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

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1 Enclosure: M Agenda item: 17 GOVERNING BODY Title of paper: QIPP Delivery Update 2018/19 Date of meeting: 4 th July 2018 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 planning 2018/19. The report summarises the current QIPP plan position and sets out the approach to closing the planning gap through developing additional savings opportunities and mitigating delivery risks. Issues arising: The CCG has a QIPP target of 14.3m in 2018/19 Prior to June, QIPP schemes had been identified totalling 12.7m, leaving a gap of 1.6m in unidentified QIPP Additional areas of QIPP opportunity have now been identified and approved by the Financial Recovery Board for further development. These areas provide an agreed framework for closing the QIPP gap, bringing the total identified schemes to 14.4m. CCG leads are developing detailed plans for each area to set out how the savings can be realised. Revised risk assessments on the full QIPP plan show there is residual delivery risk totalling 4.3m within the plan this is expected to go down as the additional opportunities are worked up in full and mitigation work continues Collaborative work with Bexley and Lewisham CCGs is underway to strengthen delivery of planned and unplanned care schemes in relation to Lewisham and Greenwich NHS Trust, mitigate risks and progress additional opportunities.

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: Financial Recovery Board 13 June 2018 change proposals and additional opportunity areas approved Greenwich Executive Group 20 June 2018 for noting Finance, Performance & QIPP Committee 27 June 2018 for discussion Recommendations to the Governing Body: The Governing Board is asked to NOTE the QIPP planning position. (Please provide details below where Yes is indicated) Impact on Governing Body Assurance Framework (x) Yes x No N/A Impact on Environment (x) Yes No x N/A Legal Implications (x) Yes No x N/A Resource and or financial implications (x) Yes x No N/A Equality impact assessment (x) Yes No x N/A Privacy impact assessment (x) Yes No x N/A Impact on current NHS Outcomes Framework areas (x) Yes No x N/A Patient and Public Involvement (x) Yes No x N/A Communications and Engagement (x) Yes No x N/A Impact on CCG Constitution (x) Yes No x N/A Attachments: (i) QIPP Delivery Update 2018/19 2

3 QIPP Delivery 2018/19 Update to Governing Body July 2018 Robert Shaw, Director of Commissioning

4 Contents 1. Matters for Noting by the Governing Body 2. QIPP Plan Overview 3. High Level Risks to QIPP Delivery 4. Next Steps Page 2

5 1. Matters for noting by the Governing Body Governing body is asked to note the following: The draft Financial Recovery Plan presented to FRB in May 2018 showed a QIPP Plan requirement of 14.3m with 12.7m of schemes identified, 1.6m unidentified and 3.9m risk on identified schemes total risk of 5.5m High level areas have been identified and agreed by the CCG s SMT and Financial Recovery Board to close the QIPP planning gap and provide contingency for any shortfall from previously identified schemes The current position and additional opportunities are set out below, with further detail on work underway to mitigate delivery risks and stretch opportunities for savings from acute activity. Revised risk assessments on the total QIPP plan now show there is residual delivery risk totalling 4.3m this is expected to go down as the additional opportunities are worked up in full and mitigation work continues. The CCG is developing a collaborative approach to QIPP planning and delivery, working closely with Bexley and Lewisham CCGs to establish joint work programmes for planned and unplanned care. Page 3

6 2. QIPP Plan Overview Current position based on latest delivery and risk updates, includes additional areas of opportunity. QIPP 2018/19 Jun-18 Total ( 000s) Acute Community Mental Health Prescribing Continuing Care Other Total required 14,287 Identified Schemes - Total Identified Schemes - Risk Adjusted Over identified schemes 14,391 8,211 2, ,300 1,340 1,223 9,977 4,194 2, ,075 1, QIPP Risk Total 4,310 4, Page 4

7 3. High Level Risks to QIPP Delivery Risk Area Risk Description RAG Mitigation Approach Delivery Resource The CCG may have insufficient clinical and operational resources to deliver all transformational schemes on time. Recruitment to vacant commissioning and clinical posts Regular reviews of workload and prioritisation Collaborative workstreams with additional support Planning Quality & Patient Safety Communication & Engagement Procurement / Contracts 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 Further modelling / analysis underway to verify potential savings available Work up additional opportunities to meet any shortfall Complete detailed planning, early escalation of any significant risks or changes Development of Planned and Unplanned Care Boards to oversee joint work programmes Collaborative governance and reporting arrangements to be confirmed Completion of EIA, QIAs at planning stage Periodic reviews to be scheduled Quality / patient experience measures to be monitored alongside finance/activity reporting GP engagement strategy/plan being developed Involvement of GPs as Executive and Project Leads IT / forms work to improve compliance with pathways Engagement regarding specific schemes via appropriate contract management channels Collaborative work through Planned Care Board and Unplanned Care Board Target opportunities at PbR providers Early planning for QIPP pipeline to account for time constraints Page 5

8 4. Next Steps Delivery Assurance Finance / Activity Tracker to feed into highlight reports at scheme level Highlight reports to QIPP Planning, Delivery & Monitoring Group focusing on progress against milestones and managing risks Weekly programme updates to Senior Management Team July report with Month 1 data to Finance, Performance & QIPP Committee, followed by July Financial Recovery Board Scheme Development Undertake Deep Dive reviews with each budget holder Fast track proposals for new schemes business cases where applicable On-going pipeline development of local QIPP opportunities for 2019/20 Collaborative Work Bexley, Greenwich & Lewisham Planned Care and Unplanned Care programmes establish programme priorities and work streams; progress joint business cases South East London Treatment Access Policy alignment and opportunities Manage alignment with South East London work streams Develop 2019/20 QIPP plans at collaborative level Page 6