MEETING: Governing Body Item Number: 9.1 DATE: 24 ......AGENDA ITEM NO. 4 Page 1 of 7 GM ASSOCIATION...

MEETING: Governing Body Item Number: 9.1 DATE: 24 November 2015

REPORT TITLE:

GM ASSOCIATION OF CCGs: Association Governing Group (AGG) Summary notes from a meeting held 3 November 2015

CORPORATE OBJECTIVE ADDRESSED:

Supporting our population to stay healthy and live longer in all areas of the Borough.

REPORT AUTHOR:

Hamish Stedman, Chair

PRESENTED BY:

Dr Tim Dalton

RECOMMENDATIONS/DECISION REQUIRED:

To be received for information

EXECUTIVE SUMMARY The Governing Body is asked to receive the minutes of the GM Association of CCGs AGG meeting held on the 3 November 2015 for information.

FURTHER ACTION REQUIRED:

None

EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a

result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.

23

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Page 124

AGENDA ITEM NO. 4

Page 1 of 7

GM ASSOCIATION OF CCGs: Association Governing Group (AGG)

DATE 3rd

November 2015

TIME 08.30- 12.30

AJ Bell Stadium, 1 Stadium Way, Barton-upon-Irwell, Salford, M307EY

Attendance: Steve Allinson (SA) NHS Tameside & Glossop CCG

Trish Anderson (TA) NHS Wigan Borough CCG

Wirin Bhatiani (WB) NHS Bolton CCG

Tim Dalton (TD) NHS Wigan Borough CCG

Alan Dow (AD) NHS Tameside & Glossop CCG

Chris Duffy (CD) NHS Heywood, Middleton & Rochdale CCG

Michael Eeckelaers (ME) NHS Central Manchester CCG

Denis Gizzi (DG) NHS Oldham CCG

Nigel Guest (NG) NHS Trafford CCG

Anthony Hassall (AH) NHS Salford CG

Su Long (SL) NHS Bolton CCG

Lesley Mort (LM) NHS Heywood, Middleton & Rochdale CCG

Gaynor Mullins (GMu) NHS Stockport CCG

Kiran Patel (KP) NHS Bury CCG

Hamish Stedman (HS) NHS Salford CCG (Chair)

Bill Tamkin (BT) NHS South Manchester CCG

Simon Wootton (SW) NHS North Manchester CCG

Apologies: Martin Whiting (MW) NHS North Manchester CCG

Ian Wilkinson (IW) NHS Oldham CCG

Karen Proctor

Ed Dyson

Stuart North

(KPr)

(ED)

(SN)

NHS Salford CCG

NHS Central Manchester CCG

NHS Bury CCG

In Attendance: Alison Bali (ABa) GM Association of CCGs (Minutes)

Rob Bellingham (RB) NHSE - GM & Lancs Sub Region Team

Andrea Dayson (ADa) GM Association of CCGs

Melissa Surgey (MS) GM Association of CCGs

Annette Walker (AW) NHS Bolton CCG (CFO Chair)

Kath Wynne- Jones (KWJ) NHS Oldham CCG (HOC Chair)

Janet Ratcliffe (JR) SCN

Sarah Rickard

Jonathan Kerry

(SR)

(JK)

Stroke ODN

NHS Wigan Borough CCG

1.WELCOME & APOLOGIES FOR ABSENCE

• Noted.

2. DECLARATION OF INTEREST

• No declarations of interest declared other than acknowledgement that GPs present when

there is reference to the GP contract.

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AGENDA ITEM NO. 4

Page 2 of 7

3. MINUTES OF THE LAST MEETING (20.10.15) & REVIEW OF THE ACTION LOG (A)

• Minutes agreed as an accurate record of the meeting.

Action Log:

Agenda

Item No.

ACTION LOG PROGRESS

2. • AD to approach SW to lead the link between the GM

housing providers and the PSR work programme

• AD to seek nominations for the GM Devolution CO

interview panel by email

Complete

Awaiting

confirmation of date

3. • AGG agreed to support the Pilot based at Salford.

• SP to schedule community pharmacy provision for

OOH emergency repeat prescriptions on the forward

plan for December and March.

Complete

Complete

5.

• GL to write a letter to Ian Williamson highlighting our

current position regarding clear leadership through

Trafford CCG.

• SP to circulate the Cancer Vanguard Slides

In progress

Complete

6.

• SP to put SRO Workforce on the AGG forward for

December.

Complete

8.

• AGG agreed recommendations

• SW to circulate the GM pharmacy stocktake

completed by Clare Vaughan for information.

Complete

Complete

9.

• TA to discuss GM representative within Wigan CCG

Agreed this will be

Jonathan Kerry

3a. PTS PROCUREMENT

• Agreed that this would be a level B decision at AGG

4. DEVOLUTION UPDATES:-

4.1 ASSURANCE SYSTEM FOR CCGs (A)

• Proposal is based on the discussions at the last away day in October

• NHSE will present a short paper to the November Devolution Programme Board regarding

their involvement and assurance in the newly formed devolved GM system. In essence they

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AGENDA ITEM NO. 4

Page 3 of 7

will only intervene if GM as a conurbation is a cause for concern OR if one organisation is

consistently underperforming.

• AGG need to consider options and agree how we manage ourselves as a system and provide

assurance to NHSE.

• Options could include an OFSTED style framework, however some of the proposed domains

for this are larger than individual localities

• We should not develop another laborious mechanism that replaces the one we already have

or requires duplication.

• New process could include more forward planning to mitigate risk requiring robust reporting

processes into AGG and devolution architecture.

• Assurance processes does not necessarily result in delivery of targets - we should create an

assurance system which encourages behaviours and processes to deliver improved

outcomes

• Potential to create an executive group which comprises of all localities who are accountable

for performance.

• CQC are moving towards holding place based systems to account – this could work for AGG

in line with locality plans.

• Issue will be that some providers sit across multiple "places" - it will be a complex process to

define footprints upon which accountability will work

• There will still need to be one individual who we are accountable to - most likely the GM

Chief Officer

• SL will continue to develop this proposal.

4.2 PRIMARY CARE TRANSFORMATION INITIATIVE

• Tracey Vell has been asked to support the transformation initiative - brings a different

perspective to work and new dynamic.

• Transformation initiative is exploring the appetite for primary care providers to work more

collaboratively similar to MCP model.

• Idea will be discussed informally at Primary Care Summit on 4th November, more work

needed to link into local primary care plans.

• Primary care is integral to the transformation initiative areas - primary care and acute

hospital care have parity of esteem.

• Opportunity for GM to influence the national contract content in 2017.

• The work that GM and RB are leading is focusing on development of new approaches to

primary care – this is not intended to undermine individual localities.

• The language used is important to make this message very clear

• Must ensure we uphold the Primary Care Medical Standards - is there appetite for

investment in rolling these out on a wider footprint

• Could be a powerful mechanism to bring all GPs into new ways of working - although

conscious there is more detail needed.

• The Summit should focus on the clinical perspective - this model could enable enriched

primary care services.

AGREED:

• The AGG supported SL to develop the proposal further

• To arrange a focussed AGG OD session to develop the assurance model - AD

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AGENDA ITEM NO. 4

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• Should consider if this proposal will a) mitigate risk and b) be commercially viable

• RB and GM will feedback to Summit and work up proposals further before a formal launch -

AGG will agree timing of this in advance

ACTION:

• RB to circulate original transformation initiative EOI

4.3 PRIMARY CARE 7 DAY ACCESS

• CFOs were tasked by AGG with doing due diligence on 7 day access funding.

• AW provided a verbal update a paper will be provided at the next AGG.

• Assured 15/16 part year funding but this will be confirmed at the next AGG.

• CFOs are now looking at assuring the whole of primary care budgets - need to agree with

NHSE process for devolving this funding back to CCGs.

• CFOs will formally make recommendation at AGG on 17th November so funding can be

released into the system.

• £7m available to GM CCGs to deliver 7 day access in 15/16 year (for those without PMCF)

• £9.4m from this year's allocation that will be available for 16/17 year - CFOs want to ensure

all CCGs get their fair share, may need to consider risk share

• Discussions with Ian Currell at NHSE highlights £12m available for enabling 7 day access.

• Agreed to delegate authority to AW as CFO chair to authorise letter from Ian Williamson to

Ian Currell to release £7m funding.

Action:

• MS to add 7 day access funding to 17th November AGG agenda

• AW to authorise a letter from IW to release the funding when CFOs have provided due

diligence.

4.4 LOCALITY PLANS

• 9/10 localities have submitted updated locality plans, executive summary and updated

financial modelling.

• Finance and activity figures for bridging the gap do not add up - detail not known for latter

years of the five year plans.

• Sign off is through the Health and Wellbeing Boards - dates scheduled over next month

• Difficulty with provider sign up to the plans - no consensus on whether plans are

commissioning plans or whole place plans.

• Financial templates were submitted on 31st October and are being analysed by PwC.

• Stocktake of the GM wide work streams taking place - SROs concerned about how the GM

work will align with the locality plans and avoid double counting.

• Workshop on 5th November to triangulate all the work and explore GM wide metrics.

• SROs have received a slide pack with a stocktake of all 10 localities.

ACTION:

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AGENDA ITEM NO. 4

Page 5 of 7

• TA to arrange for circulation of stocktake slide pack to CFOs

4.5 DIGITAL ROAD MAP

• Jonathan Berry from Wigan CCG joined the group for this item - lead on roadmap work on

behalf of GM.

• Makes sense to do roadmap work on a GM footprint due to devolution work.

• GM level work is about nurturing and progressing work already in place locally and scaling

up.

• Not all localities are starting at the same place - task group are mapping out starting points

and individual visions.

• Ultimately visions are very similar so this work will be about sharing learning and supporting

one another

• The digital roadmap work group sits under the GM IM&T group and are linked into the AGG

infrastructure.

• The template submitted to NHSE is not a full list of all stakeholders - will also include primary

care providers, third sector, care homes and hospices, NWAS

• Estates and IM&T will be core enablers for the transformation initiatives

5. WET AMD

• Advised that this should be discussed in part 2 of individual CCG boards due to commercial

sensitivity.

• AGG requested that a narrative is prepared by SW for CCG boards

6. STROKE PATHWAY

• Janet Ratcliffe and Sarah Rickard from the SCN joined the meeting for this item

• Full implementation of stroke centralisation from April 2015

• Data in the report is only the first quarter (April - July 2015)

• Tony Rudd (Stroke National Clinical Director) conducted site visits at Bolton and East

Cheshire due to concerns about compliance – data issues with Bolton.

• Model based on 90% of all patients going to the hyper acute stroke units, current data

shows only 77%- ODN looking at why this is, could be due to late presentation

• Team level data does not show whole patient journey

• Fairfield Hospital is the best performing stroke unit in the country; Salford Royal is the

largest (and 3rd best performing hyper acute unit)

• ODN is going to do a piece of work around data entry to improve reliability of figures

• Centralisation is improving the quality of stroke care, this will be further confirmed upon

completion of ODN review in January 2016

• SSNAP data doesn't tell the whole story - ODN review will also look at patient experience

AGREED:

• Quarterly updates are requested

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AGENDA ITEM NO. 4

Page 6 of 7

across whole pathway.

• AGG would like more data on outcomes at a population level rather than by provider

• Steve Dixon currently represents the CCGs on the stroke ODN board - 2 spaces on the ODN

board and 3 spaces on clinical group – capacity issue need to consider how this is

progressed.

• Still issues with ESD and HoCs are putting in place standards to improve service

improvements.

• Would like to see data on mortality rates and levels of disability post-stroke.

• Overall this is a good news story, and should be publicised.

• Data can be taken by commissioners to their providers to challenge them on their stroke

unit quality and outcomes

• Planning a commissioner event in the New Year to demonstrate how to use SSNAP data

• Next set of data will be ready at the end of the month and the ODN will be share this with

CCGs.

7. REVIEW OF SCREENING & IMMUNISATION

• Agreed that there was not enough context to make a decision on this and would like public

health advice

ACTION:

• AD to approach Wendy Meredith to review this and make a recommendation.

8. AGG EXECUTIVE GROUP

• AD has circulated a role profile for membership of this group and asked for expressions of

interest by 6th November

• Noted that it continues to be challenging to balance local and GM commitments.

• Still no clarity or agreement on whether we should fund these posts and if so how?

• We still have not agreed future funding arrangements for strengthening wider AGG support

e.g. Secretariat, chair.

• Need to strike a balance between consistent representation and strong leadership and wider

involvement of existing SROs.

• Whoever takes on these roles need to work together cohesively as a group.

• Agreed that we cannot make a long term decision on this immediately and needs further

focus.

• An election may be an option to select these when all EoI gathered as it is assumed that AGG

will select those that they wish to represent them at a GM level.

• Agreed to select reps and review April 2016.

9. AOB

9.1 DELIVERING EFFECTIVE PRIMARY CARE ENGAGEMENT

• Some AGG members would like to input into this.

• GM would welcome clinical reps to support the engagement work further.

9.2 COMMITTEE IN COMMON

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AGENDA ITEM NO. 4

Page 7 of 7

• Some discussion regarding the future of this beyond Healthier Together and how this links to

potential AGG joint committee arrangements and devolution architecture.

• Further discussion required through the AGG executive group when elected.

NEXT MEETING

DATE: Tuesday 17th

November 2015

TIME: 13.30- 17.30

VENUE: Town Hall- Reception Room

Page 131


Page 132

MEETING: Governing Body Item Number: 9.2 DATE: Tuesday 24th November 2015

REPORT TITLE:

Month 7 Corporate Report

CORPORATE OBJECTIVE ADDRESSED:

All

REPORT AUTHOR:

Trish Anderson / Mike Tate / Julie Southworth

PRESENTED BY:

Mike Tate

RECOMMENDATIONS/DECISION REQUIRED:

To note the contents of the paper.

EXECUTIVE SUMMARY The report is designed to give the Governing Body a regular monthly update on how the CCG is performing against its local priorities. Furthermore, the report details CCG performance against the Everyone Counts Planning Guidance Indicators and the CCG Outcomes Indicator Set.

FURTHER ACTION REQUIRED:

EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a

result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.

Page 133


Page 134

Chief Officer

Trish Anderson

Corporate

Report

Month 7

2015/16

5

Page Responsibility Director Associate Director Committee

3 Overview

4 Quality Julie Southworth Sally Forshaw Clinical Governance

5 Prescribing & Continuing Healthcare Julie Southworth Linda Scott Clinical Governance

6 Workforce Julie Southworth Kathryn Ball Corporate Governance

7 Programmes Trish Anderson John Marshall Corporate Governance

8 - 9 Finance Mike Tate Craig Hall Finance & Performance

10 QIPP Mike Tate Chris Melling Finance & Performance

11 Commissioned Services Mike Tate Kim Godsman Finance & Performance

12 Performance Mike Tate Chris Melling Finance & Performance

13 - 17 Performance Theme: Mental Health Mike Tate Chris Melling Finance & Performance

Wigan Borough CCG: Corporate Report Month 07: 2015/16

Page 136

Overview & Emerging Challenges

Month 7

This dashboard is designed to give the Governing Body a regular monthly update on key areas within the CCG and to provide details of emerging challenge. For month 7 rather than the full performance report a performance theme will now be incorporated into the report. This month Mental Health has been selected for an in-depth review. Each directorate has identified key areas to inform the report and are listed below: Emerging Challenges 1) The emerging Greater Manchester (GM) Devolution agenda and potential funds transfers to the devolution budget.

2) Identify additional opportunities to address the CCGs cumulative shortfall in funding identified in the Locality Plan submitted as part of GM devolution (October 2015)

3) Fully meeting the requirements of Winterbourne.

4) Closing the in-year QIPP gap of £6.7m.

5) Managing demand in the acute sector, particularly over performance at WWL.

6) Community care providers developing sufficient capacity to receive patients and services deflected from Acute Hospital care.

7) Managing and resourcing the co-commissioning of Primary Care with NHS England.

8) Patient Transport Services contract will not be finalised until 2016/17. Challenges for 2016/17 which include: 1) The resources (Commissioner and Provider) necessary to support the service transformation in 2016/17 detailed in the strategic plan. Delivery will require major commitment from

all stakeholders.

2) Further developing the QIPP programme to meet 2016/17 requirements and beyond..

3) Increasing cost pressures on the CCG.

4) Future Mental Health tariff

5) Potential cuts to local authority budgets as a result of the new Comprehensive Spending Review (CSR) for the five years following 2016/17

Page 137

Quality & Safety Sally Forshaw / Julie Southworth

Clostridium Difficile Infection Clostridium Difficile Infections

Comments

Provider Q1 Q2 Q3 Q4

Wrightington, Wigan & Leigh NHS

Foundation Trust (WWLFT)

Data available

31 October 2015

5 Boroughs Partnership NHS Founation

Trust (5BPFT)Pending

Bridgewater Community NHS Foundation

Trust (BCFT)

Data available

31 October 2015

Serious Incidents (SIs) & Never Events (Nes)

CQUIN Schemes: RAG Status

GREEN - Fully Met AMBER - Partially Met RED - Not Met

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

Actual 2 13 11 6 10 9 8

Plan 6 6 6 7 7 7 7 7 7 7 7 7

0

2

4

6

8

10

12

14

Actual Plan

Serious Incidents (SIs): A positive position has been reported to the CCG Clinical Governance Committee at November 2015. 5BPFT has advised that they are commissioning Consequence UK to drive improvement in their internal SI process. NHSE C&M and Commissioners have endorsed this approach. CQUINs: The schemes are monitored on a quarterly basis. Position reported at Quarter 2 2015/2015: - BCHFT: All Q2 targets achieved (RAG status - Green)

- WWLFT: All targets achieved with one exception; the National Sepsis scheme. This scheme has 2 components (1) Screening on admission (2) Treatment received within 1 hour of admission. The target set was 67% and the Trust has achieved 61.8%. Actions are in place to support achievement of the Q3 target which is set at 80% .

- 5BPFT: All Q2 targets achieved (RAG status - Green) C.Difficile: The position for October 2015 at the point of reporting is : Non-Acute (WBCCG) = 6 Acute (WWLFT) = 2 This number is subject to change post validation of cases via the HCAI DCS at 22 November 2015 Reported cases in year to date: Non Acute (WBCCG) = 35 against the set objective of 81 Acute (WWLFT)= 9 against the set objective of 19


Over Time 14 12 13 12 11 10 9

To Time 54 49 36 39 49 41 41

0

10

20

30

40

50

60

70

80

To Time Over Time

Page 138

Prescribing & Continuing Healthcare Linda Scott / Julie Southworth

Medicines Management: QIPP Savings Medicines Management: QIPP

Comments

Medicines Management: Monthly Costs & Full Year Forecast

Continuing Healthcare (excluding children and staffing budgets):

Monthly Costs & Full Year Forecast


Actual (£) 224,662 219,110 213,415 218,560 139,509 173,942 176,964

Plan (£) 219,583 219,583 219,583 219,583 219,583 219,583 219,583 219,583 219,583 219,583 219,583 219,583

£0

£50,000

£100,000

£150,000

£200,000

£250,000

Actual (£) Plan (£)

1. Medicines Management QIPP Savings Savings for work completed to end October 2015: £1,366,160 (88.9% of forecast target). Of the 14 QIPP areas under review; 5 areas were over the pre-set target, 6 were moving close to achieving target and 3 were not close to achieving the pre-set target. All Practices have attended a Peer Review and selected their 2015/15 prescribing work programme. 2. Medicines Management Total Costs Information received from the Business Services Authority for month 4 shows an increase in GP prescribing costs from April to August 2015. If costs continue at this rate the full year impact will be a £2.3million overspend. This is being seen with GM CCGs and nationally. The Medicines Management Team is reviewing repeat prescribing systems in Practices where there is a much bigger than average increase in items. 3. Continuing Healthcare Expenditure The current forecast is to budget. At 31/10/2015 the CCG has 577 adult patients in receipt of CHC and 382 patients are in receipt of Funded Nursing Care. There was an increase of £1.6 million budget in month 3 for the payment into national CHC risk share pool for retrospective request for payment. There was an increase in allocation in month 5 of £240k from the GM Risk Reserve - CHC element.


Expenditure 2,082,34 2,075,63 3,599,10 2,030,70 2,130,70 2,050,00 2,050,70

£0

£1,000,000

£2,000,000

£3,000,000

£4,000,000


FY Forecast 24,368,2 24,368,2 26,033,2 26,033,2 26,273,0 26,273,0 26,273,0

FY Budget 24,368,2 24,368,2 26,033,2 26,033,2 26,273,0 26,273,0 26,273,0 26,273,0 26,273,0 26,273,0 26,273,0 26,273,0

£23,000,000£23,500,000£24,000,000£24,500,000£25,000,000£25,500,000£26,000,000£26,500,000


Expenditure £5,175,9 £4,968,7 £5,210,6 £5,257,2 £5,053,3

£4,800,000

£4,900,000

£5,000,000

£5,100,000

£5,200,000

£5,300,000

£61,491,000

£59,114,741

FY Budget FY Forecast

Page 139

Workforce (Human Resources) Kathryn Ball / Julie Southworth

Employment Composition: Headcount

Comments

Staff Turnover (FTE)

Absence Rates

101 102 110 112 113 116 116

21 21 13 15 15

24 24 11 11 11 11 11

11 10 10 10 12 10 10

10 10

40

60

80

100

120

140

160

180

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

Permanent Fixed Term Contract Governing Body Clinical Leads

1. Employment Composition: Headcount The CCG's total headcount and composition is 160 and is within budget. There report included amendments to the September data. During this month there were 13 appointments which included 1 flexible retirement, 6 apprentices, 3 full time fixed term contract appointments and 3 part time permanent appointments (job share). There was one leaver in September and the loss of one member of staff. In October there was one new starter to a full time substantive post. There was one leaver in October. There is no significant change to the age profile, gender split or ethnic origin of CCG staff. 2. Staff Turnover Staff turnover remains well below the national average. 3. Absence Rates The staff attendance rate showed a small increase in October and is skewed by long term absences. The rate remains broadly in line with the HSCIC average. Continued monitoring and support remains in place to proactively manage attendance and to support those staff who are currently absent from work.

2.61%

2.18%

2.41%

2.39%

2.42%

2.53%

2.55%

2.0%

2.1%

2.2%

2.3%

2.4%

2.5%

2.6%

2.7%

Apr-

15

Ma

y-1

5

Jun

-15

Jul-1

5

Aug

-15

Sep

-15

Oct-

15

Nov-1

5

Dec-1

5

Jan

-16

Fe

b-1

6

Ma

r-1

6

% Absence HSCIC Average

5.46%

6.24%

7.66%

7.59%

7.56%

8.34%

8.49%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

Apr-

15

Ma

y-1

5

Jun

-15

Jul-1

5

Aug

-15

Sep

-15

Oct-

15

Nov-1

5

Dec-1

5

Jan

-16

Fe

b-1

6

Ma

r-1

6

% Turnover National Average

Page 140

Programmes John Marshall / Trish Anderson

Progression Against Plan (Average %) - 2015/16

Comments

Progression Against Plan (Average %) - 2016/17

Active Projects Delivering the Strategic Plan - Shown by Stage of Progression

0% 10% 20% 30% 40% 50% 60% 70% 80%

Diabetes

Dermatology

PCRS

Asthma

15/16 Plan 15/16 Actual

1. Progression Of All Programmes & Projects To Agreed Timescale For 2015/16 The Diabetes project is back on track for an operational service in Apr 2016. The Dermatology project is under consideration for implementation within the OP Project group. The specifications of the OP Project are themselves under review which may affect the intended benchmark delivery plan. 2. All Programmes & Projects To Be Aligned To Corporate Objectives and NHS Outcomes For 2015/16. The strategic portfolio is fully aligned with the Corporate Objectives and NHS Outcomes. 3. Active Programme & Projects Capable Of Achieving Savings Objectives For 15/16 See comment 5 below. 4. Overall Progression Against Five Year Plan See comment 5 below. 5. Emerging Challenges The CCG Strategic plan has been successfully reconfigured into a joint Wigan Locality Plan within the GM Devolution programme. This plan is subject to further iterative development with GM. This requires the development /delivery plans of all projects to be reconciled and will result in a complete renewal of the benchmarks against which 'progression against plan' are measured. This collaborative process will take effect in the next Corporate Report but it may require several months of iteration with partners before this 'Progression Against Plan' dashboard is a jointly endorsed feature. In the interim all projects will continue to be assessed against the original Apr 2015 benchmark to provide assurance of progress against plan.

17

6

35 13

3

29

Projects - Stage of Progression

Concept

Feasibility

Work Up

Procurement

Implementation

Performance Management

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

OP Projects*

OP Respiratory

Maternity Reforms

Frail & Elderly

GPOOH

16/17 Plan 16/17 Actual

Page 141

Finance Craig Hall / Mike Tate

Planned Surplus

Comments

Running Costs

Better Payment Practice Code (BPPC)


Remaining Surplus 4,268 3,889 3,509 3,130 2,751 2,371 1,994

Cumulative Actual 263 642 1,022 1,401 1,780 2,160 2,537

Cumulative Plan 263 642 1,022 1,401 1,780 2,160 2,537 2,913 3,289 3,664 4,039 4,531

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

Cumulative Actual Remaining Surplus Cumulative Plan

Underlying Recurrent Surplus - The CCG is on target to achieve a 1.0% recurrent surplus at the end of 2015/16. Surplus: Year To Date Performance - The year to date surplus (£2.54m) is in line with the planned surplus at month 07. Surplus: Full Year Forecast - At month 07 the CCG has total allocations of £487.7m. The CCG is forecasting to achieve its statutory duties in 2015/16 and achieve the planned surplus of £4.5m. The CCG continues to report a risk adjusted surplus position of £4.5m (i.e. no net risks). The CCG will review this position constantly and will report any changes to the risk adjusted surplus position at month 8 and if it becomes clear that the net risks will affect the outturn position and can’t be mitigated against they will be reflected in the forecast position by month 8. Running Costs - The running cost expenditure at month 07 is lower than budget by £270k and the CCG is forecasting to remain within target throughout 2015/16.

Better Practice Payment Code (BPPC) - The CCG has met the required target at month 07 for both the number and value of invoices across both NHS and Non-NHS invoices.


Value % 100 100 100 99 100 100 100

Number % 98 99 98 98 100 99 99

Target % 95 95 95 95 95 95 95 95 95 95 95 95

90

91

92

93

94

95

96

97

98

99

100


Annual Plan 7,089 7,089 7,089 7,089 7,089 7,089 7,089 7,089 7,089 7,089 7,089 7,089

Forecast Actuals 7,089 7,089 7,076 7,031 6,936 6,837 6,819

Planned Variance 0 0 0 0 0 0 0 0 0 0 0 0

Forecast Variance 0 0 -13 -58 -153 -252 -270

-500

-400

-300

-200

-100

0

100

Planned Variance Forecast Variance

Page 142

Finance Craig Hall / Mike Tate

Wrightington, Wigan & Leigh Foundation Trust

Comments

Continuing Healthcare

Primary Care (Including GP Prescribing)


Annual Plan 166,244 166,244 166,621 166,621 166,671 166,671 167,038


CCG Forecast Variance 0 0 0 0 0 1,000 1,022

-1,000

0

1,000

2,000

3,000

4,000

5,000

Planned Variance CCG Forecast Variance

Contract performance data from WWLFT shows a year to date over performance of £5.1m based on month 06 activity, which forecast for the year would be a potential full year over performance of the contract at £10.2m. This is based upon contractually unchallenged reported activity. The finance and commissioned services teams continue to apply contractual levers and a range of contractual challenges to mitigate this potential over performance .At month 07 the reported financial position with WWLFT stands at an over performance of £1.0m. This takes into account the outcome of the quarter 1 discussions and mitigtions that the CCG is taking against future overtrades: As reported in month 06 NHS England has requested that CCGs review their ability to discharge the Continuing Care legacy payments in cash. The CCG are confident in their ability to assess the outstanding cases in line with the timetable. However, the delay in the receiving documentation from the family and legal reasons such as probate can affect payment in cash. The NHS England Director of Financial Control wrote to CCGs on the 6th November stating that any underutilised provisions would not be able to be kept by CCGs. Any unutilised provision will be held by NHS England. However, the CCG would have a reduced contribution to the risk pool in 2016/17;

GP Prescribing forecast outturn position has again maintained at the level reported in month 06, £2.3m

overspent which is in line with NHS Business Services Authority forecasts. This increased cost is being

reflected in other CCGs within GM and nationally. The forecast reflects the overspend although it is

anticipated that there may be a potential price reduction later in the financial year, as has been the case in

previous years.


Annual Plan 26,634 26,634 28,299 28,299 28,539 28,539 28,539



Forecast Variance 0 0 0 0 0 0 0

-500

-400

-300

-200

-100

0

100

Planned Variance Forecast Variance


Annual Plan 109,55 109,55 110,64 110,64 110,64 110,64 109,99



Forecast Variance Primary Care 0 0 0 0 0 0 0

Forecast Variance GP Prescribing 0 0 0 0 2,376 2,376 2,376

-500

0

500

1,000

1,500

2,000

2,500

Planned Variance Forecast Variance Primary Care Forecast Variance GP Prescribing

Page 143

QIPP Chris Melling / Mike Tate

QIPP 15/16 Progress (£000's)

Comments

Risk of Delivery (£000's)

Non Elective Admissions (WWL)

The 2015-16 QIPP target per the financial plan is £22.8m. Full year forecast of the schemes

identified in the plan is currently £16.1m, leaving an unidentified QIPP gap of £6.7m. At month 7,

£9.6m has been delivered against the year to date plan of £10m.

Of the £16.1m of identified schemes, £11.4m of schemes are classed as a medium risk in terms

of full year delivery. A significant element of this falls under Commissioning Intentions, hence it is

reliant on the contract with our main provider achieving plan.

Non elective admissions is a high cost area for acute activity. In order to reduce costs and improve

patient experience, it is essential where appropriate to reduce admissions to acute care. As can be

seen from the graph opposite, there has been an increase in non elective admissions in

September 2015 and this needs to be monitored to ensure that non elective activity does not

become unfavourable.

High, £292

Medium, £11,418

Low, £4,362

0 5,000 10,000 15,000 20,000 25,000

YTD Actual

YTD Plan

Full Yr Forecast

QIPP Target

YTD Actual YTD Plan Full Yr Forecast QIPP Target

QIPP £9,596 £10,041 £16,072 £22,803


2015/16 1861 1835 1874 1917 1805 1972

2014/15 1991 2094 2006 2072 1982 1942 2085 1879 1994 1903 1744 1994

1500

1600

1700

1800

1900

2000

2100

2200

Page 144

Commissioned Services Kim Godsman / Mike Tate

Accident & Emergency: WWL (Sit Rep Report)

Comments

Improved Access To Psychological Therapies: Access & Recovery Rate

Winterbourne View Register

96.1

2%

87.6

5%

92.0

7%

97.5

4%

96.6

2%

97.5

0%

98.4

7%

97.6

8%

98.0

0%

94.0

5%

96.8

0%

95.0

3%

84%

86%

88%

90%

92%

94%

96%

98%

100%

Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15

Performance Performance Standard

Wrightington, Wigan and Leigh NHS Foundation Trust (WWL FT) did meet the A&E performance target of 95% (of patients admitted, treated or transferred within 4 hours of arrival) in October achieving 95.03% (these figure are non published).

IAPT Access standard for July 2015 was not met, however, currently ytd we have achieved our prevalence target. The CCG continues to work with the providers to establish the reasons for the discrepancies between what is reported locally and what is reported via HSCIC.

The CCG continues to work with the Local Authority to resettle patients on the Winterbourne View register from out of area hospitals. No resettlements have been achieved to date.

One individual who was due to be discharged at the end of September will now be formally discharged at a meeting on the 23rd November. The discharge date slipped due to the delay in receiving the clinical reports from the current clinical team. This issue was escalated at an executive level with the provider.

Problems with adaptations at the community setting have delayed another patient discharge scheduled for mid October. Based on the estimated timescales set out by the organisations involved in the discharge, a date of the 29th February 2016 has been set for when the individual can reasonably expect to be moved to his community placement.

10 10 10 10 10 10 10 10 10 10 10 10

0

3

6

9

12

15

Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15

Mar 31st Cohort Discharged To Date0.7

2%

0.7

3%

0.7

1%

0.8

5%

0.4

3%

0.8

5%

0.9

4%

1.0

9%

1.7

6%

1.5

8%

1.5

1%

0.8

4%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40%

1.60%

1.80%

2.00%

Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15

Access Access Standard Recovery Recover Standard

1 1 1

2 2 2

4 4 4 4 5 5

0

1

2

3

4

5

Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15

New Adm New Adm Discharged

Page 145

Performance Chris Melling / Mike Tate

Outcomes Ambitions Indicators (Year-To-Date)

Comments

Constitution Indicators (Year-To-Date)

Activity/Better Care/Other Indicators (Year-To-Date)

7

1

3

5

0

1

Green

Amber

Red

Green

Amber

Red

RED: Failing AMBER: Failing (within 5%) GREEN: Achieving

Outcomes Ambitions Indicators: There is one headline indicator rag rated Red which is currently below target; Potential Years Of Life Lost: Amenable To Healthcare. The 2014 published rate (2,726.5) is above the plan of 2.330.0. There are 3 supporting indicators rated Red, currently below target; MRSA, C-Diff and Emergency Admissions for Lower Respiratory Tract Infections (C&YP). There is one indicator rated Amber; Emergency Admissions: Acute ACS Conditions. Constitution Indicators: One headline indicator is rated Amber ; Ambulance Category A 19 Minute Response Times. Year-to-date performance is slightly below the 95% standard achieving 94.97%. There is 1 supporting indicator rated Amber; Cancelled Operations: Not Treated In 28 Days. Activity/Benchmarking Indicators: Three activity indicators are rated Red; Elective Daycases (All Specialities), First Outpatient Appointments Following a GP Referral (All Specialities), and GP Referrals (G&A Only). The two activity indicators are rated Amber; First Outpatient Appointments Following an Other Referral (All Specialities), and Other Referrals (G&A Only). Other Indicators: There are two indicators rated Red; IAPT 6wk Waiting Times for both Finished and Entering treatment. The six indicators rated Amber all related to GP Survey.

7

1

0

15

1

0

Green

Amber

Red

Green

Amber

Red


4

6

2

7

2

3

Green

Amber

Red

Green

Amber

Red


No Indicators Marginally Failing

No Indicators Failing

No Indicators Failing

Headline Indicators Headline Indicators

Supporting Indicators

Activity & Better Care Indicators

Other Indicators

Supporting Indicators

Page 146

Performance Theme of the Month: Mental Health

Current Wigan Borough CCG Performance

Improving Access To Psychological Therapies (IAPT)

Improving Access to Psychological Therapies is an NHS programme for treating people with depression and anxiety disorders. The access rate indicator measures the proportion of people that enter treatment against the level of need in the general population, whilst the recovery rate indicator focuses on recovery of patients completing a course of treatment. The primary purpose of the waiting times indicators is to measure waiting times from referral to treatment.

IAPT Access Rate: Wigan Borough CCG July performance fell below the monthly plan of 1.25% achieving 0.84%. However, year-to-date (April to July) performance remains above plan achieving 5.68%.

IAPT Recovery Rate: Wigan Borough CCG July performance was above the target of 50.00% achieving 51.52%. Year-to-date (April to July) performance is also above target achieving 52.57%.

IAPT Waiting Times: Entering Treatment: Wigan Borough CCG July performance (<6wks) was above the standard of 75.00% achieving 92.11%. Performance (<18wks) was also above the standard of 95% achieving 98.68%. Finishing Treatment: Wigan Borough CCG July performance was below the standard of 75.00% achieving 38.24%. Performance (<18wks) was also below the standard of 95% achieving 94.12%.

Dementia: Wigan Borough CCG Dementia Diagnosis rate was above plan (66.70%) for the month of September 2015 achieving 71.15%.

Community Mental Health: CPA: Wigan Borough CCG performance in Q1 and Q2 of 2015/16 was above the target of 95.00% achieving 96.89% and 97.35% respectively. Early Intervention: data shows in 2013/14 the total number of cases recorded was 52 and in 2014/15 the total number of cases recorded was 54. 2015/16 year-to-date (Q1 & Q2) cases currently total 14.

Dementia The dementia indicator measures the number of people aged 65 and over diagnosed with dementia. A timely diagnosis enables people living with dementia, and their carers/families to access treatment, care and support, and to plan in advance in order to cope with the impact of the disease.

Community Mental Health

Care Programme Approach (CPA): Measures the number of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric inpatient care. Early Intervention (EI) Services: Measures cases of first episode Psychosis which have been taken on by EI teams.

Page 147

Mental Health Performance: 2015/16 Improving Access To Psychological Therapies (IAPT) Outcomes

IAPT Access Rate: Monthly Performance

Comments

IAPT Access Rate: Year To Date Benchmarking

IAPT Recovery Rate: Monthly Performance

1.7

6%

1.5

8%

1.5

1%

0.8

4%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

1.8%

2.0%


Rate Plan

IAPT Access Rate Wigan Borough CCG July performance fell below the monthly plan of 1.25% achieving 0.84%. Looking at year-to-date performance (April to July) across the Greater Manchester area, 4 of the 12 CCG's are below the 5% target. Wigan Borough CCG is above target with an Access rate of 5.68%, the equal fourth best performance in Greater Manchester. IAPT Recovery Rate Wigan Borough CCG July performance was above the target of 50.00% achieving 51.52%. Year-to-date (April to July) performance is also above target achieving 52.57%.

47.2

2%

56.0

0%

53.5

7%

51.5

2%

42%

44%

46%

48%

50%

52%

54%

56%

58%


Rate Plan

5.1

7%

5.7

6%

2.8

0%

5.8

3%

1.9

1%

3.9

7%

7.6

9%

3.0

4%

5.6

8%

5.5

2%

5.0

2%

5.6

8%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

Bolton Bury C Mcr HMR N Mcr Oldham Salford S Mcr Stockport Tameside Trafford Wigan

Rate Plan

Page 148

Mental Health Performance: 2015/16 Improving Access To Psychological Therapies (IAPT) Waiting Times

IAPT Waiting Times: Patients Entering Treatment In Month

Comments

IAPT Waiting Times: Patients Finishing Treatment In Month

IAPT Waiting Times: Year To Date Benchmarking (Patients Entering Treatment)

98% 98% 96%

99%

64% 64% 70% 92% 50%

60%

70%

80%

90%

100%


18W Rate 6W Rate 18W Plan 6W Plan

95% 96% 95% 94%

0% 0% 0% 0% 0% 0% 0% 0% 31% 19% 21% 38% 0% 0% 0% 0% 0% 0% 0% 0% 0%

20%

40%

60%

80%

100%



99% 95%

77%

95%

84%

97% 96%

89%

97% 95% 99% 97%

91% 48% 27% 59% 17% 66% 83% 31% 78% 71% 91% 70% 0%

20%

40%

60%

80%

100%



IAPT Waiting Times: Patients Entering Treatment The IAPT Waiting Time indicator measures the proportion of people that wait 6 & 18 weeks or less from referral to their first IAPT treatment appointment against the number of people who enter treatment in the reporting period. Wigan Borough CCG July performance (<6wks) was above the standard of 75.00% achieving 92.11%. Performance (<18wks) was also above the standard of 95% achieving 98.68%. IAPT Waiting Times: Patients Finishing Treatment The IAPT Waiting Time indicator measures the proportion of people that wait 6 & 18 weeks or less from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period. Wigan Borough CCG July performance (<6wks) was below the standard of 75.00% achieving 38.24%. Performance (<18wks) was also below the standard of 95% achieving 94.12%.

Page 149

Mental Health Performance: 2015/16 Dementia

Dementia Diagnosis Rate: Monthly Performance

Comments

Locality Register List Size Rate/1k

Atherleigh 352 8,231 42.77

North Wigan 424 11,125 38.11

Patient Focus 378 9,409 40.17

TABA 336 8,875 37.86

ULC 286 7,916 36.13

Wigan 577 14,232 40.54

GP Practice Register List Size Rate/1k

Y02322: Dr Ahmad & Partners 108 1,334 80.96

Y02322: Leigh Family Practice 86 1,217 70.67

Y02321: IntraHealth Tyldesley 39 594 65.66

Y02885: IntraHealth Marsh Green 10 165 60.61

P92041: Dr Pitalia & Partners 91 1,539 59.13

Dementia Diagnosis Rate: 2014/15 Benchmarking

Dementia Prevalence (September 2015) : Locality & Top 5 GP Practice Rates

71.3

3%

70.4

0%

71.1

5%

64%

65%

66%

67%

68%

69%

70%

71%

72%

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

Rate Plan

Dementia Diagnosis Rate Wigan Borough CCG Dementia Diagnosis rate was above plan (66.70%) for the month of September 2015 achieving 71.15%. Looking at performance for 2014/15 (the most recent date for all Greater Manchester CCG data) 8 of the 12 CCG's performed better than the target of 66.70%. However, Wigan Borough CCG performance of 64.09% was below target. Dementia Prevalence Of the 6 Wigan localities, Atherleigh has the highest dementia prevalence rate per thousand patients (42.77) and ULC has the lowest prevalence rate of 36.13. Practice code Y02322 is the GP practice with the highest dementia prevalence rate per thousand patients (80.96).

70.7

3%

75.7

9%

68.7

3%

63.7

5%

63.4

5%

73.1

9%

76.3

7%

69.0

9%

68.1

9%

66.4

3%

68.2

8%

64.0

9%

55%

60%

65%

70%

75%

80%


Rate Plan

Page 150

Mental Health Performance: 2015/16 Community Mental Health

CPA Within 7 Days: Quarterly Performance

Comments

CPA Within 7 Days: Year To Date Benchmarking

Early Intervention in Psychosis: Cumulative Annual Performance

97.3

4%

93.7

2%

98.3

3%

95.6

7%

95.5

8%

96.1

9%

92.5

9%

92.2

7%

96.8

9%

97.3

5%

#N

/A

#N

/A

88%

90%

92%

94%

96%

98%

100%

Q1:13/14 Q2:13/14 Q3:13/14 Q4:13/14 Q1:14/15 Q2:14/15 Q3:14/15 Q4:14/15 Q1:15/16 Q2:15/16 Q3:15/16 Q4:15/16

Rate Plan

Care Programme Approach (CPA) Within 7 Days Wigan Borough CCG performance in Q1 and Q2 of 2015/16 was above the target of 95.00% achieving 96.89% and 97.35% respectively. Performance been above target in 7 of the 10 quarters since Q1 of 2013/14. Looking at the year-to-date (April to September) performance of the CCGs across the Greater Manchester area, 3 of the 12 CCG's are below the 95% target. Wigan Borough CCG is above target with a year-to-date CPA rate of 97.14%, the seventh best performance in Greater Manchester. Early Intervention In Psychosis Data reported shows the number of all new cases taken on the caseload of an EI team from 1 April to the end of the latest quarter, building cumulatively. In 2013/14 the total number of cases recorded was 52 and in 2014/15 the total number of cases recorded was 54. 2015/16 year-to-date (Q1 & Q2) cases currently total 14.

3 13 29 52 8 16 26 54 6 14 0

10

20

30

40

50

60

Q1:13/14 Q2:13/14 Q3:13/14 Q4:13/14 Q1:14/15 Q2:14/15 Q3:14/15 Q4:14/15 Q1:15/16 Q2:15/16 Q3:15/16 Q4:15/16

97.8

3%

97.9

2%

93.6

7%

98.4

7%

91.6

0%

98.0

6%

96.3

8%

94.1

7%

98.2

6%

96.9

7%

98.4

0%

97.1

4%

88%

90%

92%

94%

96%

98%

100%


Rate Plan

Page 151


Page 152

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