TITLE OF REPORT: Board Assurance Framework Quarter /18. Diane Sankey, Governance, Risk & Complaints Manager

Transcription

1 NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 10 of Meeting: 27 April 2018 TITLE OF REPORT: Board Assurance Framework Quarter 2017/18 AUTHOR: PRESENTED BY: PURPOSE OF PAPER: (Linking to Strategic Objectives) Diane Sankey, Governance, Risk & Complaints Manager Su Long, Chief Officer This paper provides details of the strategic, financial and operational risks associated with achieving Bolton CCG s 2017/18 objectives and its 5 year aims and provides assurance to the governing body that risks are effectively identified and monitored. Corporate risks assessed as High (15 or above) are routinely reported to the Board and these are referred to in Q report. LINKS TO CORPORATE OBJECTIVES (tick relevant boxes): RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) COMMITTEES/GROUPS PREVIOUSLY CONSULTED: REVIEW OF CONFLICTS OF INTEREST: VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT: Deliver Year 2 of the Bolton Locality Plan. Ensure compliance with the NHS statutory duties and NHS Constitution. Deliver financial balance. Regulatory Requirement. Standing Item. The Board is asked to accept the Board Assurance Framework and the assessment of strategic and high level corporate risks for Q (January to March 2018). Clinical & Associate Directors Chief Officer and Chief Finance Officer Executive Committee Audit Committee Conflicts of interest reviewed throughout the review process Risks identified as a result of patient complaints, incidents or service user feedback are added to the Risk Register if necessary and managed as part of the Assurance Framework as appropriate. 1

2 OUTCOME OF EQUALITY IMPACT ASSESSMENT (EIA) AND ANY ASSOCIATED RISKS: This standard report relates to risks identified by the CCG and has been considered against the criteria of EIA. EIAs may be necessary for some objectives/risks and these will be considered on an individual basis 2

3 Board Assurance Framework and Risks Quarter 2017/18 1 Executive Summary 1.1 There were 18 risks included in the CCG Board Assurance Framework for 2017/18. These have been assessed by Executive leads/risk owners and reviewed by the Executive Committee using the CCG s risk matrix. Q BAF was also reviewed by the Audit Committee on 18 April There were 6 risk reductions achieved at year end, including the financial risk F QIPP savings target 2017/18 which was met and the risk closed. 1. Operational risk O- pressures on quality and performance leading to failure to meet targets increased from a risk score of 12 (significant) in Q to (high) in Q. Risk O was affected by the increasing demand for local healthcare services; demand is also referred to in other financial and strategic risks included in the BAF. 1. There are 8 risks with a score of 15 or above for Q. F6 Year on Year increase in acute activity and pressures O1 Primary care capacity O2 System wide workforce shortages O Pressures on quality and performance leading to failure to meet targets O5 Demand and capacity issues leading to compliance failure S1 Lack of clear shared vision for a Local Care Organisation S6 Funding for estates configuration S7 Demand for healthcare increases and cannot be controlled 1.5 Full details of each risk and mitigations in place are attached. 1.6 Other risks included in the corporate risk register on Q with a risk score of 15 or above are also outlined in this report /18 Bolton CCG Objectives

4 2. Financial, Operational and Strategic Risks for 2017/18 are summarised in the BAF dashboard below.

5 Bolton CCG Board Assurance Framework - Dashboard 2017/18 CCG OBJECTIVES Q Q Risk No Risk description Owner Year 2 Locality Plan NHS Statutory Duties & Constitution Financial Balance Target Risk Move ment Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Risk Score Year End Risk Score Strategic Operational Financial F1 F2 F F Transformation funding does not deliver outcomes and benefits of the Locality Plan IB 9 9 Reductions to expected growth in CCG allocations and LA resources IB 8 Inflation rates above expected levels, high agency rates IB 8 Failure to deliver QIPP programmes and savings IB 0 F5 Failure to secure IT funding IB 8 F6 Year on year increases in acute activity and pressures* BS O1 Primary Care capacity SLiv O2 O O O5 S1 S2 S S S5 System wide workforce shortages SL Pressures on quality and performance leading to failure to meet targets JB 12 Resistance to change from staff, patients and public SLiv Demand and capacity issues leading to compliance failure ML Lack of clear shared vision for a Local Care Organisation SL Lack of clear and established system leadership, governance and processes SL 12 Commissioning remains fragmented SL 9 12 Top down reorganisation or restructuring leading to loss of control SL Lack of engagement from workforce, public and patients SL 9 9 S6 Funding for estates configuration IB 12 S7 Demand for healthcare increases and cannot be controlled* BS 20 Total 18 Risks *F6 and S7 are linked to demand

6 Other key issues from corporate risk register Quarter 2017/18.1 There were high risks on the corporate risk register in Q outlined below. They do not relate to the Clinical Commissioning Group s operational issues but are external risks. Risk Ref Description 20 Potential closure or suspension of care homes due to Regulator concerns/financial sustainability and failure of some providers to sustain improvements leading to lack of nursing bed availability. 21 Failure to meet infection control targets (Cdiff 19 and MRSA target zero) 27 A&E resilience and failure to meet hour 95% target NWAS response times and ambulance handover targets not met for 2017/ Recommendations.1 NHS Bolton Clinical Commissioning Group Governing Body Board is asked to: Accept the Board Assurance Framework and note the high level corporate risks for Q/Year end. Name of person presenting the paper: Title: Su Long, Chief Officer : 27 April

7 BAF Report Qtr 1 Last Review : 05/0/2018 Risk Number: F1 F1. Transformation funding does not deliver outcomes and benefits required of the Locality Plan Ian Boyle 07/0/ Q Q 28.8m Transformation Fund awarded with detailed financials at scheme level Investment Agreement signed by all partners and joint systems in place for reporting Health & Wellbeing Exec oversight Robust monitoring in place at scheme level and reported to each Strategy & Planning Group Payments confirmed for whole of 2017/18 and confirmation of financial impact as a result of delays in schemes completed Confirmation of impact on outcomes & benefits as a result of delays in schemes reviewed by H&WB Exec Assurances to Board: System Sustainability & Transformation Board Bolton Health & Wellbeing Executive Monthly Finance Report to System Sustainability & Transformation Board Monthly report to Finance & QIPP Committee Reporting to GM Health & Social Care Partnership Gaps in Assurances : Commissioning arrangements not fully established for all schemes Printed: 20/0/2018 Slippage in some schemes Evaluation of some schemes taking place 2018/19 Locality Plan monitoring 2017/18 established, reviewed by Strategy&Planning Groups. Submissions to System Sustainabilty & Transformation Board and GM Health & Social Care Partnership Page 1 of 18

8 BAF Report Qtr 1 Last Review : 05/0/2018 Risk Number: F2 Compliance With NHS Statutory Duties Constitution Achieve Financial Balance 2017/18 Ian Boyle F2. Reductions to expected growth in CCG allocations and LA resources 07/0/ Q Q Financial Plan submitted and signed off by CCG Board Detailed monthly reports and presentations to Executive Cttee Finance & QIPP Committee and monthly monitoring reports to Board Joint Bolton System Financial Position report to F&Q Cttee Treatment of 0.5% of non recurrent allocation confirmed Q IBCF spending plans monitored via Joint Commissioning Board Bolton FT DoF and LA Treasurer attendance at F&Q Cttee and Bolton Finance Leads meeting monthly Summary QIPP reporting to NHS England Area Team CCG CFO attendance at BFT Finance and Investment Committee Assurances to Board: Finance and QIPP reports to Board Gaps in Assurances : Detailed monthly reports and presentations to Executive Cttee Further NHS England decisions impacting on CCG allocations CCG understanding of impact of IBCF Schemes Financial position of whole Bolton system reported through individual governance structure and to Bolton Health & Wellbeing Exec & Board Printed: 20/0/2018 Page 2 of 18

9 BAF Report Qtr 1 Last Review : 05/0/2018 Risk Number: F Achieve Financial Balance 2017/18 Ian Boyle F. Inflation rates above expected levels, high agency rates 07/0/ Q Q Finance & QIPP Committee oversight System Sustainability & Transformation Board Strategic Workforce Board CCG/FT Contracts settled in 2017/18 BFT Agency spend included in monthly joint reports to Finance & QIPP Cttee Assurances to Board: CCG Executive oversight System Sustainability & Transformation Board reporting to Health & Wellbeing Board Finance & QIPP Cttee Monthly Finance reports to Board Gaps in Assurances : n/a Ongoing monitoring by System Sustainability & Transformation Board New HR lead in post at BFT to provide detailed actions to contain agency spend Monthly Finance & QIPP reports to Board Printed: 20/0/2018 Page of 18

10 BAF Report Qtr 1 Last Review : 05/0/2018 Risk Number: F Achieve Financial Balance 2017/18 F. Failure to deliver QIPP savings Ian Boyle 07/0/ Q Q CCG Financial Strategy Financial Plan 2017/18 New contract in place for 2017/18 with Bolton FT Close monitoring by CFO and Executive Cttee Finance & QIPP Cttee oversight Detailed analysis of QIPP schemes off track and meetings held with leads to identify mitigating actions Strategic discussions at CFO level across GM Review of each scheme at Finance & QIPP Cttee, focus on new models of care Assurances to Board: Finance & QIPP minutes to Board Monthly QIPP monitoring reports to Board Internal and External Audit reviews CCG continues to report financial balance QIPP schemes delivering Gaps in Assurances : none None Balanced QIPP position & achieved CCG control total Printed: 20/0/2018 Page of 18

11 BAF Report Qtr 1 Last Review : 05/0/2018 Risk Number: F5 Achieve Financial Balance 2017/18 Ian Boyle F5. Failure to secure IT funding 07/0/ Q Q CCG Executive oversight of GMMS delivery IM&T Operational Board GM IM&T Operations board and programme board maintain oversight of performance GM IM&T Assurance group maintain oversight of both groups and of finances NHS Digital national issue, ensure all funding is secured for GM wide system CFO/IMT Leads meeting taken place SIP created Finance & QIPP Cttee - all IT funding now received Regular IT project tracker report to CCG Executive Assurances to Board: Minutes from GMSS Ops Board & Programme Board submitted to Bolton IM&T Ops Board Monthly Finance reports to CCG Board CCG Executive oversight Bolton Locaility Digital Strategy Gaps in Assurances : Lack of Senior Leadership and assurance with implementation of new GP IT Operating Model Locality work underway for long term IT solution Regular IT project tracker oversight by Executive Cttee Monthly Finance reports to Board Printed: 20/0/2018 Page 5 of 18

12 BAF Report Qtr 1 Last Review : 11/0/2018 Risk Number: F6 Achieve Financial Balance 2017/18 Barry Silvert F6. Year on year increases in acute activity and pressures* Links with BAF Risk S7 -Demand for healthcare /0/2017 Q Q Locality Plan and BQC 2018/19 Operational Plans in place Joint planning process with Bolton FT Joint QIPP Plans across Trust and CCG to reduce demand - refreshed Q CCG/FT Collaborative Capacity & Demand Programme Planned Care Strategy & Planning Group (Demand Management) GM Work Programme and approaches Urgent & Emergency Care Board Ongoing monitoring through Quality & Performance Groups with Providers System Sustainability & Transformation Board Finance & QIPP Cttee Assurances to Board: System Sustainability & Transformation Board reporting to Health & Wellbeing Exec Monthly Corporate Performance Report to Board Monthly Finance Report to Board Locality Plan Performance Dashboard Additional Performance Updates to Board when required Gaps in Assurances : Lack of assurance on data quality and robust data intelligence to monitor changes month on month to identify shifts in performance No reduction in activity in non-bolton FT Contracts Lack of detailed trajectories for activity reduction at speciality level Ongoing Monitoring of Strategy & Planning Groups activity plans by SS&T Board Development work with CCG and Bolton FT BI Teams Internal Audit Data & Performance GMcr Finance & Activity Sub-Group to undertake strategic review of performance across Providers, review data and contracts with CCGs (HRG, PBRs, block contracts) GMcr Specialist Commissioning Sub-Group Development of detailed trajectories & action plans as part of CCG/FT capacity and demand work Printed: 20/0/2018 KPI targets for reduced acute activity Joint QIPP Plans Transformation Fund Investment Agreement - monitoring of actual activity against plan Page 6 of 18

13 BAF Report Qtr 1 Last Review : 06/0/2018 Risk Number: O1 Compliance With NHS Statutory Duties Constitution S Liversedge O1. Primary Care capacity /0/2017 Q Q Primary Care Workforce reform monitored through System Sustainabilty & Transformation Board - includes enhanced Primary Care Workforce i.e. Pharmacists, MSK, Mental Health, Health Improvement Practitioners Primary Care Commissioning Committee Population Health & Prevention Strategy Group Strategic Workforce Board Planned Care Strategy (Demand Management) Recruitment progressing as per Primary Care Strategy & Planning Group -18/20 Pharmacists in post -Mental Health Practitioners recruited Q Assurances to Board: CCG Exec oversight Primary Care workforce monitoring reports to Board System Sustainability & Transformation Board reporting to Health & Wellbeing Exec and Board Gaps in Assurances : Delays in recruitment of MSK Practitioners Primary Care Mental Health Practitioners to commence in post 2018/19 Implementation of Primary Care Programme as per Strategy & Planning Group Action Plan Scoping of community services & support requirements at neighbourhood level wrapped around GP Practices to be undertaken (April - Sept 2018) Printed: 20/0/2018 Increase in primary care workforce Pharmacists, Mental Health, MSK and Health Improvement Practitioners in GP Practices by July 2018 Page 7 of 18

14 BAF Report Qtr 1 Last Review : 09/0/2018 Risk Number: O2 Compliance With NHS Statutory Duties Constitution O2. System wide workforce shortages Susan Long 07/0/2017 Q Q Local and national and international recruitment drives for recruitment and retention of doctors, nurses & AHPs within the Bolton system including return to work and retirement opportunities Strategic Workforce Board overseeing re-designed roles and workforce. Care Home & Home Care S&P Group reviewing workforce in care homes and domiciliary care Joint Leadership Group Safeguarding Intelligence Forum - subgroup of Adult Safeguarding Board Number of applictions to universities for health professional posts increased this year and more Trainee Nursing Associate roles recruited to 2017 Workforce Engagement Forum (system wide) Assurances to Board: System Sustainability & Transformation Board reporting to H&W Board and Exec CCG Executive oversight Gaps in Assurances : Delays in recruitment and upskilling workforce for re-designed roles Lack of joined up working across system on workforce re-design and lack of information sharing Ongoing recruitment and retention of doctors, nurses & AHPs within the Bolton system Ongoing monitoring of vacant posts Reduction in overseas registrants New HR Lead at BFT to provide detailed actions to contain agency use and spend Printed: 20/0/2018 Reduced agency spend and number of vacancies by March 2018 Reduced staff turnover and staff sickness Page 8 of 18

15 BAF Report Qtr 1 Last Review : 11/0/2018 Risk Number: O Compliance With NHS Statutory Duties Constitution O. Pressures on quality and performance leading to failure to meet targets Jane Bradford 07/0/ Q Q Ý Quality and Safety Committee Quality & Performance Meetings with providers and minutes of these to Quality & Safety Cttee Corporate Performance Report - monthly Incident reporting systems embedded across health economy Significant Incident Review Group and SI Policy in place Compliments, PALS & Complaints Policy Assurances to Board: Quality & Safety Cttee minutes to Board Corporate Performance and specific quality reports to Board with focus on clinical specialty areas Monthly Patient Experience story to Board Gaps in Assurances : Performance data Q-Q shows slippage in several key targets and potential patient safety incidents continue to be received from member practices Printed: 20/0/2018 Quality & Performance concerns identified for Bolton locality include -A&E resilience and targets -NWAS response times and handover targets -Diagnostics -18 RTT -GMMH performance -Potential closure or suspension of nursing and care homes due to regulator concerns or financial stability Continued monitoring via regular Contract & Performance meetings and oversight by Quality & Safety Cttee. Review by Quality & Safety Cttee of performance targets slippage at May 2018 meeting Continued monitoring by Contract, Quality & Performance meetings with Providers. Quality issues included in Quality Matrix and escalated to Q&S Cttee where appropriate. Key quality risks scored 12 or above included on Corporate Risk Register Page 9 of 18

16 BAF Report Qtr 1 Last Review : 05/0/2018 Risk Number: O O. Resistance to change from staff, patients and public S Liversedge /0/ Q Q Primary Care Joint Commissioning Group Population Health Strategy & Planning Group Co-Design Strategy & Planning Group S&P Groups reporting to System Sustainability & Transformation Board and have operational risk logs in place Patient engagement events and Comms & Engagement roadshows held 2017 Primary Care Communications & Engagement Strategy in place Joint meeting held CCG & Alliance (CVS & Healthwatch) to agree messages/engagement with patients in neighbourhoods Assurances to Board: System Sustainability & Transformation Board reporting to Health & Wellbeing Board and Exec Committee oversight and minutes to CCG Board Feedback from CCG Summer Comms & Engagement Roadshow to Board Gaps in Assurances : None Patient engagement events to be continued throughout 2018 Further develop Comms & Engagement Plan Continue development of staff engagement and public support to Locality Plan Printed: 20/0/2018 Page 10 of 18

17 BAF Report Qtr 1 Last Review : 05/0/2018 Risk Number: O5 Compliance With NHS Statutory Duties Constitution Achieve Financial Balance 2017/18 Melissa Laskey O5. Demand and capacity issues leading to compliance failure /0/2017 Q Q Commissioning Partnership Board and SS&T Board System & Planning Groups for all programmes CCG/FT Collaborative Capacity & Demand Programme Contract Monitoring and Performance Groups Quality Strategy and Quality & Performance meetings with all Providers Robust performance management and Board reports Quarterly Assurance with GMH&SCP Quarterly CCG Improvement & Assessment Framework (IAF) by NHS England Assurances to Board: Corporate Dashboard & Performance Report Quarterly updates on CCG IAF System dashboard presented monthly to System Sustainability & Transformation Board Gaps in Assurances : Quarterly Assurance meetings held with GMH&SCP reviewed by Health & Wellbeing Executive Data quality issues and consistent reporting across all providers National and local recruitment issues of key speciality doctors and nurses Ongoing Performance Monitoring Finalise CCG/FT Capacity & Demand work Plans for addressing issues through new roles through Strategic Workforce Board and GM Workforce Programme Continued actions for resolution of data quality and reporting issues Printed: 20/0/2018 Board Performance Reports CCG Improvement & Assessment Framework (IAF) NHSE GM H&SCP assurance process Page 11 of 18

18 BAF Report Qtr 1 Last Review : 06/0/2018 Risk Number: S1 S1. Lack of clear shared vision for a Local Care Organisation Susan Long /0/2017 Q Q GM Policy and Direction Locality Plan governance and Health & Wellbeing Executive Co-design work stream Joint Leadership Group and The King's Fund Facilitation 2017 Health & Wellbeing Board development sessions and governance review System Sustainability & Transformation Board Executive/Board Development sessions and ongoing discussion relating to future direction Developement of neighbourhoods LCO peer to peer workshop with other localities Assurances to Board: Monthly updates to CCG Executive Health & Wellbeing Executive Updates to Board Development Meeting Quarterly Locality Plan Update Reports to Health & Wellbeing Board Gaps in Assurances : Formal agreements to future direction required across organisations Ensure fit with GM H&SCP through monthly LCO meetings Agreement through Health & Wellbeing Executive Review system governance Staff engagement Bi-monthly monitoring returns to GMH&SCP from May 2018 CCG Exec and Board to consider consultation with stakeholders and patients and agree timescale for a LCO Vision in collabortion with partner organisations. Printed: 20/0/2018 Page 12 of 18

19 BAF Report Qtr 1 Last Review : 11/0/2018 Risk Number: S2 Compliance With NHS Statutory Duties Constitution Susan Long S2. Lack of clear and established system leadership, governance and processes /0/ Q Q 5 Year Locality Plan Updates and improved reporting from all Locality Plan work programmes to System Sustainability & Transformation Board Transformation Fund Investment Agreement with GMH&SCP Consistent documentation and monitoring via Locality PMO Joint QIPP work streams agreed with BFT Quality & Performance meetings with Providers Health & Wellbeing Board & HWB Exec Board development sessions and HWB governance review Assurances to Board: Locality Plan governance via System Sustainability & Transformation Board and Health & Wellbeing Executive Local Commissioning Partnership Board - Integration Quarterly Locality Plan update to Board Gaps in Assurances : Monthly Corporate Performance report to Board - inc Locality Plan reporting Clear system accountability for Bolton performance Compliance with monitoring processes Complete the review of system governance Embed evaluation process of TF schemes CCG Exec, Board and stakeholders to agree timescales for LCO governance Regular and transparent system reporting Internal audits of monitoring processes Printed: 20/0/2018 Page 1 of 18

20 BAF Report Qtr 1 Last Review : 05/0/2018 Risk Number: S Compliance With NHS Statutory Duties Constitution Achieve Financial Balance 2017/18 Susan Long S. Commissioning Remains Fragmented 12 0/05/ Q Q Bolton Locality Plan System Sustainability & Transformation Board Health & Wellbeing Executive Primary Care Commissioning Committee with MoU in place with NHSE re full delegated commissioning arrangements Joint Commissioning Partnership Board Strategy & Planning Group for all Programmes (includes Council, CCG, Public Health Commissioners) Engaged with GP membership on joint commissioning Q Assurances to Board: CCG Executive and Board Development oversight Commissioning Partnership Board Regular Board updates - Jan 2018 progress report received CCG rated as a 'Good' CCG in 20 and 2017 Quarterly Assurance meetings with GMH&SCP Gaps in Assurances : CCG Board and Council Cabinet agreement to joint commissioning in principle Agreement to the Locality Single Commissioning Function (SCF) Agreement in principle to Single Commissioning Function (SCF) - work ongoing Ensure fit with GMcr Commissioning Review outputs - work ongoing Development of Operating Framework for SCF Bi-monthly monitoring returns to GMH&SCP from May 2018 GMcr Devolution governance/commissioning review at Board Development meetings Formal Board agreement to Single Commissioning Function Printed: 20/0/2018 Page 1 of 18

21 BAF Report Qtr 1 Last Review : 09/0/2018 Risk Number: S Compliance With NHS Statutory Duties Constitution Susan Long S. Top down reorganisation or restructuring leading to loss of control 07/0/ Q Q CCG Constitution Bolton Locality Plan Health & Wellbeing Board & Exec GM Healthier Together Cttee in Common Chief Officer & NHSE Team Meetings GM CCGs Association Group Joint Commissioning Committee Assurances to Board: CCG Executive Committee Health & Wellbeing Board Joint Commissioning Cttee minutes to Board GM reports to Board Gaps in Assurances : Lack of formal agreement to Local Care Organisation and Single Commissioning Function Assurance of GM decision making will not impact statutory CCG duties Close involvement in GM Joint Commissioning Board and commissioning review. CCG voice in decision making is retained Printed: 20/0/2018 Page 15 of 18

22 BAF Report Qtr 1 Last Review : 09/0/2018 Risk Number: S5 Compliance With NHS Statutory Duties Constitution Susan Long S5. Lack of engagement from workforce, public and patients 07/0/ Q Q Lets Make it... Better Bolton campaign ongoing 2017/18 Comprehensive communication and engagement work with public, GPs and stakeholders. Patient engagement and experience reports monitored by Quality and Safety Committee Use of social websites, twitter by CCG and website BQC monitored by Joint Commissioning Cttee Community Engagement (E&D and ETAG) Roadshows and other public events jointly with Bolton Council over Summer 2017 Locality Plan Toolkit launch Aug 17 Good GP Member Practice engagement, GP Events at The Bridge and Clinical Leads meetings CCG staff Away Day July 17 and staff briefings throughout 2017/18 Assurances to Board: CCG Executive oversight System Sustainability & Transformation Board reporting to Health & Wellbeing Exec Patient Engagement reports and updates to Board Monthly patient story to Board CCG rated as 'Good' CCG in 20 & Review of CCG gave assurance that stakeholders feel engaged and involved in Locality Plan development Gaps in Assurances : Joint communication & engagement strategies to be developed Ongoing public engagement/consultation with staff/gp member practices Joint Communication & Engagement strategies to be developed Ongoing joint stakeholder engagment events, campaigns and Locality Plan Toolkit Printed: 20/0/2018 Page of 18

23 BAF Report Qtr 1 Last Review : 06/0/2018 Risk Number: S6 Achieve Financial Balance 2017/18 Susan Long S6. Lack of Funding for estates configuration 07/0/ Q Q Sustainable Development Strategy included in Bolton Locality Plan. Bolton Estates Strategy Bolton Strategic Estates Group - Chairs meet monthly to review operational matters CFO and Bolton FT Senior Estates Lead attend the GM Health & Social Care Partnership monthly Strategic Estates Board meetings Two Memorandum of Understanding between National and GM Bodies GM Bodies to enable GM to work with local partners and Central Government to support delivery of the Estates Strategy CCG Health & Safety Cttee includes rep from NHS Property Services Assurances to Board: CCG Executive oversight Bolton Strategic Estates Group and update reports to Board Gaps in Assurances : Estates concerns escalated to NHS England Funding agreement to Locality Estates requirement by GMH&SCP Funding the revenue consequences of capital GMH&SCP Capital Finance Strategy implementation Notification of Estates funding from GMH&SCP Team Printed: 20/0/2018 Long term capital funding to be agreed for the Bolton health economy Page 17 of 18

24 BAF Report Qtr 1 Last Review : / / Risk Number: S7 Compliance With NHS Statutory Duties Constitution Achieve Financial Balance 2017/18 Barry Silvert S7. Demand for healthcare increases and cannot be controlled* Links with BAF Financial Risk F6 Year on Year increase in acute activity /0/ Q Q Bolton Locality Plan and Bolton Quality Contract (BCQ) 2018/19 Operational Plans Joint Commissioning Partnership Board Urgent & Emergency Care Board Strategy & Planning Groups CCG/FT Capacity & Demand Programme and joint planning process with Bolton FT CCG review and redesign of services with partner organisations Comprehensive communication and engagement work with public, GPs and stakeholders Joint Demand Management Programme Activity against Locality Plan in Board performance reports in place Internal monthly Finance & Activity meetings GM Work Programmes/approaches Assurances to Board: Monthly Corporate Performance Report with monthly deep dive into key areas/programmes Locality Plan Performance Dashboard Monthly Finance Report System Sustainability & Transformation Board reporting to Health and Wellbeing Board Gaps in Assurances : No evidence of reduction in activity in non Bolton FT contracts Lack of final detailed activity trajectories at speciality level Lack of assurance on data quality and robust data intelligence to identify shifts in performance Lack of assurance of delivery of activity shifts and reductions modelled in Bolton Locality Plan In depth monitoring of Bolton Locality Plan including actual activity against plan and joint demand management plans Non Bolton FT contractual performance management Further development of detailed activity trajectories and Action Plans through CCG/FT capacity and demand work Printed: 20/0/2018 Board Performance Report with high level activity monitoring (actual against plan) Transformation Fund Investment Agreement Page 18 of 18