Enclosure: F Agenda item: 9 GOVERNING BODY. Title of paper: Recovery Plan (Financial Recovery Board) Date of meeting: Wednesday 23 March 2016

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1 Enclosure: F genda item: 9 OVERNIN BODY Title of paper: Recovery Plan (Financial Recovery Board) Date of meeting: Wednesday 23 March 2016 Presented by: Prepared by: Title: Turnaround Director & Interim Director of Commissioning & contact: gina.shakespeare@nhs.net Title: Turnaround Director & Interim Director of Commissioning & contact: gina.shakespeare@nhs.net 1. To commission high quality, cost effective services to meet the needs of local people which improve health outcomes and reduce inequalities. 2. To ensure that the patients and the public s voice is heard so that we improve the quality of the services that we commission for the diverse needs of our population. 3. To develop reenwich CC as a clinically driven organisation with effective member engagement, that can attract and retain excellent staff, deliver effective governance and its full statutory and financial duties. 4. To create and optimise a data and intelligence rich environment to inform commissioning decisions at CC, Transformation Steering roup, Syndicate and practice level. 5. To develop a long term approach to improving healthcare and delivering more integrated services for the population of reenwich delivered by sustainable providers through partnership working with RB, local providers, the community and voluntary sector. x x x x Purpose of the report: To report to the overning Body progress on achievement of financial recovery and turnaround. The revised governance arrangements are described. The Turnaround Director has assumed responsibility for the Programme Management Office and the QIPP programme and this report considers progress on the QIPP 2016/17 programme planning, delivery and monitoring, and internal assurance. The FPQ s monitoring of progress in delivery of the Financial Recovery Plan and the level of assurance it has taken on this is summarised. Issues rising: This paper reports on the progress towards the recovery plan. Summary of ctions: 1. ppointment of Turnaround Director, also acting as interim Director of Delivery & Transformation 2. rrangement of fortnightly Financial Recovery Board (FRB) meeting 3. rrangement of weekly QIPP Planning, Delivery and Monitoring roup (QPDM) 4. Four programmes have been scoped to support recovery: QIPP Delivery Organisational Capability & capacity Operational Planning for 2016/ /17 Contract Resolution within ffordable Envelopes 1

2 Enclosure: F genda item: 9 Committee involvement: reenwich Executive Committee: 2 March 2016: approval granted Recommendations to the overning Body: The overning Body is asked to: Note the detailed arrangements for the Financial Recovery Board (FRB) to replace QPE formal ratification of which will take place under item 15 of this meeting; and arrangements for the QIPP Planning, Delivery and Monitoring roup Note the continued role of the Finance, Performance and QIPP (FPQ) Committee in taking assurance on financial recovering on behalf of the overning Body. (Please provide details below where YES is indicated below) Impact on overning Body ssurance Framework (x) Yes x No N/ Impact on Environment (x) Yes No N/ x Legal Implications (x) Yes No x N/ Resource and or financial implications (x) Yes x No N/ Equality impact assessment (x) Yes No N/ x Privacy impact assessment (x) Yes No N/ x Impact on current NHS Outcomes Framework areas (x) Yes x No N/ Patient and Public Involvement (x) Yes No N/ x Communications and Engagement (x) Yes x No N/ Impact on CC Constitution (x) Yes No x N/ x ttachments: Report of the Financial Recovery Board March 2016 (i) (ii) (iii) (iv) (v) (vi) nnex Membership and Terms of Reference of the Financial Recovery Board nnex B Membership and Terms of Reference of the QIPP Planning, Delivery and Monitoring roup, which reports to the Financial Recovery Board. nnex C key governance structures and relationships nnex D functionality of financial recovery nnex E reenwich CC s QIPP Programme Management methodology nnex F - Summary of Finance Performance & QIPP committee assurance tracker as at February

3 reenwich overning Body: Report of the Financial Recovery Board March 2016 Introduction Following the report to the overning Body in January 2016, it was agreed to move the organisation into turnaround as insufficient progress had been made in delivering the Recovery Plan, such that the overning Body was not assured that a balanced budget complying with NHS Business Rules could be agreed for 2016/17. This is the first report on this matter since that decision was made. Following detailed work to construct the 2016/17 budget the CC s QIPP requirement for 2016/17 has been reassessed at 19.8M, a movement from 13.5M. The derivation of this requirement is considered in detail in the Chief Financial Officer s financial update ( elsewhere on this agenda). Elsewhere on this agenda, the overning Body is asked formally to ratify the creation of a Financial Recovery Board (FRB), accountable to the overning Body and reporting directly to it; in the light of the urgency of the requirement to enter turnaround the FRB Board has in fact been meeting since 17 th February and this is its first report to overning Body. Purpose The paper s purpose is to report to the overning Body progress on governance and achievement of financial recovery and progress in turnaround. The revised governance arrangements are described. The Turnaround Director has assumed responsibility for the Programme Management Office and the QIPP programme and this report considers progress on the QIPP 2016/17 programme s planning, delivery and monitoring and internal assurance. The FPQ s monitoring of progress in delivery of the Financial Recovery Plan and the level of assurance it has taken on this, is summarised. overnance of Financial Recovery t the inception of turnaround, evidence based organisational arrangements were set out and refined in discussion at the Commissioning Leadership roup and the reenwich Executive roup. This report describes these arrangements set out as follows: 1. nnex contains the membership and Terms of Reference of the Financial Recovery Board 2. nnex B contains the membership and Terms of Reference of the QIPP Planning, Delivery and Monitoring roup, which reports to the FRB 3. nnex C captures the key governance structures and relationships 4. nnex D sets out the functionality of financial recovery 5. nnex E describes the CC s QIPP Programme Management methodology Because of the urgency of turnaround the QPDM is meeting weekly and the FRB fortnightly and the former QIPP and Programme Executive has now been stood down. 1

4 ssurance of Financial Recovery The Finance, Performance and QIPP Committee receives an updated tracker based on the CC s original Financial Recovery Plan along with a suggested assurance level of each of the actions; in due course once the new Financial Recovery Plan is prepared and endorsed, a tracking mechanism will be agreed. summary of the assurance tracker presented in full to the FPQ at its February 2016 meeting, is attached at nnex F, for assurance purposes. Execution of Financial Recovery The FRB s emphasis is on execution and its meets frequently to track the progress of the four key programmes and agree any mitigations or recovery activity necessary; it also tests the level of clinical ownership and confidence in the measures coming forward, whilst detailed scrutiny of individual QIPP projects takes place at QPDM. Resourcing of Financial Recovery In common with many others, the CC is heavily reliant on interim staff up to the most senior executive level. The CC has recruited a Turnaround Director who is also covering the vacancy of Director of Delivery and Transformation; an additional Programme Management Office Director; an additional contracting consultant; and three additional project managers supporting QIPP projects. The resources associated with QIPP delivery and management, including the PMO and the team supporting operational planning, strategy and performance ( the including Better Care Fund) have been temporarily placed in the responsibility of the Turnaround Director in order to achieve alignment of contract values, operational planning activity and performance assumptions and QIPP. In addition, a team from Deloitte has recently returned to site to review progress on the company s September recommendations to the CC on financial recovery, ensure lessons learned are captured and support the financial planning requirements arising from 2015/16 close down as they impact on 2016/17 financial planning. Structure of the Financial Recovery Programme Evidence suggests that failure to execute and align contracting, QIPP and operational planning is associated with financial and delivery difficulties in commissioning organisations; and that absence of capacity and capability in each of these respects results in poor delivery. For that reason four key programmes have been scoped and are reporting to the FRB to support recovery, namely: a. QIPP Delivery b. Organisational Capability and Capacity c. Operational Planning for 2016/17 d. 2016/17 Contract Resolution within ffordable Envelopes 2

5 In addition, the FRB will oversee the NHSE requirement for a Financial Recovery Plan which resulted from the discussions held following the February operational planning submission and an NHS England Stocktake with the CC. Delivery of QIPP Clinical Commissioners are working alongside commissioning, quality, performance and finance and informatics staff to scope opportunity to reduce costs and improve quality, productivity and value for money an deliver approved opportunities. The CC s QIPP programme for 2015/16 underperformed and the CC is facing a number of challenges including the identification and validation of opportunities, their development into sound business cases, robust processes of internal assurance to ensure that yields are realisable and execution of changes using procurement, decommissioning, contract variation and negotiation. The FRB s programme on Organisational Capability and Capacity will be crucial in enabling the CC to operate at a level compatible with sustained recurrent financial balance, once interim capacity has left the organisation. The two Children s and dult s Population Steering roups will play a key role in developing opportunities for QIPP; the CC is also a Wave One Right Care CC and opportunities are being generated through this initiative, including at a well attended local workshop in February The CC is also using the Deloitte ny Town Opportunity Benchmarking tool and other sources such as Better Care Better Value, to identify and triangulate potential QIPP. n effective partnership of clinical commissioner and manager to build and deliver business cases is a hall mark of commissioning organisations delivering strong QIPP programmes and despite some difficulties arising from high staff turnover, these relationships are being built. The Turnaround Director and PMO Director have adopted a rigorous internal QIPP assurance mechanism which implements the Deloitte recommendations on assessment of a QIPP scheme and goes on to attribute a financial yield value based on the resulting categorisation of each scheme. The Programme Management methodology enables each scheme to proceed from the opportunity identification stage through to the most highly assured category ( blue ) using defined stages and consistent assessment. Whilst the application of this method to the QIPP Programme in early March 2016 resulted in a low value for the QIPP programme, this approach will enable the CC to be confident in predicting the QIPP yield which will be built into its 2016/17 Operational Planning ssumptions and its Financial Recovery Plan. The QIPP programme is continually updated and validated following the weekly QPDM meeting as each scheme proceeds through the process. The team has also revised the business case template to improve ease of use and added a formal sign off process of multi-disciplinary verification, since sound financial and activity data are essential to ensure schemes are robust and sound processes to determine clinical ownership and quality assurance will ensure that the initiatives are well founded. Early dialogue has taken place with partners at Lewisham and reenwich NHS Trust and commissioner colleagues in RB and Bexley CC to scope a potential integrated CIP/QIPP 3

6 opportunity on excess bed day and staff costs for lengths of stay over 9 days at the Trust. Meetings are also being held with partners at Oxleas Foundation Trust to explore how key r services can be secured for better value for money, for example through improved bed utilisation. Table One below, describes the QIPP Programme as at and which was reported to and agreed by, the FRB on the 16 th March. The reenwich Executive roup has asked to receive a regular summary of the QIPP Programme at its meetings, for information, in order to ensure clinical commissioners are well informed about the programme content and its development. Table One: Weighted QIPP nalysis as at 16 March 2016 ssurance Category ross Value Weighting Factor Risk ssessed QIPP '000 % ' Still to Find 6908 Total The overning Body is recommended to: 1. Note the detailed arrangements for the Financial Recovery Board (FRB) to replace QPE - formal ratification of which will take place under item 15; and arrangements for the QIPP Planning, Delivery and Monitoring roup 2. Note the continued role of the Finance, Performance and QIPP Committee in taking assurance on financial recovery on behalf of the overning Body 4

7 TERMS OF REFERENCE reenwich Financial Recovery Board (FRB) 1. Constitution The reenwich Financial Recovery Board (RFB) reports to the reenwich overning Board (B). It is an executive forum focussed on delivery of financial recovery. It is not intended to be a permanent addition to the CC s governance arrangements. Its activities support the Finance Performance and QIPP Committee (FPQ) in its assurance role, which the FPQ retains in its entirety. 2. Purpose The purpose of the FRB is to: Lead and drive the financial recovery of the CC such that it can return to recurrent financial balance within the NHS accounting rules as quickly as possible consistent with patient safety and quality. It will do by ensuring that QIPP Plan, 2016/17 Contracts, the 2016/17 Operating Plan and the capability and capacity of the CC are all mutually consistent and are aligned to that recovery. 3. Duties/ Roles and Responsibilities The FRB shall ensure that each of the four programmes is effectively lead, directed and reported and that they are mutually consistent and supportive in achieving financial recovery. It shall: Lead and direct the CC s QIPP Plan, ensuring that it is consistent with and is supported by, the contracts which the CC establishes for 2016/17, receiving regular written reports from the QIPP Planning, Delivery and Monitoring roup which reports to it; the FRB will sponsor the QIPP programme ensuring that it retains a high profile within the CC, is well founded within Right Care principles and that it receives the resources it needs to deliver ; the Board shall be the final approver for Business Cases recommended to it Lead and direct the CC s contact agreements for 2016/17, receiving regular written reports from the Executive Owner, ensuring that they are delivered within the affordable contract envelopes the Board mandates, that they explicitly support QIPP delivery and reflect wherever possible, Right Care Lead and direct the development and approval of the CC s 2016/17 Operational Plan, receiving regular written reports from Executive Owner and ensuring that the plan optimises levels of clinical safety, quality, activity and performance consistent with the CC s duty to deliver financial balance and the 9 NHS Mandated Must Do s Lead and direct the continuous review of the organisation s capacity and capability such that its effectiveness as a commissioning organisation is evaluated, that areas for development and improvement are identified and that interventions are designed to deliver improvement, receiving regular reports from the Executive Owner Ensure that the importance of financial recovery is communicated to member practices and Networks so that they are engaged in this purpose, their ideas and requirements are Chair Dr Ellen Wright Page 1 of 4 Chief Officer nnabel Burn

8 responded to and that they are fully informed and equipped to play their part in the delivery of QIPP, contractual controls and demand management and fully involved in redesign and transformation, receiving regular reports from the Executive Owner Ensure through the Sponsor of Clinical Safety and Quality, that the CC s financial recovery is safe and that clinical quality is a primary concern of all those promoting, designing and executing change Ensure that the importance of financial recovery is communicated to patients and their representatives, articulating the importance of financial recovery, of Right Care and promoting the reputation of the CC in achieving the highest standards of commissioning Challenge and verify all Programme Plans, through the Responsible Owners, to ensure that they are mutually consistent and supportive, realistic and robust Ensure the sub-groups reporting to it are working collaboratively and in a common direction, and that opportunities, risks issues and dependencies in each are known shared and managed Hold Executive and Clinical Responsible Owners to account for their Programme s performance and for confirming that their programmes comply with agreed CC processes and policies and supporting them in their roles Identify, monitor and manage risks, issues and dependencies within the Financial Recovery Programme, considering an analysis of Risk across the delivery of the overall programme ctively support all employees to promote openness, honesty and value for money ccount to the CC s overning Body in the manner and at the frequency, it requires and report regularly to the Finance Performance and QIPP Committee in order to support the latter s assurance responsibilities FRB is authorised to request any information it requires from other groups within the CC or responsible individuals leading on developing or working on Recovery related schemes Should FRB consider it necessary to obtain outside legal, clinical or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise it can approve such spend on its own and its sub-committees behalf. Logistics shall be delivered by the PMO. 4. ccountability The FRB is accountable to the B. The following groups are accountable to it: QIPP Planning, Delivery and Monitoring roup (QPDM) The Clinical and Executive Owners of each of the four programmes are accountable to the FRB. 5. Committee Membership The FRB will be sponsored by the CC s Clinical Chair and ccountable Officer and chaired by the CC Turnaround Director Chair Dr Ellen Wright Page 2 of 4 Chief Officer nnabel Burn

9 Executive and Clinical Owners of the four programmes shall attend to: present updates at set ateways and by exception when a Programme has missed 3 milestones or have a R rating which breaches agreed parameters. The Director of Integrated overnance shall be the Sponsor of clinical safety and quality, Other clinical or management experts may be also invited to support decision making or policy development. Terms of Reference and membership will be reviewed after six months of operation PROPOSED MEMBERSHIP Nature of Membership ccountable Officer Yes Senior Sponsorship of the Board Clinical Chair Yes - Senior Sponsorship of the Board Chief Finance Officer Yes Core Member Turnaround Director Yes Chairs the Meeting Director of Strategy & Performance Yes Executive Owner of Organisational Capability and Capacity Director of Integrated overnance Yes - Sponsor of Clinical Safety and Quality in addition to Patient Engagement Director of Delivery and Transformation (Covered by Turnaround Director in Interim) Yes Executive Owner of QIPP, Operational Plan and Contract greements Ranil Perera or Nayan Patel Yes Lead P (ssurance) (lternate Meetings) PMO Director Yes responsible for logistics Members will be expected to attend 85% of all meetings, and nominate a deputy if not attending. 6. Quorum Meetings can take place, if a quorum of at least one third of members is present. This must include the Turnaround Director, Clinical Chair, and Chief Finance Officer or their nominated deputies. 7. Reporting rrangements and Supporting Structures high level summary of the progress of recovery will be regularly provided to B. In addition the FRB will provide an assurance report in respect of Financial Recovery to the FPQ. 8. Frequency of Meetings The group will meet initially fortnightly, but this may increase or decrease depending on the progress of recovery. The genda and supporting papers will be circulated at least 3 business days before the meeting, to ensure members can consider the proposals in advance. Business cases must be submitted 5 business days before the meeting to allow for review and verification. ctions and decisions from all meetings will be recorded and minutes circulated to FRB members. Chair Dr Ellen Wright Page 3 of 4 Chief Officer nnabel Burn

10 9. Paper preparation and circulation The logistics for the FRB will be provided by the PMO Team within the CC. 10. Declarations of interest register of declaration of interest will be maintained by the secretariat of this committee. 11. Equality Statement We are committed to undertaking Equality Impact ssessments, which involve assessing the likely or actual effects of policies or services on people who use them. It helps us to make sure the needs of people are taken into account when we develop and implement a new policy or service or when we make a change to a current policy or service. For further information please see the reenwich CC website: Monitoring dherence to the Terms of Reference / Review The Terms of Reference and membership will be reviewed as required, and at least on an annual basis. ny changes must be approved by the overning Body. Version Date mended Summary of Changes pprovals required 1.0 7/2/16 Initial Draft by NV 2.0 7/2/16 Review by Turnaround CL Director 2.1 7/2/16 Formatting NV 2.2 9/2/16 Membership change FRB following decision by ccountable Officer /2/16 Revisions following E FRB Chair Dr Ellen Wright Page 4 of 4 Chief Officer nnabel Burn

11 TERMS OF REFERENCE QIPP Planning, Delivery & Monitoring roup (QPDM) 1. Constitution The QIPP Planning, Delivery & Monitoring roup (QPDM) is accountable to the reenwich Financial Recovery Board (FRB) and reports to it. The QPDM supports the Finance Performance and QIPP, Market Management and Procurement and Quality Committees. The QPDM is supported by the Children s, dults, and Primary Care Co-Commissioning Transformational Steering roups. 2. Purpose The purpose of the QPDM is to drive, challenge and monitor the planning processes and delivery of the CC s QIPP Programme, holding Responsible Owners and their Programme Managers and clinicians to account for the delivery of QIPP schemes. 3. Duties/ Roles and Responsibilities The QPDM will: ct as a final review ateway for Business Cases before they are submitted to FRB for sign off ensuring that they have been challenged and verified from all necessary perspectives including Finance, Informatics, Clinical Quality and Safety, Commissioning and Contracting, HR and IT Receive and review delivery reports, programme risks and mitigation measures provided by Responsible Owners to ensure that they are realistic, robust and deliverable, by exception when they have breached agreed parameters i.e. one red R rating or two consecutive amber R ratings as determined by the PMO Co-ordinate a rolling QIPP planning process as the Steering roups identify and develop new opportunities for deliverable schemes and identify Responsible Owners Recommend to the FRB where the development of a QIPP project should be resourced or if such work should cease Consider the risks, issues and dependencies within the QIPP Programme as a whole ssess and allocate the resource requirements needed to deliver the QIPP Programme, escalating any additional requirements to Directors for approval ctively support all employees and clinical commissioners to promote Right Care, Clinical Safety, and Value for Money in their work on QIPP Obtain external legal, clinical or other independent professional advice to support effective execution of the QIPP programme or evaluation of Business Case Further develop a set of tools to enable the development of business cases and support execution of the QIPP Programme. dvise the Responsible Executive Director for Organisational Capacity and Capability, of learning and development needs within the CC s workforce and clinical commissioners, which will support the development and execution of QIPP Chair Dr Ellen Wright Page 1 of 4 Chief Officer nnabel Burn

12 Responsible Owner Responsibilities: Ensure their Programmes comply with agreed CC processes and policies Ensure that all documentation required by the CC is properly completed, authorised where appropriate and kept up to date (Business Cases, PIDs, Project Plans, Risk and Issues Logs, Mitigation Plans) Ensure attendance by an informed party to support the QPDM in fulfilling its responsibilities 4. ccountability The QPDM is accountable to the FRB. Its emphasis is delivery and execution and it will support but not duplicate the responsibility for assurance of QIPP and Performance, held by the Finance Performance and QIPP Committee. The QPDM will interface with the formal committees in the CC such as Quality, Market Management and Procurement and Finance, Performance and QIPP where needed to support those assurance responsibilities and other decision making. 5. Committee Membership The QPDM will be chaired by the CC s PMO Director Terms of Reference and membership will be reviewed annually, or as required by changes in organisational requirements. PROPOSED MEMBERSHIP PMO Director P Executive ssociate Director of Finance / Head of Finance Head of nalytical Support ssociate Director of Transformation ssociated Director of Delivery ssociate Director of Integrated Commissioning ssociate Director for Medicine Management ssociate Director for Strategy and Performance CSU cute Contract Manager Community Contract Manager PMO Support Officer Clinical and Executive Owners and Project / Programme Managers Core Member or s Required Yes Chair Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes s required Core Members will be expected to attend 85% of all meetings, and nominate and notify a deputy if not attending. Chair Dr Ellen Wright Page 2 of 4 Chief Officer nnabel Burn

13 6. Quorum Meetings can take place, if a quorum of at least one third of members is present. 7. Reporting rrangements high level written summary of the progress of the QIPP Programme will be incorporated into the Programme Report on QIPP required by the FRB. 8. Frequency of Meetings The group will meet weekly. The genda and supporting papers will be circulated at least 3 business days before the meeting, to ensure members can consider the proposals in advance. Business cases and papers must be submitted 5 business days before the meeting to allow for review and verification. ctions and decisions from all meetings will be recorded and minutes circulated to QPDM members. 9. Paper preparation and circulation The logistics for the QPDM will be provided by the PMO Team within the CC. 10. Declarations of interest register of declaration of interest will be maintained by the secretariat of this committee. 11. Equality Statement We are committed to undertaking Equality Impact ssessments, which involve assessing the likely or actual effects of policies or services on people who use them. It helps us to make sure the needs of people are taken into account when we develop and implement a new policy or service or when we make a change to a current policy or service. For further information please see the reenwich CC website: Chair Dr Ellen Wright Page 3 of 4 Chief Officer nnabel Burn

14 12. Monitoring dherence to the Terms of Reference / Review The Terms of Reference and membership will be reviewed as required, and at least on an annual basis. ny changes must be approved by the Financial Recovery Board Version Date mended Summary of Changes pprovals required 1.0 5/2/16 Initial Draft by Head of PMO was reviewed by Turnaround Director Version 2.0 created for CL discussion by CL Formatting CL /2/16 Membership change FRB following decision by ccountable Officer /2/16 Revisions following FRB E Chair Dr Ellen Wright Page 4 of 4 Chief Officer nnabel Burn

15 nnex C - Financial Recovery overnance overning Body ssurance Finance, Performance & Quality Committee(s) Programme implementation ( ) ssurance Financial Recovery Board Ensure clinical engagement reenwich Executive roup Market Management & Procurement Board pproval for route to market QIPP Planning, Delivery and Monitoring Idea generation & critique Population Health Transformation Steering roups (dult & Children) pproved by reenwich Executive roup 2 nd March 2016 In draft JB

16 nnex D - Financial Recovery Functionality Financial Recovery Board pproval & sign-off for schemes, provide assurance to overning Body / Trust Board, holding to account for delivery of benefits PMO QIPP & Planning, Delivery and Monitoring Day to day tracking and monitoring of scheme delivery Proactive / Preventative Care Urgent / Unplanned Care Planned Care Internal Controls & Decommissioning pproved by reenwich Executive roup 2 nd March 2016

17 nnex E - Financial Recovery Process Complete idea template & log idea with Jenny Briggs and copy Nick Varney Develop business case with clinical lead to outline scope and high level opportunity offered Present to QPDM Review activity and financial modelling with BI team. Neil Taylor and Seelan unaseelan to sign off o: o to gateway 2 (Or agree alternative project path by exception) Stop: PMO Record Decision and Rationale Review links to Strategic Plan. Chris Soltysiak to sign off Involve PR Discuss medicine issues with MMT llocate Clinical Lead & Project Manager (if needed). Log with Nick Varney for QIPP pipeline Present to QPDM o: o to gateway 3 Refine: Back to gateway 2 Stop: gree approvals route (i.e. whether overning body approval is needed) Present to FRB o: Refine: Stop Present to B (if required) o: o to gateway 4 Refine: gateway 2 Stop Prepare project delivery plan & log with PMO Review route to market with procurement & contracting team. Mike Procter to sign off Review quality & equality impact with Quality team. Maggie iken to sign off Prepare service specification, KPIs, draft contract. Vicki Robinson to sign off Present to MMPB if required o: o to gateway 5 Stop: Undertake formal procurement, waiver, SFI, framework, or implement pilot Present to FRB gree monitoring framework and controls for tracking financial benefits. Nick Varney to sign off gree contract management and performance monitoring responsibility. Mike Procter and Chris Soltysiak to sign off o: o to gateway 6 Hand over to contract managers for ongoing monitoring of performance PMO team to continue tracking financial benefits delivery Complete lessons learned & project closure documentation Present to QPDM Project Closure pproved by reenwich Executive roup 2 nd March 2016

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19 ction Tracker of Financial Recovery Plan Deloitte Recommendation Lead Director 1. Undertake further analysis to understand drivers of acute activity, its future financial impact, and action plan to reduce activity. Level of ssurance as at FPQ meeting 24 February 2016 ctions Required 1.1 Undertake further analysis to understand the drivers of acute activity and its future financial impact (e.g. analysis of causes of an increasing conversion rate). Draw on analysis to shape QIPP programmes and contract negotiations for Report progress to Commissioning reenwich Executive February 3rd Review remit of both CSU and CC informatics teams to ensure CC has robust analytics available in a clear and consistent manner (all options should be considered). R Specific plan of action required to resolve this issue 2. Identify clearly the financial gap that needs to be met through disinvestment and QIPP. 2.1 Ensure more robust financial planning and analysis and reporting of schemes, and their phasing. Specific actions have been taken but further embedding work to be done. Continue to monitor progress through FPQ 2.2 Undertake a full exploration of the potential contract pressures and investment requirements in the local health economy over the medium term. This process will also help to identify the financial gap to be met through disinvestment and QIPP. Progress to be monitored through Commissioning E 3. Establish programme governance around QIPP with pace and urgency. 3.1 Standardise and strengthen QIPP risk reporting and ensure mitigations are properly documented and reported. Ensure project leads escalate risks within 48 hours or via QIPP meetings. Embed this approach to risk categorisation and management widely into organisational processes and reporting.

20 3.2 dd delivery R ratings to QIPP and BCF schemes. Remains open. 3.3 Ensure robust KPIs are used including using non financial KPIs to assess performance. R PMO to ensure that process is in place for months 11 & Set up a QIPP Steering roup (this is QIPP and Programme Executive) and ensure that there are clear processes for identifying and prioritising QIPP opportunities. QPE reports to reenwich Executive who will monitor. Close action. 3.5 Establish regular use of scenario planning to support good decision making in particular this should include financial scenarios with sensitivity analysis. Further work to be completed on financial modelling of QIPP schemes. Commissioning E to monitor progress in February Establish and agree a timetable of critical dates for the QIPP programme and ensure this is communicated internally. Establish clinical, project and executive ownership of each QIPP scheme to ensure escalation channels are clearly defined and used effectively. Monitor through FRB Monitor through FRB 3.8 Establish a value threshold for QIPP schemes to ensure that time and resources are not expended on schemes with limited financial benefit. FRB to agree 3.9 Consolidate and risk adjust the BCF schemes (i.e. make them real and clearly understood as to their relationship to QIPP and the organisation s business). Decide how to report both internally and up to NHS England in a more meaningful manner. Refresh for next year to be completed by March Establish a QIPP tracker scheme. PMO to prioritise development of in year QIPP tracker by the end of January 3.11 Formalise the PMO structure, and ensure that it is understood and used across the organisation. Ensure it is properly and adequately resourced (it is a 13m QIPP programme). Complete appointments 3.12 Increase the pace and urgency of implementing governance changes for QIPP programme management in order to focus on development and delivery of QIPP in 2016/17 and beyond. Formal approval at E 4. Create an outline 2016/17 QIPP programme using nytown benchmarking and Deloitte analysis. 4.1 Triangulate Deloitte analysis with existing QIPP ideas in order to create a more robust outline programme for 2016/17 and beyond. Proposed QIPP programme adopting Pipeline; Planned; and Realisable categories will be refreshed and submitted to FRP of 2nd March 2016

21 4.2 Undertake an assessment of all the potential future schemes identified by Deloitte with a view to including in revised commissioning intentions (Nov ov Body). See 4.1 above 5. Invest in additional capacity and capability in light of the plan to deliver higher levels of QIPP over medium term. 5.1 ddress skills gaps within the staff team through structured training. Simon Hall Focus on recruitment to substantive posts and monitor through reenwich Executive 5.2 ddress skills gaps within the clinical commissioning team and overning Body. Simon Hall Focus on recruitment to substantive posts and monitor through reenwich Executive 5.3 Undertake an assessment of the level of staff sickness and vacancies; ensure this is reported to the SMT regularly. Simon Hall Continue to monitor through reenwich Executive 5.4 Invest in additional capacity and capability in light of the plan to delivery higher levels of QIPP over the medium term. This applies to finance, delivery and the PMO in particular. Simon Hall Monitor through FRB 6. ppoint a member with a financial background and qualification to the udit Committee. 6.1 ppoint a member with a financial background and qualification to the udit Committee at the earliest opportunity. (JW has already stepped down as udit Chair, and will become associate lay member of B). 7. Improve transparency of financial information in committee papers, ensuring sufficient challenge is able to be given by members of committees/overning Body 7.1 Improve level and type of financial information in committee papers in order to support decision making. This should include consistent reporting of QIPP delivery at FPQ Committee which includes analysis and commentary. Continue to monitor through FPQ Statement of Financial Position to include comparators to previous month end and previous financial year and position. Establish a checking mechanism in Finance for all figures in reports in line with Deloitte recommendations on page 62 (errors). Continue to monitor through FPQ Continue to monitor through FPQ

22 7.4 Be clear which information on finance and performance should be presented to FPQ, udit and to ov Body (end practice of using the same report differentiate depending on role of meeting). Continue to monitor through E 7.5 Improve note taking and minuting of committee meetings. Ensure Chair of meeting plays an active role in agreeing minutes and agenda in advance of meeting taking place Continue to monitor through SMT 7.6 Use Executive Summaries of Committee/B reports more effectively (provide training to report writers to enable this to happen). Continue to monitor through SMT 7.7 Make clear how financial risks in FPQ report relate to CC s risk register. Ensure that risk management process is reviewed for its robustness in relation to financial risk management. Continue to monitor through FPQ 7.8 Establish a single version of the truth so that reporting is understood by all relevant parties and reported consistently to all committees/forums (using PMO structure). Continue to monitor through FPQ 7.9 Re-establish combined performance and finance reports but with meaningful cross references. R Monitor through FPQ 7.10 Ensure that financial matters are given sufficient prominence in committee meetings. Continue to monitor through FPQ

23 ction Tracker of Financial Recovery Plan Deloitte Recommendation Lead Director 1. Undertake further analysis to understand drivers of acute activity, its future financial impact, and action plan to reduce activity. Level of ssurance as at FPQ meeting 24 Feb Undertake further analysis to understand the drivers of acute activity and its future financial impact (e.g. analysis of causes of an increasing conversion rate). 1.2 Review remit of both CSU and CC informatics teams to ensure CC has robust analytics available in a clear and consistent manner (all options should be considered). R 2. Identify clearly the financial gap that needs to be met through disinvestment and QIPP. 2.1 Ensure more robust financial planning and analysis and reporting of schemes, and their phasing. 2.2 Undertake a full exploration of the potential contract pressures and investment requirements in the local health economy over the medium term. This process will also help to identify the financial gap to be met through disinvestment and QIPP. 3. Establish programme governance around QIPP with pace and urgency. 3.1 Standardise and strengthen QIPP risk reporting and ensure mitigations are properly documented and reported. Ensure project leads escalate risks within 48 hours or via QIPP meetings.

24 3.2 dd delivery R ratings to QIPP and BCF schemes. 3.3 Ensure robust KPIs are used including using non financial KPIs to assess performance. R 3.4 Set up a QIPP Steering roup (this is QIPP and Programme Executive) and ensure that there are clear processes for identifying and prioritising QIPP opportunities. 3.5 Establish regular use of scenario planning to support good decision making in particular this should include financial scenarios with sensitivity analysis. 3.6 Establish and agree a timetable of critical dates for the QIPP programme and ensure this is communicated internally. 3.7 Establish clinical, project and executive ownership of each QIPP scheme to ensure escalation channels are clearly defined and used effectively. 3.8 Establish a value threshold for QIPP schemes to ensure that time and resources are not expended on schemes with limited financial benefit. 3.9 Consolidate and risk adjust the BCF schemes (i.e. make them real and clearly understood as to their relationship to QIPP and the organisation s business). Decide how to report both internally and up to NHS England in a more meaningful manner Establish a QIPP tracker scheme Formalise the PMO structure, and ensure that it is understood and used across the organisation. Ensure it is properly and adequately resourced (it is a 13m QIPP programme) Increase the pace and urgency of implementing governance changes for QIPP programme management in order to focus on development and delivery of QIPP in 2016/17 and beyond. 4. Create an outline 2016/17 QIPP programme using nytown benchmarking and Deloitte analysis.

25 4.1 Triangulate Deloitte analysis with existing QIPP ideas in order to create a more robust outline programme for 2016/17 and beyond. 4.2 Undertake an assessment of all the potential future schemes identified by Deloitte with a view to including in revised commissioning intentions (Nov ov Body). 5. Invest in additional capacity and capability in light of the plan to deliver higher levels of QIPP over medium term. 5.1 ddress skills gaps within the staff team through structured training. Simon Hall 5.2 ddress skills gaps within the clinical commissioning team and overning Body. Simon Hall 5.3 Undertake an assessment of the level of staff sickness and vacancies; ensure this is reported to the SMT regularly. Simon Hall 5.4 Invest in additional capacity and capability in light of the plan to delivery higher levels of QIPP over the medium term. This applies to finance, delivery and the PMO in particular. Simon Hall 6. ppoint a member with a financial background and qualification to the udit Committee. 6.1 ppoint a member with a financial background and qualification to the udit Committee at the earliest opportunity. (JW has already stepped down as udit Chair, and will become associate lay member of B). 7. Improve transparency of financial information in committee papers, ensuring sufficient challenge is able to be given by members of committees/overning Body 7.1 Improve level and type of financial information in committee papers in order to support decision making. This should include consistent reporting of QIPP delivery at FPQ Committee which includes analysis and commentary.

26 7.2 Statement of Financial Position to include comparators to previous month end and previous financial year and position. 7.3 Establish a checking mechanism in Finance for all figures in reports in line with Deloitte recommendations on page 62 (errors). 7.4 Be clear which information on finance and performance should be presented to FPQ, udit and to ov Body (end practice of using the same report differentiate depending on role of meeting). 7.5 Improve note taking and minuting of committee meetings. Ensure Chair of meeting plays an active role in agreeing minutes and agenda in advance of meeting taking place 7.6 Use Executive Summaries of Committee/B reports more effectively (provide training to report writers to enable this to happen). 7.7 Make clear how financial risks in FPQ report relate to CC s risk register. Ensure that risk management process is reviewed for its robustness in relation to financial risk management. 7.8 Establish a single version of the truth so that reporting is understood by all relevant parties and reported consistently to all committees/forums (using PMO structure). 7.9 Re-establish combined performance and finance reports but with meaningful cross references. R 7.10 Ensure that financial matters are given sufficient prominence in committee meetings.

27 ction Tracker of Financial Recovery Plan Deloitte Recommendation Lead Director 1. Undertake further analysis to understand drivers of acute activity, its future financial impact, and action plan to reduce activity. Level of ssurance as at FPQ meeting 24 Feb Undertake further analysis to understand the drivers of acute activity and its future financial impact (e.g. analysis of causes of an increasing conversion rate). 1.2 Review remit of both CSU and CC informatics teams to ensure CC has robust analytics available in a clear and consistent manner (all options should be considered). R 2. Identify clearly the financial gap that needs to be met through disinvestment and QIPP. 2.1 Ensure more robust financial planning and analysis and reporting of schemes, and their phasing. 2.2 Undertake a full exploration of the potential contract pressures and investment requirements in the local health economy over the medium term. This process will also help to identify the financial gap to be met through disinvestment and QIPP. 3. Establish programme governance around QIPP with pace and urgency. 3.1 Standardise and strengthen QIPP risk reporting and ensure mitigations are properly documented and reported. Ensure project leads escalate risks within 48 hours or via QIPP meetings.

28 3.2 dd delivery R ratings to QIPP and BCF schemes. 3.3 Ensure robust KPIs are used including using non financial KPIs to assess performance. R 3.4 Set up a QIPP Steering roup (this is QIPP and Programme Executive) and ensure that there are clear processes for identifying and prioritising QIPP opportunities. 3.5 Establish regular use of scenario planning to support good decision making in particular this should include financial scenarios with sensitivity analysis. 3.6 Establish and agree a timetable of critical dates for the QIPP programme and ensure this is communicated internally. 3.7 Establish clinical, project and executive ownership of each QIPP scheme to ensure escalation channels are clearly defined and used effectively. 3.8 Establish a value threshold for QIPP schemes to ensure that time and resources are not expended on schemes with limited financial benefit. 3.9 Consolidate and risk adjust the BCF schemes (i.e. make them real and clearly understood as to their relationship to QIPP and the organisation s business). Decide how to report both internally and up to NHS England in a more meaningful manner Establish a QIPP tracker scheme Formalise the PMO structure, and ensure that it is understood and used across the organisation. Ensure it is properly and adequately resourced (it is a 13m QIPP programme) Increase the pace and urgency of implementing governance changes for QIPP programme management in order to focus on development and delivery of QIPP in 2016/17 and beyond. 4. Create an outline 2016/17 QIPP programme using nytown benchmarking and Deloitte analysis.

29 4.1 Triangulate Deloitte analysis with existing QIPP ideas in order to create a more robust outline programme for 2016/17 and beyond. 4.2 Undertake an assessment of all the potential future schemes identified by Deloitte with a view to including in revised commissioning intentions (Nov ov Body). 5. Invest in additional capacity and capability in light of the plan to deliver higher levels of QIPP over medium term. 5.1 ddress skills gaps within the staff team through structured training. Simon Hall 5.2 ddress skills gaps within the clinical commissioning team and overning Body. Simon Hall 5.3 Undertake an assessment of the level of staff sickness and vacancies; ensure this is reported to the SMT regularly. Simon Hall 5.4 Invest in additional capacity and capability in light of the plan to delivery higher levels of QIPP over the medium term. This applies to finance, delivery and the PMO in particular. Simon Hall 6. ppoint a member with a financial background and qualification to the udit Committee. 6.1 ppoint a member with a financial background and qualification to the udit Committee at the earliest opportunity. (JW has already stepped down as udit Chair, and will become associate lay member of B). 7. Improve transparency of financial information in committee papers, ensuring sufficient challenge is able to be given by members of committees/overning Body 7.1 Improve level and type of financial information in committee papers in order to support decision making. This should include consistent reporting of QIPP delivery at FPQ Committee which includes analysis and commentary.

30 7.2 Statement of Financial Position to include comparators to previous month end and previous financial year and position. 7.3 Establish a checking mechanism in Finance for all figures in reports in line with Deloitte recommendations on page 62 (errors). 7.4 Be clear which information on finance and performance should be presented to FPQ, udit and to ov Body (end practice of using the same report differentiate depending on role of meeting). 7.5 Improve note taking and minuting of committee meetings. Ensure Chair of meeting plays an active role in agreeing minutes and agenda in advance of meeting taking place 7.6 Use Executive Summaries of Committee/B reports more effectively (provide training to report writers to enable this to happen). 7.7 Make clear how financial risks in FPQ report relate to CC s risk register. Ensure that risk management process is reviewed for its robustness in relation to financial risk management. 7.8 Establish a single version of the truth so that reporting is understood by all relevant parties and reported consistently to all committees/forums (using PMO structure). 7.9 Re-establish combined performance and finance reports but with meaningful cross references. R 7.10 Ensure that financial matters are given sufficient prominence in committee meetings.