Corporate Objective addressed by this paper (please select one or more with an X):

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1 Enclosure: I genda item: 13 GOVERNING BODY Title of paper: QIPP Delivery Update 2018/19 Date of meeting: 9 th January 2019 Presented by: Robert Shaw Prepared by: Kat Macann Title: Director of Commissioning & contact: Robert.shaw6@nhs.net Title: Head of QIPP PMO (Interim) & contact: kat.macann1@nhs.net Corporate Objective addressed by this paper (please select one or more with an X): 1. To commission safe, sustainable, efficient and affordable services to meet the health and wellbeing needs of the population of Greenwich and reduce x health inequalities; 2. To ensure the CCG s position recovers to meet its financial duties and x performance standards; 3. To nurture and support primary care to be resilient and thrive; x 4. To strengthen productive relationships with partners and the public to work as a health and care system; 5. To actively engage with our communities to improve their experience of healthcare; 6. To play an active and influential role in shaping SE London and London wide commissioning. Purpose of the report: The purpose of the report is to inform the Governing Body of the status of QIPP delivery to date in 2018/19. The report summarises the QIPP position and sets out key areas of work to strengthen delivery and mitigate risks. Issues arising: Financial reporting shows QIPP savings achieved in the first 8 months of the financial year total 8,219k against a month 8 target of 9,082k (90% delivery). forecast outturn for each scheme has been calculated based on actual acute data to month 7, and projected performance for the remainder of the year, taking into account delivery progress, key risks and agreed actions set out in the CCG s Financial Recovery Plan. Based on this approach, we are forecasting delivery of 12,598k savings against the target of 14,287k (88%), a shortfall of 1,689k. The majority of risks to achieving this position sit with schemes to reduce acute activity and a recovery plan was developed in October in partnership with Lewisham CCG which sets out risk mitigation work for selected schemes. Recovery actions continue to be monitored closely by the CCG s QIPP Planning, Delivery and Monitoring Group, as well as the Bexley, Greenwich and Lewisham Executive Group which means bi-monthly.

2 Summary of actions, if any, following this meeting: The CCG will continue to progress planning and delivery of the QIPP programme with appropriate support from management to mitigate risks and enable the delivery of a balanced financial position for the new financial year. Previous committee involvement: Integrated Governance Committee 19 December 2018, for noting. Recommendations to the Governing Body: The Governing Board is asked to NOTE the QIPP performance as at Month 8. (Please provide details below where Yes is indicated) Impact on Governing Body ssurance Framework (x) Yes x No N/ Impact on Environment (x) Yes No x N/ Legal Implications (x) Yes No x N/ Resource and or financial implications (x) Yes x No N/ Equality impact assessment (x) Yes No x N/ Privacy impact assessment (x) Yes No x N/ Impact on current NHS Outcomes Framework areas (x) Yes No x N/ Patient and Public Involvement (x) Yes No x N/ Communications and Engagement (x) Yes No x N/ Impact on CCG Constitution (x) Yes No x N/ ttachments: (i) QIPP Delivery Update 2018/19 2

3 QIPP Delivery Update 2018/19 Report for Governing Body 9 January 2019 Robert Shaw, Director of Commissioning Kat Macann, Head of QIPP PMO

4 Contents 1. Matters for Noting Finance Summary Month BGL Delivery Update Planned Care BGL Delivery Update Unplanned Care High Level Risks to QIPP Delivery 10 2

5 1. Matters for Noting (1/2) This report summarises progress to date delivering the CCG s QIPP programme for 2018/19, and is for noting by Governing Body. QIPP Financial Performance For most cute schemes, the month 8 forecast position has been calculated by the Finance team based on performance up to month 7 projected forward, with some variations to reflect delivery progress and timing. The revised Forecast Outturn for some acute schemes includes the impact of actions set out in the CCG s Financial Recovery Plan ie it is assumed that risk mitigation actions will be successful. The CCG s QIPP Planning, Delivery and Monitoring group will continue to monitor these actions closely to minimise the risk of further slippage. Based on year to date performance and the recovery plan actions set out in this report, Greenwich CCG is on track to deliver 12,589k QIPP savings in 2018/19, against a target of 14,287k a projected shortfall of 1,689k. This represents movement of -70k compared to the position reported to the Integrated Governance Committee in November (month 7). 3

6 1. Matters for Noting (2/2) QIPP Delivery Update The CCG continues to monitor delivery of local QIPP schemes via weekly QPDM meetings, where risks and issues are discussed and actions identified. The CCG is working in partnership with Bexley and Lewisham CCGs to strengthen QIPP delivery in 2018/19 and plan for 2019/20. The BGL Executive Group meets bi-monthly to review delivery progress, address risks and coordinate planning for 2019/20. The most significant delivery risks continue to sit with cute Planned Care schemes, reflecting wider challenges with acute activity across Bexley, Greenwich and Lewisham. 4

7 2. QIPP Finance Month 8 position Programme 18/19 Plan (000s) Forecast Outturn Change from Nov forecast % delivery Forecast YTD Plan Variance (M8) (000s) YTD ctual (M8) YTD Variance (M8) cute - Other 2,035 1, % ,357 1, cute - Planned 3,692 1, % -1,889 2,366 1,066-1,300 cute - Unplanned 1,965 2, % 870 1,213 1, CHC 1,340 1, % Contractual non-acute 1,959 2, % 100 1,282 1, Corporate / Estates / Other 2,100 2, % ,245 1, Prescribing 1,300 1, % Totals 14,391 12, % -1,689* 9,082 8, *Shortfall adjusted by 104k as QIPP target is 14,287k 5

8 3. BGL Delivery Update Planned Care SRO for BGL Project Lead/s (Greenwich) Robert Shaw Roger Hendicott Planned Care Irene Grayson Primary Care QIPP Schemes Total Forecast Outturn 3,692k 1,803k Delivery Risk Rating Highlights / chievements BGL Cardiology Diagnostic business case conditionally approved by Financial Investment Committee this was the first BGL wide business case to be developed through a joint working approach Faecal Immunochemical Testing (FIT) business case approved by FIC GP referral run rate YTD is only 1% above 17/18 baseline Diabetes Transformation: Patient engagement and provider engagement groups held to start developing clinical model; positive engagement from LGT Priorities Next Month Follow up on Cardiology Diagnostics address questions raised by committees Referral Management Options Paper to go to Financial Investment Committee for approval Follow up with LGT / ICDT regarding development of Business Case for Transforming Outpatients BGL QIPP planning workshops for 19/20 prepare for BGL QIPP ssurance session to be held in January Diabetes: Further workshop on model development with patients and clinicians Risks / Issues Risk: Planned Care Board workstreams may not mobilise at the pace required to deliver 2018/19 savings due to limited project management capacity and lead in time required Risk: BGL groups having to set 19_20 and deliver 18_19 with limited resources Issue: Delivery capacity changes to workforce / roles is putting pressure on commissioning leads 6 Response Operational groups are forming and developing work plans for most workstreams. BGL Directors of Commissioning to review progress and assign leads to priority workstreams Recruit to vacant posts at BGL level to attract additional resources. Interim resources from ttain. Short term additional resource secured to support BGL Diabetes workstream

9 3. Planned Care Scheme risks Scheme Cardiology Notes The forecast position for this scheme includes 100k additional savings (reduced from 130k) as set out in the Financial Recovery Plan (FRP) resulting from joint BGL work on Cardiology Diagnostics. business case for a new BGL approach to Cardiology Diagnostics was conditionally approved by the Financial Investment Committee, however the timescale for implementation and savings impact is later than was assumed in the Financial Recovery Plan. Further work is needed by Commissioning Leads and the CSU to mitigate this risk. Ophthalmology SLM reports have shown activity over performance for the most months. The forecast position presented in November assumed that this over performance would turn around quickly with the impact of the new Minor Eye Conditions Service launched in September, however this has been revised this month to a more conservative forecast based on average monthly activity. ctivity over performance is offset by expected savings from a contract challenge and delayed implementation of the MECS. Planned Care - acute activity QIPP stretch target The forecast outturn is based on a savings impact from January 2019 from two new schemes: Outpatient transformation Colorectal straight to test Radiology Tquest These schemes are not forecast to deliver the full amount originally set as a stretch target, and the CCG is not yet able to monitor the impact of the schemes due to the reporting time lag. 7

10 4. BGL Delivery Update Unplanned Care SRO for BGL Project Lead/s (Greenwich) Diana Braithwaite (Lewisham CCG) Gemma O Neil, Jayne Mason dults Kelly Sylvester CYP QIPP Schemes Total Forecast Outturn 1,965k 2,835k Delivery Status Highlights / chievements Key winter QIPP schemes in place Second meeting of unplanned care board greement on 6 days admissions avoidance audit in new year. Reviewing option for further opportunities within Respiratory admissions and GUI Delivering on excess bed days Priorities Next Month Winter Plans/Excess Bed Days: Scheme/s process and monitoring to rolled out and report due for the &E Delivery Board. Development of KPIs for scheme/s. Care Homes Key Messages: Go live mid-november. Care Homes udit: Results of Lewisham audit and share with Bexley and Greenwich. Lewisham Care Homes Summit OOH providers (SELDOC), safeguarding and primary care. Review of ttain Unplanned Care Modelling for BGL Local action plans to address risk mitigation priorities Risks / Issues Investment Strategies: The Business Cases completed by ttain for Bexley CCG require investment. Delivery capacity: This continues to be an issue as there is no assigned BGL Unplanned Care Lead to support programme management, delivery for Care Homes or the Unplanned Group and reporting the &E Delivery Board. 8 Response Work stream leads to address through each CCG s governance routes. Standing agenda item for BGL Executive Group to discuss resourcing pressures and potential solutions. Short term additional resource secured to support Respiratory work stream.

11 4. Unplanned Care scheme risks Scheme Care Homes Notes The Financial Recovery Plan included an improvement in performance for this scheme. Performance over the last three months has been stronger than earlier in the year, however there is still a risk this will not deliver the full savings due to ongoing challenges with care homes adoption of the initiatives. The FRP has a further QIPP delivery target of 90k from a BGL Communication and Education programme, which is included within the forecast. Frequent ttenders at ED Paediatric mbulatory Care Respiratory care pathways Unplanned Care Stretch Target 9 Full implementation of this scheme has been delayed due to issues progressing recruitment via Oxleas. Some savings have been achieved but not at the level originally planned. There has been a significant deterioration in savings over the past 2 months this needs to be investigated with the CSU. The Financial Recovery Plan assumed delivery of 100k QIPP savings due to pathway transformation work, which has been delayed. The November report included this within the forecast outturn, but while planning us underway we are not expecting implementation until 2019/20 so this has been discounted in the forecast. Irrespective of this, we are continuing to see a significant underspend against non elective activity in this area. The forecast is based on delivering 110k savings related to Excess Bed Days, as set out in the FRP. Financial impact is expected from December 2018, however this will not be captured in reporting until February 2019.

12 5. High Level Risks to QIPP Delivery Risk rea Risk Description RG Mitigation pproach and December Update Delivery Resource Planning Quality & Patient Safety Communication & Engagement Procurement / Contracts 10 The CCG may have insufficient clinical and operational resources to deliver all transformational schemes on time. Some schemes have been based on ambitious savings assumptions Some schemes are at an early stage of planning, so delivery risks/issues may not be fully understood Some schemes should be progressed at a collaborative level there is a risk that ownership and resources to progress these are not clear Schemes involving changes to services may negatively impact on quality or patient safety Engagement with primary care is critical to the delivery of demand management schemes Engagement with providers some schemes are reliant on providers adopting and adhering to pathways Current contractual arrangements may restrict opportunities to realise additional savings in year BGL QIPP Report DRFT G Regular reviews of workload and prioritisation bimonthly discussion at BGL Executive Group. dditional short term resource for high priority workstreams. Through the Financial Recovery Plan, the CCG has considered the position of all schemes and set out reasonable forecasts for each scheme taking into account actual delivery and potential mitigations. Delivery risks/issues have been identified and addressed as the year has gone on. Key outstanding risks/issues are noted in this report. BGL Executive Group oversight of Ongoing work to strengthen collaborative working. PMO leads across BGL are working together to provide coordination and structure, while a new joint team is recruited. Delivery resource remains a high risk. Completion of EI/QI screenings at planning stage Periodic reviews to be scheduled mid year (delayed) Quality / patient experience measures to be monitored alongside finance/activity reporting GP engagement programme as commenced in October Involvement of GPs as Exec Leads and CPLs IT / forms work to improve compliance with pathways BGL Referral Optimisation workstream established Engagement regarding specific schemes via appropriate contract management channels Planned Care Board has LGT membership Opportunities are targeted at PbR providers Early planning for QIPP 2019/20 is critical.