level 3 with member approval.

2.1.2. Urgent Care Redesign – whilst achievements have been made during 2016/17, there are a number of milestones that will continue into 2017/18. In order to reduce low acuity presentations at the hospital, primary care streaming is now being undertaken at the emergency department at the hospital both for those brought via ambulance and also for those who walk into the department. During 2016/17 the CCG completed a value stream analysis of the urgent care pathway with key stakeholders which has resulted in the development of two proposed models for an improved urgent care pathway. Further engagement work will be undertaken prior to a full formal public consultation during 2017/18.

2.1.3 Care Closer to the Individual (Better Care Fund) – key achievements in this area include the success of intermediate care in supporting 90% of people to remain at home 91 days after discharge. However, overall the various schemes within the Better Care Fund have not achieved the target of 3% reduction in non-elective admissions (actual 2.7%) and there has been no reduction in bed occupancy.

2.1.4 Transforming of Diabetes Care – key milestones have been achieved during the year and there is only one milestone that will now be achieved during 2017/18 and this is due to the delay in launching the diabetes registry. Key achievements have included the introduction of specialist foot clinics in order to reduce waiting times and amputation rates.

2.1.5 Transforming Respiratory Care – progress has been achieved during 2016/17 with the development of more local services to improve access to patients. Work will continue on the development of the

registries which will enable identification of the impact of the improved access. Further work is required to develop increased use of self management and tele health for this patient group.

2.1.6 Parity of Esteem – progress has been made during 2016/17 in particular against achievement of constitutional standards for early intervention of care packages for patients with a new diagnosis of psychosis, and also the development of an integrated provider hub which is achieving efficiencies for reinvestment in mental health.

2.1.7 Transforming Care Programme – learning disability services – notable achievements in year is the development of a Joint All Age Learning Disability Strategy with the Local Authority and adoption of an outcome based specification across Wirral and Cheshire. Work will continue on the milestones and actions that are ongoing during 2017/18.

2.1.8 Children’s Mental Health – key achievements during 2016/17 include the implementation of a primary care mental health model in October with each school having a named primary health worker. A new eating disorder model has also delivered improved access to services. Work will continue on the milestones and actions that are ongoing during 2017/18.

2.1.9 Maternity – all milestones have been achieved during 2016/17. Notable achievements include the agreement of shared care pathways between providers and also Wirral securing funding to improve perinatal mental health care.

2.1.10 Older People – frailty pathways – all milestones have been achieved during 2016/17. Key achievements include the Community Rapid Response teams and Integrated Care Co-ordination teams managing 1,164 patients by supporting them to stay at home.

2.1.11 Cancer – there is one milestone that will be achieved during quarter one of 2017/18 in that the Cancer Strategy is to be formally adopted. Key achievements during 2017/18 implementation of new pathways for three major tumour sites in order to improve rapid diagnosis from GP referral.

2.1.12 Palliative and End of Life Care – key milestones have been achieved during 2016/17 which have included enabling more patients to receive care in their preferred place for end of life care. Work will continue into 2017/18 on outstanding actions, including the roll out of an Electronic Palliative Care Co-Ordination System which is linked to the development of the Wirral Care Record.

2.2 BETTER CARE FUND 2017/18

The Better Care Fund (BCF) continues to support transformational change in Wirral and has achieved a 2.7% non-elective admission reduction at month 10 of 16/17. However, this now stands at 0.9% increase against plan due to unprecedented demand over the winter months.

All existing schemes have been reviewed in order to identify priorities for development and potential areas for recommissioning. Key priorities for 2017/19 include:

o Drive integration & develop a robust 7 day community offer

o Better Health, Better Care, Better Value

o Support wider 5 year plan (Accountable care partnership) in line with (STP) sustainable transformation plan

o Support wider system redesign

The BCF plan for 17/19 will build on recent successes identified from the ongoing evaluation of existing schemes. The focus is to scale up the most successful schemes including:

o Rapid Community Service developed to include dementia crisis response and provide support for ‘Green Car’

o Green car – expansion of hours (16 hours per day, 7 days per week)

o Ensuring immediate access to wrap-around community support offer which includes:

• Reablement at home • Domiciliary care • Mobile nights

Key areas for transformational change in 2017/18 include:

o Discharge to assess (bed based)

o Home first (individual’s own home)

o Development of the single integrated gateway to ensure robust community interventions are offered to avoid an admission wherever possible

o Investment in tele-triage / tele-health

Recently published national guidance mandates the following four conditions:

1. Plans to be jointly agreed

2. NHS contribution to adult social care is maintained in line with inflation

3. Agreement to invest in NHS commissioned out-of-hospital services, which may include 7 day services and adult social care

4. Managing Transfers of Care (a new condition to ensure people’s care transfers smoothly between services and settings)

Beyond this, areas have flexibility in how the Fund is spent over health, care and housing schemes or services, but need to agree how this spending will improve performance in the following four metrics:

1. Delayed transfers of care;

2. Non-elective admissions (General and Acute);

3. Admissions to residential and care homes;

4. Effectiveness of reablement.

In addition, following the budget announcement relating to increased funding for social care, the national guidance also includes specific reference to the ‘Improved Better Care Fund’. This is additional resource aimed at supporting social care which is channelled through the Better Care Fund. For 2017/18 this equates to £8.3m, it is proposed by the Local Authority that this is allocated in the following way:

• £5m for the protection and stabilisation of social care • £1.3m for care provision outside of hospital to support timely discharge • £2m allocated to a local ‘innovation fund’ on a non-recurrent basis to support sustainable system

transformation – proposals will be developed from across the system which will be reviewed and approved / rejected via the BCF Board.

1. PERFORMANCE AGAINST THE NHS CONSTITUTIONAL STANDARDS (February 2017)

The full performance report for January has been reviewed and discussed in detail by the Quality and Performance Committee in its March meeting. The following dashboard demonstrates the exceptions only in performance against the NHS constitutional standards and includes a trend analysis from April 2016 to February 2017. A copy of the full performance pack is available on request.

A&E The 4 hour A&E target continues to be a concern and the trend in the dashboard above demonstrates the deterioration in performance. The Wirral A&E Delivery Board monitors the progress made against the action plan. Recent initiatives include primary care streaming, review and redesign of discharge pathway and initiation of additional Better Care Fund Schemes. Ambulance The performance of ambulance response times has shown some recent improvement in terms of red category 2 calls (not life threatening) and category A calls within 19 minutes. The Wirral A&E Delivery Board monitors the performance and progress against the action plan. A recent initiative has been a pilot of primary nurse triage of ambulance arrivals at the hospital. This has had a positive impact on reducing the handover time from the ambulance to the hospital and as a result the triage will continue. RTT The referral to treatment (RTT) 18 week wait for incomplete pathway was not met in February with performance at 84.51% for Wirral CCG and 83.69% for WUTH. The CCG has not met the 92% standard since December 2015. The performance at WUTH is a significant contributing factor to the CCG as WUTH has not met their STF target or the standard since July 2016. The CCG is receiving additional support from NHS England via the Demand Management Assurance Programme and has developed an action plan to support CCG recovery. The CCG, WUTH, NHSE and NHSI (via RTT Intensive Support Team) are working together to support WUTH’s recovery of the standard. WUTH has developed a revised RTT recovery plan with support from NHSI. The initial emphasis is on data cleansing of Patient Tracking Lists, data quality, training, and harm

reviews of patients waiting more than 52 weeks. WUTH have notified the CCG that they have identified 2 patients who have waited more than 52 weeks at this point and that there are more 52 week+ waiters in March and April. WUTH have confirmed that they will adhere to their Duty of Candor for all 52 weeks waiters. Following completion of the data cleansing/quality phase, work will commence to agree recovery trajectories. This will be overseen by the newly formed RTT Recovery Board which will include all key stakeholders and is yet to host its inaugural meeting. The continued poor performance in regards of RTT at WUTH is discussed at length at the Quality and Performance Committee. Cancer Wirral CCG closely monitors the 62 target on a monthly basis and liaises with WUTH in respect of breaches and action plans. A number of actions have already been implemented and improvements are now being realised, this has included additional resources and clinics being put in place in gynaecology and targeted action plans for Head & Neck, UGI and Urology. Pathways are continually being reviewed for improvement, for example, Lung is currently under review. A key area currently is robotic capacity, this is being looked at in detail by WUTH and we are awaiting a response in terms of their proposals and timescales. WUTH have introduced robust systems to review all patient progress weekly, and when breaches occur an investigation is always undertaken and the finding fed into an action plan which is agreed and monitored by the Chief Operating Officer. WUTH report their targets quarterly and in general meet their targets for 62 day referral. IAPT In terms of the performance for the Improving Access to Psychological Therapies (IAPT) the CCG has completed a quality risk profile with NHS England and NHS Improvement and have instigated enhanced performance monitoring. A formal performance notice has been issued with required actions to be delivered for improvement during April and also reduction of waiting list during April – June. NHS Improvement is due to undertake a review of the provider during May. 4. CONCLUSION

Governing Body is asked to:-

• To note update on the implementation of the NHS Right Care programme. • To note update on Better Care Fund • Note the summary review of recent exception performance against constitutional standards.

Priority Area

Logic Model Outcome RAG Update

Increase in the number of integrated out of hospital servicesPotential reduction in acute hospital activityReduction in unwarranted variation (movement to top quartile of NHS Right Care specialties)

Achieved (year to date) a 16.5% GP referrals reduction for Wirral University Teaching Hospital NHS Foundation Trust and Spire against the Primary Care Quality Scheme (PCQS) plan 2016/17.

Use of E-Referral has increased to 78% from a baseline of 56%.

Ambulatory Care Sensitive Admissions reduced by 13.3% against plan.

Enhanced Primary Care in ‘Care Homes’ service commencing April 2017 to deliver a 10% targeted reduction in admissions from care homes from 2016/17 baseline.

100% of Wirral patients are able to access routine GP services over 7 days The Wirral Primary Care GP Access Hubs will be operational from May 2017 in each of Wirral’s Parliamentary constituencies. The service will be delivered in addition to core GP contracted hours providing a minimum of 186 additional GP appointments each week over 6/7 days (subject to the outcome of the Pilot).

>85% of patients have a ‘good’ experience of accessing GP services or a 3% increase

90% of patients have rated their overall experience of their General Practice as ‘Very Good’ or ‘Good’. We continue to be above the England average for the percentage of patients who have a ‘Good’ experience of accessing GP services (National GP Patient Survey).

100% of Primary commissioning decisions with CCG involvement The CCG currently undertakes formal joint commissioning arrangements enabling it to locally determine the primary care delivery model and primary care service design in conjunction with NHS England. This is further supported by the establishment of the Primary Medical Care Co-commissioning Committee (PMCCC), a sub-committee of the Governing Body.

As part of our application for level 3 delegated commissioning of primary care, a survey was carried out in January 2017 with our members. The outcome of the survey was not to proceed with the application. In 2017 further work will be carried out with our members supported by a robust communications and engagement plan, which has been agreed with the PMCCC. The aim of this work will be to submit an application by December 2017 for level 3 - fully delegated commissioning. If successful, the change would be effective from April 2018.

100% of Wirral practices are a member of a GP Federation Two emerging GP Federations have been formed to represent unit GP practices as provider groups – Wirral GPW-Fed Limited and Primary Care Wirral Limited.

All Wirral practices are members of one of the Federations; we will continue to work with the two Federations in 2017/18.

At least maintain the overall number of the primary care workforce across all roles

100% of primary care staff are able to access training

2016/17 Operational Plan - Update Report

New out of hospital NHS RightCare Pathways are being developed for implementation in April 2017. These will aim to move Wirral to the top quartile range of RightCare CCGs.

All primary care staff are able to access training via Bluestream Academy, an online e-learning resource. 4 Protected Learning Time (PLT) half day events are held for GPs and Nurses annually.

Investment allocation of £29k provided to GP Federations for reception training.

23 practices embarked on the GP Improvement Programme.

Wirral Primary Care Workforce Strategy to be implemented from April 2017 detailing trajectory of programme implementation to mitigate impact of general practice staff leaving the service.

Primary Care Transformation

Tran

sfor

mat

ion

Priority Area

Logic Model Outcome RAG Update

Deflection of 15% low acuity/primary care presentations away from A&E Streaming has been pushed over several keys dates, deflecting over 15% of presentations away from ED. This has overall supported capacity through the front door.

Estate that is fit for delivering new models of urgent careDelivery of care in the right place by the right professionalFeedback used to inform new care model developmentIncrease in low acuity trauma referrals Wirral Community NHS Foundation Trust's Minor Injuries Unit located at Victoria Central Hospital has piloted a pathway for the

management of low acuity trauma referrals to be managed away from the main hospital site. The findings of this pilot will be incorporated into the transformation for urgent care.

Improved patient flow through the healthcare system Wirral has focussed on improving patient flow through the hospital and recently instigated a transfer of care group to support seamless journeys for patients including the principle of Home First.

3.5% reduction in non-elective admissions Care closer to home schemes e.g. rapid response and ICCT have contributed to 2.7% reduction in non-elective admissions. A number of new schemes will be implemented in 2017/18 to ensure the 3.5% target is achieved.

Aligned, clinically consistent, cost effective services The Urgent Care Alliance has been superseded by the Urgent Care Transformation Group. A period of engagement will be undertaken from May 2017 with all key stakeholders to propose potential options for the future this will include a review of clinical governance, contracting and funding arrangements.

3% reduction in non-elective attendances Care closer to home schemes supported via BCF have contributed to reducing non elective admissions by offering pathways and services i

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