2012/13 Financial Position and Recovery Plan Month 7 YTD - - PowerPoint PPT Presentation
Croydon Attachment D1 2012/13 Financial Position and Recovery Plan Month 7 YTD Performance November 2012 0 Index 1. Financial Position Summary 2. Mitigations 3. QIPP Recovery Performance 4. 5 Year Projection (pre-QIPP) 5.
Attachment D1
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Financial Performance Target/ Indicator Measure Target Forecast Status Performance Trend Statutory Break Even Duties Revenue Resource Limit (RRL) Stay within RRL £595.9m £604.9m Red Capital Resource Limit Stay within CRL £2m £2m Green Cash Resource Limit Stay with Cash Limit £595.9m £604.9m Red (min. £9.0m cash support required) Administration Duties Better Practice Payment Policy Payment of valid invoices within 30 days. 90% Non NHS 87% to 80% NHS 82% to 96% Amber Other Significant Financial Targets QIPP Delivery of Programme Savings £25m £21m Red Running Costs Stay within running cost envelope. £12m £12m Green
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Description Plan £m Downside Case £m Mid Case (Forecast) £m Best Case £m Forecast Outturn before Risks/Mitig./Reserves (9.0) (20.2) (20.2) (20.2) Further Risks- Acute
(2.5) (1.0) (1.0) (1.8)
(9.0) (25.1) (23.0) (21.2) Mitigations - Acute
2.5 1.8 3.5 2.3 4.5 Net Position pre Contingency (9.0) (21.3) (17.7) (14.4) Contingencies - PCT Local
6.0 3.0 5.7 3.0 5.7 3.0 5.7 3.0 Net Financial Position (M7 FOT) 0.0 (12.6) (9.0) (5.8) Net Financial Position (M6 FOT) 0.0 (12.6) (9.0) (5.0)
5 For Month 7, the estimated CCG component of the adverse FOT performance is £7.6m. It should be noted that adverse variance of 2nd take specialist commissioning (£1.5m for renal and mental health) is currently shown under CCG.
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7 These variances exclude the risk of continuing care restitution settlements which is currently being evaluated.
The forecast outturn on specialist services does not reflect “2nd take” services. Currently there is a £1.5m adverse variance on these services (renal and mental health) which is currently reported under CCG acute/mental health. The PCT is working closely with the London Specialist Commissioning Group and providers to disaggregate.
The CCG has established 6 GP Network across Croydon. For the first time the Month 6 position was analysed and presented by GP Network using actual acute and prescribing data, and fair shares for the balance. Whilst no network is in balance, there are individual practices in a surplus position.
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Please note The YTD and FOT figures for the Long Term Conditions and GP Support for Care Homes projects have been reduced to zero due to the lack of monitoring information available. In previous reports, these projects were reporting to plan.
PMO RAG Rating Number of Projects Annual Plan (£000) Forecast Saving (£000) Variance (£000)
The Patient Navigation Service (£0.4m QIPP) has won the HSJ Efficiency in Commissioning Support Services Award for 2012 and has been shortlisted as a finalist for the prestigious HSJ Awards 2012 for Secondary Care Service Redesign (with Croydon Health Services NHS Trust) 11
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14 Trust (M7 FOT) POD Action
All / General Planned Care
northern practices (1 Oct 2012) re Kings/GST
reduce activity in acute. All / General Non Elective Care
admissions and readmissions
admissions, incl risk stratification across all practices in 2012/13 CUH (£2.9m Adv) Non elective Maternity High Cost Drugs
ESH(£2.2m Adv) Non elective SWLEOC
St George’s (£0.7m) Critical Care
King’s Healthcare (£2.4m Adv) Maternity OP Proc
Guy’s and St Thomas ( £1.9m Adv) Non elective Critical care
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for Remaining ‘in progress’ projects, followed by implementation and monitoring
with key output being shape of the health economy by end of 2014/15.
(3YP) development begins with CCG leadership & borough team, followed by detailed modelling
On-going development of Clinical Commissioning Group and support structures
Jul 2012 Jan 2013 Oct 2012 Apr 2012
year QIPP schemes; with PID completion and sign off where appropriate
for the remaining two years devised from the in-year elements of the 3YP
stream begins in earnest with appointment of prog. lead assuming receipt
down into in-year plans for the next three years
borough MD followed by restructuring of borough team, to include additional recovery resource
& mobilisation of year 2 QIPP schemes begins Apr 2013
control of bulk of commissioning agenda, subject to authorisation caveats
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QIPP Category 2011/12 Outturn 2012/13 Planned Net Savings Confirmed Work in Progress Total Mental Health 1,465 3,083 3,083 Acute Sector 1,977 9,978 9,978 Primary Care 1,294 824 824 Community Support Services
1,416 Activity Shifts
1,147 Long Term Conditions 480 2,158 600 2,758 Urgent Care 2,365 104 300 404 Planned Care 3,547 1,407 1,407 End of Life 350 877 877 Staying Healthy
325 Back office 2,965 177 100 277 Staffing
240 Prescribing 2,325 800 800 Total 16,769 22,536 1,000 23,536 Unidentified 1,464 Target savings for 2012/13 22,536 1,000 25,000
RED HIGHLIGHT: Delivering shifts of activity, but not seeing underperformance on acute SLAs 20
Project £’000 PMO Rating Status Description Acute KPI/CQUINs – CUH 8,145 G New Savings from agreed contract levers with CUH Mental Health Efficiency 2,030 R New Reduction in acute MH contract value, activity reductions and shifts into primary care CCHS (Community) Efficiency 1,416 G New Reduction in agreed value of CCHS contract COPD Community Service 874 R Exp. COPD ‘hot clinic’ to avoid emergency admissions, doors opened in March Prescribing Efficiency 800 G New Reduction in GP prescribing spend. Limited data YTD. LSCG Efficiencies 778 G New Principally reduced pricing for SCG services Acute KPI/CQUINs – Other Trusts 746 G New Savings from agreed contract levers with other Acute Providers Mental Health National Efficiency 735 G New National efficiency adjustment Urology Service Redesign 600 G New Savings agreed with CUH through service redesign Intermediate Ophthalmology Pathway 575 R FYE Community triage service established to reduce activity flow into Secondary Care Total (67% of total target) 16,699
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Potential Projects Lead Estimated value £’000 Decrease in urgent care spend through redirecting patients to primary care, stretching the UCC, through NHS 111 and introducing ambulatory care pathways Melody Woolcock 300 Reduction in long term conditions spend through pathway re-design, case management approach and risk stratification Philippa Robinson 600 Reduction in booking costs for intermediate services Josie Wright 100 Reduction in acute drugs spend through re-establishing a robust process of checking all drugs bills for NICE compliance etc. Eileen Callaghan Establishing surgical thresholds for outlier procedures including cardiology, and if necessary introducing triage functions to gate-keep TBC 2013/14 RAID (Rapid Assessment, Interface and Discharge) Services for alcohol TBC 2012/13 CQUIN Total 1,000
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Risk Mitigation 1 Lack of support from clinical commissioners to the relevant aspects of the programme.
GP Networks.
2 Lack of buy in from acute clinicians and management to support the required service developments.
3 Loss of organisational memory due to the transition process.
4 Lack of resources to deliver the programme as a result of the reduction in headcount.
5 Failure of specific QIPP plans.
6 Unforeseen cost pressures in other areas such as continuing care and forensic mental health
likely to give rise to cost pressures.
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Base case requires £17.2m savings to achieve statutory breakeven in 2013/14 In both cases, the challenge from 2013/14 – 2015/16 is averaged to describe 3 year challenge (£13m- £20m pa). => 13/14 QIPP Target = £20.0m
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Acute: Non Elective Care 11.1 5.6 LTC Transformation Decommission acute capacity Self Management Acute: Planned Care 15.9 8.0 Referral Mngt (CReSS) PC Strategy / ECI Stretch Acute: Maternity 0.0 0.0 Review care pathways/KPIs Community/ Primary Care/Cont care 1.4 1.4 Procurement / Case Review Benchmarking / Best Practice Mental Health 2.6 2.6 Service Review – best practice Decommission inpatient capacity Prescribing 1.9 1.9 Continue best practice Other/Corporate 0.5 0.5 Review of non-running costs Total 33.4 20.0
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Governance structure has been designed along the lines used for NHS Sutton & Merton with a separate Challenge Trust Board formed to
inform Finance Committee and the Joint Boards. A second structure has been agreed from 1 April 2013 when CCG is authorised.
SWL Joint Finance Committee Croydon Challenged Trust Board SWL PCTs Joint Boards QIPP Op’s Board (weekly) Acute Task Group (monthly in QOB) Croydon CCG Board Croydon CCG Management Team (Incldedicated Recovery Agenda) Strategic Transformation Board 32
A second structure has been proposed to operate from 1 April 2013 when CCG is authorised. Inevitably there will be an equivalent body to the current Challenged Trust Board arrangement that would between the CCG Governing Body and NHS Commissioning Board.
QIPP Op’s Board(weekly) Acute Task Group (monthly in QOB) NHS Commissioning Board Croydon CCG Management Team (Incldedicated Recovery Agenda) Strategic Transformation Board Croydon CCG Governing Body Integrated Governance Committee Finance Committee Members
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Accountable Officer (Designate) Borough Managing Director Chief Finance Officer (Finance and Recovery) Commissioning Managers (QIPP leads) Programme Office Support Head of Programme Office Programme Office Support Data analyst (to be appointed by CSU) Director of Commissioning
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