Integrated Finance and Performance Report. Body... · 3 Summary of Current Position • Month 5...

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Integrated Finance and Performance Report.

WNCCG Governing Body

Meeting Date : 26/09/2019

Item 19.74aii

Content

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Page. Item.

3-6. Acute and Emergency.

7-8. Delayed transfers of Care.

10-11. Elective Access

14-15. Cancer.

15-16. Dementia

16-22. IAF

23-26 Finance Report

27-30 In hospital variance

31-32 Out of hospital variance

33-39

40-57

Financial control

QIPP

3

Summary of Current Position

• Month 5 validated position is 78.9% against a trajectory of 90% • Month to date unvalidated position (as at 11 September ) is 72.59 %,. Performance has been improving since beginning of the financial year,

but a noticeable dip in August. High attendance coupled with a high number of Major (3085) and Minor (2210) may be a contributing factor for a dip in performance. Total A&E attendances in August were 6,299 which is comparable with QEH forecast @ 6,396.

• QEH have been requested to analyse current GP Streaming service to inform future model of ED triage and streaming. Current funding of GP streaming is a cost pressure to the CCG. An evaluation of the current service has been undertaken by the CCG which highlighted the poor effectiveness of the current service. QEH is in agreement with the evaluation and has served the notice to the Agency to cease as from 3 October. Alternative models to achieve the required outcomes is currently being considered by the QEH.

Action taken to date

• ED workforce review to increase senior clinical shop floor presence and alignment of staffing to demand profile

• Revised escalation arrangements in place (internally and externally) to facilitate early escalation of flow issues and senior support to implement actions

• From 1st July 2019 all 4 PCNs across West Norfolk have Extended Access and therefore increased capacity

Further actions planned in 2019/20 Lead Date

• Review of ED Model of Care to reduce waiting time to triage and increase number of patients streamed to primary care. This will also reduce exit block following DTA

QEH Ongoing

• Increase primary care support to non English speaking patients in Kings Lynn Hub to reduce number of inappropriate ED attendances and associated time of these patients in ED. Funding has been agreed to support all the PCNs.

Gina Titman September 2019

• Winter Initiatives have been collated in readiness for the WSORT group on winter funding to support hospital flow FRS August 2019

• System work plan to be developed through the WSORT group to provide a clear programme of improvements / initiatives including SDEC. Engagement required with QEH and primary care; QEH has commissioned 2020 Consultancy to agree an action plan focusing flow at the front, middle and back door . A number of workshops/meetings have been diarised.

QEH / System August 2019

• An STP wide Task and Finish Group to align all NEAT provision with the aim to enhance the Services prior to winter is underway

Ross Collett Commencing August 2019

A&E attendances YTD M4–West Patients Only

5

Provider 18/19 19/20 % var 18/19 19/20 Var' % varRM1 NNUH 88.7% 79.0% -9.7% 1 3,446 3,642 196 5.7%RCX QEH 86.2% 83.5% -2.7% 2 750 888 138 18.4%RGP JPUH 91.3% 88.1% -3.3% 3 688 758 70 10.2%STP STP 88.8% 82.0% -6.8% 4 643 709 66 10.3%

N.B. NNUH includes WIC since Oct-17. 5 458 524 66 14.4%6 401 463 62 15.5%7 212 273 61 28.8%

18/19 19/20 Var' % var 8 337 396 59 17.5%0 0 0 - 9 530 580 50 9.4%

15,114 16,000 886 5.9% 10 531 564 33 6.2%0 0 0 - 11 606 631 25 4.1%0 0 0 - 12 227 247 20 8.8%0 0 0 - 13 608 628 20 3.3%

15,114 16,000 886 5.9% 14 421 436 15 3.6%15 1,787 1,800 13 0.7%16 284 296 12 4.2%17 381 392 11 2.9%

18/19 19/20 Var' % var 18 498 499 1 0.2%3,177 3,126 -51 -1.6% 19 510 509 -1 -0.2%7,056 7,431 375 5.3% 20 180 175 -5 -2.8%3,427 3,911 484 14.1% 21 1,462 1,445 -17 -1.2%1,454 1,532 78 5.4% 22 15,114 16,000 886 5.9% 23

18/19 19/20 Var' % var 18/19 19/20 Var' % var2,429 2,595 166 6.8% 1 4,062 4,360 298 7.3%2,207 2,396 189 8.6% 2 7,153 7,411 258 3.6%2,123 2,357 234 11.0% 3 1,816 2,005 189 10.4%2,021 2,165 144 7.1% 4 1,929 2,079 150 7.8%2,050 2,150 100 4.9% 5 2,022 2,113 91 4.5% 6 2,262 2,224 -38 -1.7% 7 15,114 16,000 886 5.9% 8

9

10

11 18/19 19/20 Var' % var 12 4,730 4,687 -43 -0.9% 13 10,384 11,313 929 8.9% 14 15,114 16,000 886 5.9% 15 Grand total

MondayTuesdayWednesday

Arrival modeAmbulance (inc. air ambulance)

ThursdayFridaySaturdaySundayGrand total

Table 2.6 - Year on year comparison by arrival mode

65-84LitchamSouthgates

19-64

Other (inc. on foot)

85+Grand total

King's LynnSwaffhamCoastal

Age band St John's0-18 Campingland

Grand total Great MassinghamSt James

Table 2.4 - Year on year comparison by age bandBurnhamThe Hollies

WSH BoughtonOther Watlington Medical

QEH St ClementsJPUH Howdale

Provider PlowrightNNUH Manor Farm

The Woottons

Table 2.3 - Year on year comparison by providerGrimston MedicalFeltwell

Variance 886 Upwell Health% variance 5.9% Heacham Group

15,114 Vida19/20 actual 16,000 Bridge Street

Table 2.1 - Metric summary Table 2.7 - Year on year comparison by practice

18/19 vs 19/20 ACTUAL Practice

Practices and hubs are sorted highest to lowest year on year growth (by #). If more

than one CCG is selected, only those with the highest year on year growth appear.

Table 2.2 - A&E 4 Hour Target

Table 2.8 - Year on year comparison by hub

HubDownham Market

Table 2.5 - Year on year comparison by day of the week

Day of A&E arrival

18/19 actual

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Fig 2.1 - A&E arrivals by month

Actual 2018/19 Actual 2019/20

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Fig 2.2 - A&E arrivals by hour (week days)

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Fig 2.3 - A&E arrivals by hour (weekends/Bank Holidays)

18/19

19/20

EM Admissions–West Patients Only

5

18/19 19/20 Var' % var 18/19 19/20 Var' % var1 506 655 149 29.4% 1 1,712 1,873 161 9.4%2 321 448 127 39.6% 2 415 516 101 24.3%3 376 342 -34 -9.0% 3 254 326 72 28.3%4 379 336 -43 -11.3% 4 206 255 49 23.8%5 271 269 -2 -0.7% 5 193 240 47 24.4%6 302 261 -41 -13.6% 6 441 486 45 10.2%7 245 248 3 1.2% 7 367 406 39 10.6%

18/19 19/20 Var' % var 8 245 243 -2 -0.8% 8 286 314 28 9.8%0 0 0 - 9 184 215 31 16.8% 9 825 843 18 2.2%

7,538 7,987 449 6.0% 10 231 210 -21 -9.1% 10 229 244 15 6.6%0 0 0 - 11 175 189 14 8.0% 11 118 127 9 7.6%0 0 0 - 12 147 178 31 21.1% 12 158 164 6 3.8%0 0 0 - 13 211 168 -43 -20.4% 13 179 184 5 2.8%

7,538 7,987 449 6.0% 14 143 168 25 17.5% 14 523 528 5 1.0%15 156 154 -2 -1.3% 15 206 207 1 0.5%16 151 144 -7 -4.6% 16 118 117 -1 -0.8%17 128 138 10 7.8% 17 82 77 -5 -6.1%

18/19 19/20 Var' % var 18 110 135 25 22.7% 18 320 299 -21 -6.6%5,445 6,172 727 13.4% 19 122 135 13 10.7% 19 319 294 -25 -7.8%1,466 1,242 -224 -15.3% 20 133 119 -14 -10.5% 20 250 210 -40 -16.0%104 86 -18 -17.3% 21 124 116 -8 -6.5% 21 300 250 -50 -16.7%523 487 -36 -6.9% 2,878 3,116 238 8.3% 22

7,538 7,987 449 6.0% 7,538 7,987 449 6.0% 23

18/19 19/20 Var' % var 18/19 19/20 Var' % var830 949 119 14.3% 1 3,253 3,484 231 7.1%

2,645 2,890 245 9.3% 2 2,117 2,285 168 7.9%2,762 2,954 192 7.0% 3 1,084 1,132 48 4.4%1,301 1,194 -107 -8.2% 4 1,047 1,059 12 1.1%7,538 7,987 449 6.0% 5

6

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8 18/19 19/20 Var' % var 9 4,253 4,635 382 9.0% 10 3,285 3,352 67 2.0% 11 7,538 7,987 449 6.0% 12

13

14

15 Metric 18/19 19/20 Var' % var

0 -1,671 1,728 57 3.4%

0-1819-6465-8485+Grand total

Long stay (2 days+)

Length of stay

Downham MarketCoastalSwaffham

Table 1.5 - Year on year comparison by length of stay

King's LynnAge band

St John's

Intestinal Infectious Diseases

Diseases Of Oesophagus, Stomach And Duodenum


Hub

Avoidable emergency admissions

NNUHQEHJPUHWSHOther

EM admissions from care homes

Short stay (0-1 days)

Emergency via GP (inc. OOH)Emergency via Consultant ClinicEmergency via Other

Grand total

Emergency via A&E

Table 1.6 - Year on year comparison for other metrics

Table 1.3 - Year on year comparison by method of admission

Table 1.4 - Year on year comparison by age band

Grand total

Method of admission

Figure 1.1 - Trend analysis

Injuries To The Hip And Thigh

Other

Cerebrovascular Diseases

Grand totalGrand total

Infections Of The Skin And Subcutaneous Tissue

Other Soft Tissue Disorders

The Hollies

Southgates

St James

Other Bacterial Diseases

Chronic Lower Respiratory Diseases

St ClementsFeltwell

Other Diseases Of Urinary System

Other Diseases Of Intestines

Injuries To The Head

Manor Farm

Primary diagnosisSymptoms And Signs Involving The Circulatory And Respiratory Systems

Symptoms And Signs Involving The Digestive System And Abdomen

General Symptoms And SignsVariance 449

Table 1.1 - Metric summary Table 1.7 - Year on year comparison by primary diagnosis Table 1.8 - Year on year comparison by practice

18/19 vs 19/20 ACTUAL18/19 actual Vida

7,987 Bridge Street7,538

Practice

19/20 actual



% variance Other Forms Of Heart Disease

Influenza And Pneumonia

Table 1.2 - Year on year comparison by provider

6.0%

Provider

Watlington Medical

Great Massingham

Litcham

Disorders Of Gallbladder, Biliary Tract And Pancreas

Symptoms And Signs Involving The Nervous And Musculoskeletal Systems

Poisoning By Drugs, Medicaments And Biological Substances

PlowrightBoughton

HowdaleCampingland

Ischaemic Heart Diseases BurnhamOther Acute Lower Respiratory Infections

Grimston MedicalThe WoottonsUpwell HealthHeacham Group

0

500

1,000

1,500

2,000

2,500



7

18/19 19/20 Var' % var 18/19 19/20 Var' % var288 245 -43 -14.9% 1 85 122 37 43.5%221 240 19 8.6% 2 400 428 28 7.0%158 188 30 19.0% 3 97 116 19 19.6%126 158 32 25.4% 4 42 56 14 33.3%178 138 -40 -22.5% 5 27 37 10 37.0%104 128 24 23.1% 6 28 38 10 35.7%114 91 -23 -20.2% 7 177 186 9 5.1%

18/19 19/20 Var' % var 61 85 24 39.3% 8 63 71 8 12.7%0 0 0 - 97 83 -14 -14.4% 9 47 53 6 12.8%

1,671 1,728 57 3.4% 61 59 -2 -3.3% 10 35 40 5 14.3%0 0 0 - 43 55 12 27.9% 11 60 64 4 6.7%0 0 0 - 38 46 8 21.1% 12 87 91 4 4.6%0 0 0 - 24 44 20 83.3% 13 47 48 1 2.1%

1,671 1,728 57 3.4% 49 34 -15 -30.6% 14 62 63 1 1.6%17 25 8 47.1% 15 47 46 -1 -2.1%15 20 5 33.3% 16 17 15 -2 -11.8%19 14 -5 -26.3% 17 32 28 -4 -12.5%

18/19 19/20 Var' % var 10 13 3 30.0% 18 51 46 -5 -9.8%1,181 1,340 159 13.5% 6 10 4 66.7% 19 110 87 -23 -20.9%360 272 -88 -24.4% 3 7 4 133.3% 20 73 47 -26 -35.6%19 10 -9 -47.4% 6 6 0 0.0% 21 75 42 -33 -44.0%111 106 -5 -4.5% 33 39 6 18.2% 22

1,671 1,728 57 3.4% 1,671 1,728 57 3.4% 23

18/19 19/20 Var' % var 18/19 19/20 Var' % var233 252 19 8.2% 1 228 255 27 11.8%461 453 -8 -1.7% 2 229 246 17 7.4%665 743 78 11.7% 3 734 749 15 2.0%312 280 -32 -10.3% 4 471 474 3 0.6%

1,671 1,728 57 3.4% 5

6

7

8 18/19 19/20 Var' % var 9 910 897 -13 -1.4% 10 761 831 70 9.2% 11

1,671 1,728 57 3.4% 12

13

14

15 Metric 18/19 19/20 Var' % var

0 -

Other Forms Of Heart Disease Bridge Street19/20 actual 1,728 Chronic Lower Respiratory Diseases Vida

Table 1.27 - Year on year comparison by primary diagnosis Table 1.28 - Year on year comparison by practice

18/19 vs 19/20 ACTUAL Primary diagnosis

Table 1.21 - Metric summary

Practice

Provider Nutritional Anaemias Manor FarmNNUH Acute Upper Respiratory Infections Great Massingham

Influenza And Pneumonia Feltwell

Table 1.22 - Year on year comparison by providerIntestinal Infectious Diseases The HolliesIschaemic Heart Diseases St James

*Avoidable emergency admissions are defined as

conditions which could be avoided by early

intervention or effective management and treatment

within primary care.Variance 57 Other Diseases Of Urinary System Upwell Health% variance 3.4% Infections Of The Skin And Subcutaneous Tissue Grimston Medical

18/19 actual 1,671

WSH Diseases Of Oesophagus, Stomach And Duodenum Heacham GroupOther Hypertensive Diseases The Woottons

QEH Diabetes Mellitus BurnhamJPUH General Symptoms And Signs Campingland

Method of admission Noninfective Enteritis And Colitis St ClementsEmergency via A&E Metabolic Disorders Southgates

Grand total Episodic And Paroxysmal Disorders Watlington MedicalOther Acute Lower Respiratory Infections Plowright

Table 1.23 - Year on year comparison by method of admissionRenal Tubulo-Interstitial Diseases LitchamOrganic, Including Symptomatic, Mental Disorders Boughton

Emergency via Other Other

Grand total Grand total

Emergency via GP (inc. OOH) Lung Diseases Due To External Agents St John'sEmergency via Consultant Clinic Diseases Of Oral Cavity, Salivary Glands And Jaws Howdale

Downham Market

Table 1.24 - Year on year comparison by age band Figure 1.21 - Trend analysis

Age band0-1819-6465-84

Swaffham

85+King's Lynn

Coastal


Hub

Grand total

Table 1.26 - Year on year comparison for other metrics

EM admissions from care homes

Table 1.25 - Year on year comparison by length of stay

Length of stayShort stay (0-1 days)Long stay (2 days+)

Grand total



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7

Placeholder DTOC


August DToC position remain at 2%. Due to significant system-wide work, QEH DToC is below the national standard @3.5%.

C&P CCG continues to have a disproportionate number of DToCs in comparison to Norfolk and Lincolnshire. Their DToC fall across both Health and Local Authority responsibility.


• Process agreed between CCG/QEH by which Norfolk DToCs can be validated and "signed off" on a daily basis and confirmed at the call. C&P CCG is also invited in the call.

• Lead nurse for Commissioning chairs call and escalate as necessary

• Implementation of CHS Healthcare (based at the N&N) to provide support to QEH in managing self funding patients.

• Engagement commenced with integrated discharge lead from C&PCCG and agreement to meet regularly to ensure close working to manage DTOC more effectively. Escalation processes will be defined and progressed


• Lead nurse led calls will be kept under review and reinstated if position moves beyond 3.5%. Sarah Taylor Ongoing

• Escalation within C&P CCG regarding lack of capacity within CCC Sophie Ives Ongoing

• Active management and escalation of community social care delays through community MDT meeting. Formally capturing data on all social care delays in community beds commencing July 2019

Sarah Taylor BAU

8

DToC remains under 3.5% target, the nominal target of patients (15 in total with 9 from Norfolk and 5 from other CCGs) is reported per day

9

Placeholder 18 weeks RTT/ Incomplete WaitsRecovery Plan


June validated performance is slightly below compared to May performance (85%), however, there has been sustained improvement from beginning of the financial year which demonstrate focus by both CCG and QEH on RTT. QEH’s June actual performance on >18 weeks wait (2, 486) is below their forecasted position (3,028) which suggest that the Trust is still catching up on their backlog; this is inversely affecting the <18 weeks wait. Current actual position is 11,144 against forecasted plan @10, 631. Therefore, both under and over 18 weeks wait have increased this month.

From a CCG perspective only, June performance is within NHSE’s submitted trajectory.Please note data in Slide 11 is the latest published data. July data is not available


• Targeted work is being developed with the Trust to focus on Specialties above trajectory and to further reduce the number of patients having waited over 18 weeks and reduce unnecessary referral

• To date Ophthalmology workshop undertaken with good engagement from clinical staff. Review of pathway for glaucoma patients and discussions regarding community based provision where appropriate have commenced

• Work has commenced with Gastroenterology to implement Clinical Assessment Service. Wolverhampton CAS showed an overall 32% of CAS triage patients were managed without ongoing referral to hospital consultants. This will positively impact RTT.

• Business case developed for Consultant Connect. This will allow Primary Care colleagues to access timely advice and guidance and clinical support via a phone call. At full potential it is predicted to reduce 1st appointments by 1008, follow ups by 333 and emergency admission by 101 (full year effect). Progress will be reliant on agreement of investment and is currently going through Programme Board. This will in turn improve RTT’s compliance.


• CCG planned care programme group exploring possibility of outsourcing advice and guidance for GPs to reduce unnecessary referrals to the QEH

Fran Rose-Smith

Sept 2019

11

Placeholder 18 weeks RTT/ Incomplete WaitsRecovery Plan


No breach in June.

The CCG are no longer receiving reports from the QEH on patients waiting over 40 weeks. Whilst there is no contractual obligation for them to do so, this lack of oversight could result in financial penalties for the CCG as there is a shared commissioner/provider penalty of £5k per month a 52 week breach is reported. This has been escalated to QEH senior managers by the CCG, and it may be possible to resolve it via the CSU BI team providing weekly reports.

Planned Care groups and meetings have been cancelled, with the QEH internally prioritising a restructure, review of governance structures of processes and no doubt financial and quality pressures from Regulators. Please note data in Slide 12 is the latest published data. July data is not available


• As noted above, there is now a Planned Care Transformation Delivery Group providing oversight and assurance to remedial actions plans associated with 52 weeks and RTT.

• The CCG has continued to work with NHS England and local providers to introduce Capacity Alerts in ENT, Trauma & Orthopaedics (hand, wrist and shoulder) and Urology to support RTT pressures.

• The CCG has also encouraged QEH to subcontract with Independent Sector Providers for areas experiencing pressure of demand.

• The CCG have requested in writing recommencement of the 40 week wait report


• Add lack of transparency on performance to CCG’S risk Register Fran Rose-Smith

July 2019

12

Cancer


The 62 Day Cancer target continues to be a challenge during 2018/19 and into 2019/20. A Contract Performance Notice (CPN) was issued in June 2018 and further Remedial Action Plan for 2019/20 outlining when and how the Trust will ensure sustainable performance for 62 day target. The QEHKL is forecasting recovery in March 2020 which has slipped from September 2019. A new Contract Performance Notice was issued on 26 July 2019 due to continued and frequent non compliance with this Standard with a deterioration position from previous month. Due to longer and complex pathways, Lower GI and Urology are the longest wait.Please note data in Slide 14 is the latest published data. July data is not available


• NHS Improvement’s Intensive Support Team (IST) have been working closely with the Trust and an interim Project Manager has been co-ordinating the combined Cancer Plan which draws together work of the Macmillan Programme, Norfolk and Waveney Cancer Alliance as well as NHS England IST Work into an overarching Cancer Action Plan. The plan also addresses the growth in 2ww referrals that have been predicted over the coming years.

• A QEH review of governance and operational workforce has seen a number of meetings across this partnership cancelled, however, it is hoped these will recommence following review.

• Demand and Capacity work for 2WW appointments, diagnostics and treatment across the various tumour sites has taken place in order to ensure accurate trajectories were developed for the RAP for sustainable 62 Day Performance. Original RAP was aimed to meet 62 day target by August 2019, however, this will be a significant challenge to deliver and sustain for QEH.

• Cancer Transformation Funds have been allocated to the Norfolk and Waveney STP Cancer Alliance to support pathway review and transformation work for cancer pathways. The initial areas of focus are Lung, Prostate, Upper GI and Breast Cancer with recruitment in these specialities and equipment purchased. The Trust and CCG are key partners in the Alliance and the West system is benefiting in receiving dedicated fixed term resources to support the work to improve pathways. Transformation work continues across a range of Cancer pathways.


• Review of performance data on a monthly against revised trajectory from September 2019

Fran Rose-Smith/ Sian Kendrick-Jones

Sept 2019

• To gain clarity on new governance structure and personnel within QEH Cancer departments, with a view to implementing NHSI IST recommendations and Norfolk and Waveney Cancer Alliance programmes. This will also allow the CCG greater oversight and scrutiny of performance, as well QEH operational pressures. Engagement with QEH and transparency is paramount for system working and this iscurrently a challenge.

Fran Rose-Smith/ Sian Kendrick-Jones

Ongoing

13

Cancer waiting Time Standards

14


Marginal dropped in performance by 0.4% from June position. However, performance has largely remain static from April 2019 and is significantly lower than the required target.

The CCG continues to work to implement a Remedial Action Plan, focussing on the priority actions of implementing the primary care diagnosis pathway; coding support to practices; engaging “hearts and minds” of GPs; and commissioning post diagnostic support.Please note data in Slide 16 is the latest published data. July data is not available


• Leadership: WNCCG GP Lead for Mental Health has reviewed patient records in 3 Practices, focussing on Practices with the largest gap between dementia diagnoses and prevalence. • GP Engagement: National team support event being organised for November. • New GP Lead has been recruited and is now in post• EQUIP project has started with first audit booked at the end of August. • Dementia clinical pathway being reviewed.• Eclipse system searches being developed to provide easily accessible audit and data extraction, this will also support population health management. • Dementia network up and running, new TOR’s and meeting refreshed including membership. Exploring further development of this with the QEH hospital. • Dementia data being circulated in GP information packs.


• Equip Audit data retrieval post audit to explore effectiveness Mark Payne End of October 19

• Develop eclipse search tools Mark Payne End of October 19

• Review Clinical pathway with GP lead Mark Payne End of October 19

IAF

16

IAF highlights

Working Well (areas of consistent positive performance)

122c and 122d Cancer survival and patient experience125b Women’s Experiences of Maternity Services131a CHC assessments taking place in hospital128b Patient experience of Primary Care

17

Ones to Watch (recent decline and/or stasis where national average has improved)

121a Cancers diagnosed at an early stage103a Diabetes NICE compliant treatment

Areas of concern (areas of consistent under performance)

104a Falls in over 65s (identified as quick win opportunity)105b Personal Health Budgets (identified as quick win opportunity)106a Unplanned hospitalisation for chronic ambulatory and urgent care sensitive conditions107a and 107b Antibiotic prescribing124b Learning Disability Annual Health Checks125d Maternal Smoking at Delivery126 Dementia Diagnosis Rates (identified as quick win opportunity)127b Emergency Admissions for urgent care sensitive admissions127f Use of beds following emergency care admissions

CCG moved from Inadequate to Requires Improvement as of July 2019. Initial analysis shows improvement from lowest performing quartile to mid-interquartile in 5 metrics, whilst sustaining areas of improvement will move CCG to “Good” in 2020.

18

IAF overviewMost recent data* and rating from July 2019*Where applicable – each metric has a unique reporting cycle

Please note the below are no longer available in Excel as published on NHS Future Platform in Tableau only

Falls

19

IAF outcome: Better HealthUpdated:

Jul-19

Historic performance and trend

Summary of historic actions including investment

Further actions planned in 2018/19

Coding and potential contractual implications being managed through TIFG.

ECM, MH and FRS to meet to discuss intitial starting point in response to Grant Thornton audit

Recent letter from Anne Radmore seeking consistency on coding will assist as N&N and JPUH are coding according to CCG desire

FRS

FRS

RCJul-19

Context (include investment, output/outcome, current programmes/projects)

WNCCG performance has been below NHS England value since Q3 16-17 which had classified us at

the lowest performing quartile. As part of admission avoidance, WNCCG has invested £ 128k in Early

Intervention Vehicle and the NEAT scheme at circa 30k in 2018-19. The Schemes have shown

reduction (see below) in ambulance conveyancing and admissions avoidance of which 15% were falls

related. Although there is a marginal improvement in Q3 2018-19, there is also opportunity to deep

dive into this Indicator to determine reasons for poor performance.

Aug-19

Discussion with NNUH to validate their process is underway- re coding of Observation and AEC ward data Early Intervention Vehicle (EIV) Scheme is underway . Latest figure shows 822 attendances of

which 637 (77%) were not conveyed NEAT service in place since November 2018. As of April 2019, figure shows 282 referrals received into the service from which 185 (66%) admissions were avoided.

15 % of these referrals were falls related.

Update 12/7/19

Initial conversation between CCG BI and commissioning lead with QE has taken place. QEH have raised with their CFO due to potential future issues of data accuracy with coding. This has been

followed up by the commissioning team in TIFG and QEH have agreed to look at it as part of a complete package in coding changes following a recent audit by Grant Thornton which has picked up

additional inconsistency in coding.

Improving coding will also positively impact on 106a Inequality in unplanned hospitalisation for chronic ambulatory care sensitive and urgent care sensitive conditions and 127b Emergency admissions

for urgent care sensitive conditions, and potentially 105a Percentage of deaths with three or more emergency admissions in last three months of life - all of which we are poor performers in

comparison to peers and national average.

Lead Date

Ongoing

Summary of deep dive and opportunity (include findings, gaps, Right Care, WSOA, commissioning reviews etc)

Current RankMovement

in rank

Comparred to peers

156 of 195 9 of 11

n/a 2454 2051 n/a

Latest local performance

08/07/2019

Injuries from falls in people aged 65 and over (104a) TargetLatest IAF

performance

National

average

Personal Health Budgets

20

IAF outcome: Better HealthUpdated:

Aug-19




Latest local performance

08/07/2019

Personal health budgets (105b) TargetLatest IAF

performance

National

average

n/a 9 75 n/a


As there has been no additional fudning for PHBs, this has been a barrier to date in increasing

numbers of people being offered and accepting them. However, from April 2019 everyone who goes

through the CHC process will be offered a Personal Health Budget, and across Norfolk and Waveny

North, South and Norwich CCGs set up a process for all patients accessing West Norfolk's Wheelchair

service to receive a PHB too. This is refelcted in their performance which is higher than West.

There are also opportunities to link in programmes such as Mental Health Out of Area, Transforming

Care and Dementia, where high cost patients are requiring more personalised care to make it

effective and in turn save money for the system. A PHB group will be established to learn from other

areas in teh country and how this could be localised. Membership is established, but setting up the

initial meet has proved challenging with holidays and requiring NHSE/I and NCCP attendance.

There are multiple organisations who can start and complete the process for personal health budgets, and ensuring consistency in recording of each starter is reequired. There is uncertainty in the CCG

who is leading on PHBs, and given the clinical, financial and commissioning implications it requires multi-department involvement. It is now clear that NCCP are submitting returns on behalf of the

CCG, however, this will mean that anyone started on a PHB outside of NCCP will not be counted towards performance. An improved process for a centalised reporting of PHBs needs to occur, which will

form part of the group.

There are currently circa 50 new people per month going through the wheelchair service, and 20 per month going through CHC. There has alreayd been an increase in take up of PHBs through the CHC

process with 17 people being offered a PHB in Q1 2019. THis will not be reflected in IAF improvement until September 2019 when new data is released. If 20% of those going through wheelchair

services accepted a PHB, this combined with CHC would see an increase to interquartile performance.

Lead Date

Sep-19


Current RankMovement

in rank

Comparred to peers

177 of 195 10 of 11

Set up a WNCCG PHB group RH

Learning Disability Annual Health Check

21

IAF outcome: Better CareUpdated:

Jul-19





Practices are incentivised to complete through payment for each LD health check with a payment of

£135.

Further analysis is required to establish most recent position in relation to national average, and by

how much the CCG would be required to increase uptake to significantly improve national position.

Oct-19

CCG Quality Team to work with practices around assessible information standards and the patient safety reasons for completing health checks AH

Communcation to be sent to practice managers reminding of financial incentive for completing checks and coding requirements GT

There is an issue in relation to the communication methods that are trying to attract people with Learning Disabilities to attend the practice to undertake these assessments. There may also be issues

of even if the information is accessible, whether or not people with moderate to severe Learning Disabilities can attend the practice.

There is a combination of practice awareness and engagement in the programme, and also inconsistency on whether a GP, practice nurse or health care assistant can undertake the assessment.

There is also a coding issue on completion of the assessment, as without this the practice will a) not be paid and b) performance for the CCG will not increase.

Lead Date

Oct-19


Current Rank

n/a 47.8% 51.4% n/a

Movement

in rank

Comparred to peers

126 of 195 8 of 11

Latest local

performance

08/07/2019

Proportion of people with a learning disability on the GP register receiving an annual health check

(124b)Target

Latest IAF

performance

National

average

SMI physical health checks

22

2019/20 Financial ReportAugust 2019

(M05 reporting period)

Emma Kriehn-Morris, Deputy Chief Finance Officer – Financial [email protected] 666912

23

mailto:[email protected]

Summary Headlines – At a glance

24

Key Headlines

• The CCG in year financial control total is a surplus of £1.64m.

• The CCG has £5.8m cumulative deficit from prior years, and is required to deliver a surplus of £1.64m which if delivered in 19/20 will reduce the cumulative deficit to £4.1m.

• As of month 05, the CCG is forecasting delivery of the plan.

• In order to deliver financial balance across the Norfolk and Waveney CCGs financial system support is required for South Norfolk CCG. As at M04 the Governing Body approved financial support from West Norfolk of £2.5m.

• Based on the M05 position, additional support has been required, and West Norfolk are through items identified on the Financial Recovery Plan contributing a further £2.4m.

• The total financial support is £4.9m and is required in addition to delivery of the in year surplus.

• The full contingency reserves have been utilised in M05 FOT positions. A part of the reason for using the reserves is due to system support already discussed above. The CCG has used the entire of the QIPP risk reserve to balance its year to date ( YTD) position.

• The CCG has an annual QIPP target of £12.46m (Net).

Key Financial Risks/Variances

• The Queen Elizabeth Hospital (QEH) has over performed by £1.03m based on April –June data predominantly within Day cases and OP procedures. It is understood that the Trust are looking to ‘get ahead’ of their Elective activity to recognise seasonal periods where activity reduces. The over performance is considered to be a risk to the financial position of the CCG if it continues, however the Trust have advised that they are forecasting to plan. This has been escalated at the formal contract meeting (SPQRG), via an Activity Query Notice, and has been discussed with the Trust Chief Executive. CCG is forecasting QEH activity to plan .

• System support for QEH for £1.2m (as an equal share of £6m) is included in the M05 CCG forecast. This payment will only be available to the Trust if activity outside of block does not exceed plan.

• Continuing Healthcare (CHC) :NCCP revisions of CHC growth, price and case assessments has reduced the forecast risk for West Norfolk. This area remains a risk and the CCG continue to work closely to understand patient need and market risks.

• Mental Health – High Cost Out of Area Placements are a risk to the CCG due to delay in investment development including Yare Ward being operational. The YTD reflects this position with an adverse variance of £0.213m

• Prescribing – The known national risk of increasing cost pressure due to NCSO ( No Cheaper Stock Obtainable) and Category M Drugs is a key financial risk to the CCG . The YTD and FOT numbers include these costs .The effect of Brexit on Prescribing Costs is another financial risk to the CCG.

Transformation Programme – M05 Forecast Activity at QEH – M04 data YTD

Plan (£000)

(Gross)

Investment

(£000)

Plan (£000)

(Net)

Gross QIPP

FOT (£000)

FOT

Variance% of Plan

-3163 183 -2980 -3541 378 -112.0%

-1888 301 -1587 -1420 -469 -75.2%

-519 0 -519 -496 -23 -95.6%

-982 0 -982 -527 -455 -53.7%

-2089 0 -2089 -2199 110 -105.3%

-1104 0 -1104 -856 -247 -77.6%

-2911 210 -2701 -2954 43 -101.5%

-500 0 -500 0 -500

FRG 0 0 0 -871 871

-13155 694 -12461 -12863 -292 -97.8%

Programme

Frailty and Dementia

Long Term Conditions

Planned Care

SDEC

Contractural

CHC

Prescribing

Grand total

SUPPORT FOR C&P

Overview of 19/20 QIPP schemes by Programme (Gross)

Programme Rating

Summary Financial Position at Month 05

25

The summary table below aims to explain System Support in detail.

• There forecast movement of £17k between M04 and M05 is due to Additional Allocation of £17k received in M05 for Armed forces Out of Hours services.• QEH System Support is shown with the Acute sector against the QEH.• System Support reflects financial support on items from the Financial Recovery Plan (FRP) approved by Governing Body in M04• System Support Internal Stretch reflects new FRP items awaiting approval from the Governing Body based on M05 accounts.• The category ‘Other’ reflects the non-recurrent measures needed to deliver the System Support in addition to the full utilisation of reserves.

M05_2019/20 M04M05 v PRIOR MONTHForecast Movement

Sum of Annual Budget (off ISFE)

Sum of YTD Budget (off ISFE)

Sum of YTD Actual (off ISFE)

Sum of YTD Variance (off ISFE)

Sum of FOT Actual (off ISFE)

Sum of FOT Variance (off ISFE)

Sum of FOT Variance (off ISFE)

Forecast Movement

Adverse/Favourable

Acute 146,617,846 61,089,373 63,827,751 2,738,378 147,670,783 1,052,937 -149,579 1,279,698Adverse

Community 22,870,110 9,127,713 9,484,682 356,969 22,899,069 28,959 -113,961 69,031Adverse

Continuing Health 7,748,773 3,183,091 3,326,256 143,165 7,809,646 60,873 237,803 -176,930Favourable

Mental Health 22,440,846 8,914,821 9,127,495 212,674 22,506,961 66,115 341,233 -266,218Favourable

Other 2,957,160 1,232,329 375,820 -856,509 -354,459 -3,311,619 -1,615,687 -1,690,931Favourable

Better Care Fund 7,612,160 2,810,655 2,938,764 128,109 7,601,172 -10,988 659,353 -670,341Favourable

Primary Care 34,372,726 14,178,838 14,250,138 71,301 34,338,079 -34,647 -30,503 120,856Adverse

Prescribing 32,540,247 13,620,605 14,038,085 417,480 32,379,832 -160,415 349,585 -510,000Favourable

Corporate Costs 8,071,353 3,335,098 3,436,633 101,535 8,412,358 341,006 101,468 299,537Adverse

Reserves 6,905,779 4,354,769 0 -4,354,769 3,946,559 -2,959,220 -2,639,712 -504,702Favourable

CCG Deficit Control Total 1,640,000 641,669 0 -641,669 0 -1,640,000 -1,640,000 0No Change

System Support 0 0 753,967 753,967 2,500,000 2,500,000 2,860,000 -360,000Favourable

System Support Internal Stretch 0 0 287,700 287,700 2,427,000 2,427,000 2,427,000Adverse

Grand Total 293,777,000 122,488,960 121,847,291 -641,669 292,137,000 -1,640,000 -1,640,000 17,000Adverse

Summary YTD Annual

South Norfolk CCG System support in M04 Approved by Governing Body753,967 2,500,000

Internal Stretch System Support South Norfolk CCG 287,700 2,427,000

Total System Support for South Norfolk CCG 1,041,667 4,927,000

WNCCG share of QEH System Support 1,200,000

Total System Support 1,041,667 6,127,000

26

Reserves• The CCG started the year with £7.1m of reserves (excluding Delegated Primary Care Reserves).

• The CCG has released cost pressure budgets established in the 19/20 planning exercise where commissioning commitments have commenced service (noted as Release Reserve) and created new Cost Pressure budgets where service budgets have financial headroom (noted as Create Reserve).

• In August the CCG created a ring-fenced reserve for Financial Recovery items call FRP Reserve, and has currently assigned £1.3m to this reserve.

• The Forecast to M05 has utilised all of the Contingency Reserve and part of the QIPP Reserve.

• Known Commitments or protected investment reserves means that available reserves for future mitigation are now £1.4m

Forecast Reserve Utilisation Month0.5%

Contingency

Cost

Pressure

Reserve

FRP ReserveQIPP Delivery

Reserve

Unallocated

AllocationsTotal

2019/20 Opening Balance M01 1,463,369 2,780,120 0 2,874,984 0 7,118,473

M03: Create Reserve - Community Investment 1920 budget under review M03 183,969 183,969

M04: Release Reserve - Community Investment to Intermediate Care Beds M04 (183,969) (183,969)

M04: Release Reserve - Community Family Action M04 (27,500) (27,500)0

M05: Create Reserve - Disinvestment of 19/20 planned Cost Pressures M05 (1,349,046) 1,349,046 0

M05: Create Reserve - Excess Community Budget M05 22,190 22,190

M05: Allocation - Military Out of Hospital Commissioning M05 17,000 17,000

M05: Release Reserve - Community Pulmonary Rehabilitation M05 (40,000) (40,000)

M05: Release Reserve - Community Care Leavers M05 (8,900) (8,900)

M05: Release Reserve - Primary Care Locally Commissioned Services M05 (125,000) (125,000)

M05: Release Reserve - Other CCG Quality Staff support for CQC QEHKL M05 (5,001) (5,001)

M05: Release Reserve - Community Norfolk Hospice M05 (41,500) (41,500)

M05: Release Reserve - Acute QEH CCNT M05 (77,182) (77,182)

M05: Create Reserve - Excess Acute budget Bartram's Wheelchair service M05 63,199 63,199

M05: Create Reserve - Excess Community budget STEP's (service cessation) M05 70,000 70,000

M05: Release Reserve - Acute Consultant Connect (service commencement Oct.19) M05 (60,000) (60,000)

0

2019/20 Reserves Budget Movements M05 0 (1,578,740) 1,349,046 0 17,000 (212,694)

2019/20 Balance Reserves Budget M05 1,463,369 1,201,380 1,349,046 2,874,984 17,000 6,905,779

Reserves utilised in the M05 Forecast M05 (1,463,369) 0 0 (1,495,851) 0 (2,959,220)

Balance of Reserves Remaining M05 0 1,201,380 1,349,046 1,379,133 17,000 3,946,559

Known commitments against reserves or Protected values for Financial Recovery 0 (1,201,380) (1,349,046) 0 (17,000) (2,567,426)

Balance of Available Reserves Remaining M05 0 0 0 1,379,133 0 1,379,133

In Hospital Variances

27

Acute Financial Position – by contract at Month 05

28

• Queen Elizabeth Hospital (QEH). M05 forecast includes £1.2m financial system support, representing an equal share of £6m total support across the Norfolk and Waveney CCGs. This financial support is based on no 19/20 over-performance on activity where pbr. payment basis exists (Elective and Outpatients).

• Cambridge University Hospital. M05 forecast recognises ongoing underperformances within both elective and non-elective activity.• Other Non NHS Acute Contracts. M05 forecast reflects on the ongoing provision of GP Streaming provided to the QEH within A&E., beyond its original

planned date.• Winter Resilience. M05 forecast improvement follows the recoding and subsequent moving of beds to Integrated Community Beds.

Directorate Sub Directorate

Annual

Budget

(off ISFE)

'YTD Budget

(off ISFE)

'YTD Actual

(off ISFE)

'YTD Variance

(off ISFE)

'FOT Actual

(off ISFE)

'FOT

Variance

(off ISFE)

'FOT Actual

(off ISFE)

Change in

Forecast

Adverse/Fav

ourable

Acute Queen Elizabeth Hospital FT 112,253,874 46,485,330 47,519,282 1,033,952 113,453,874 1,200,000 112,176,692 1,277,182 Adverse

EEAST Ambulance Trust 8,936,011 3,723,340 3,779,160 55,820 9,107,352 171,341 9,107,352 0 No Change

Norfolk & Norwich Univ Hosp FT 7,585,568 3,141,629 3,097,983 -43,646 7,720,666 135,098 7,720,666 0 No Change

Cambridge Uni Hosp NHS FT 4,793,299 1,997,210 1,888,195 -109,015 4,531,668 -261,631 4,723,592 -191,924 Favourable

Royal Papworth Hosp NHSFT 3,231,831 1,344,160 1,304,128 -40,032 2,988,903 -242,928 2,988,903 0 No Change

Norfolk & Norwich Univ Hosp FT - Eastern Pathology Alliance2,927,585 1,210,221 1,321,998 111,777 2,927,585 0 2,927,585 0 No Change

Non Contract Activity 2,756,971 1,148,740 906,744 -241,996 2,655,941 -101,030 2,655,941 0 No Change

Other Non NHS Acute Contracts 2,228,289 928,455 997,901 69,446 2,468,378 240,089 2,164,558 303,820 Adverse

BMI Healthcare Ltd 1,939,111 807,965 758,148 -49,817 1,783,625 -155,486 1,783,625 0 No Change

High Cost Drugs 1,363,803 568,372 553,588 -14,784 1,232,970 -130,833 1,232,970 0 No Change

W Suffolk Hosp NHS FT 1,316,313 537,044 555,956 18,912 1,290,488 -25,825 1,290,488 0 No Change

Anglia Community Eye Service 1,104,908 460,380 499,410 39,030 1,201,086 96,178 1,201,086 0 No Change

Other NHS Acute Contracts 973,185 405,495 415,929 10,434 998,230 25,045 998,230 0 No Change

Queen Elizabeth Hospital FT-Non Contract 506,325 4,584 1,774 -2,810 506,325 0 506,325 0 No Change

Winter Resilience 420,620 172,833 216,505 43,672 420,620 0 530,000 -109,380 Favourable

Norfolk & Norwich Univ Hosp FT-Non Contract 1,890 785 10,935 10,150 3,779 1,889 3,779 0 No Change

Acute QIPP Not In Contract -5,721,737 -1,847,170 117 1,847,287 -5,620,707 101,030 -5,620,707 0 No Change

Acute Total 146,617,846 61,089,373 63,827,751 2,738,378 147,670,783 1,052,937 146,391,085 1,279,698 Adverse

M05 M04

Key Financial Risks (In Hospital)

29

QEH Performance (£1.03m Ytd Adverse variance and £1.2m FOT Variance) ( Please see Table above)The Queen Elizabeth Hospital (QEH) has over performed by £1.03m based on April - June data predominantly within Elective with lesser amounts in Day Cases and higher Procedures. It is understood that the Trust are looking to ‘get ahead’ of their Elective activity to recognise seasonal periods where activity reduces.

The Trust have through their Director of Finance and Chief Operating Officer made verbal assurances that the full year plan will not be exceeded. The Trust are due by the end of September to provide the CCG with a phased plan to demonstrate their assurances. Whilst the over performance is considered to be a risk to the financial position of the CCG, it is in the M05 accounts not captured in the forecast outturn. The basis of this approach is that the Norfolk and Waveney £6m System Support will not be available to the Trust if the 19/20 activity over performs.

The Forecast Outturn shows £1.2m Adverse reflecting the equal share of £6m system support.

Acute Activity Reporting (non QEH) (£1.7m YTD Adverse variance and £0.147 m FOT Favourable Variance)( Please see Table above)The NNUH contract is broken into the main contract (which includes CQUIN and High Cost drugs) and EPA .The Main Contract is underspent by £77K YtdUnder performance activity is seen within the APC unit for elective work (including activity subcontracted to the Spire) and outpatients. The EPA has over performed by £112K Ytd on activity demand.

Cambridge University is underspend against plan by £117k YTD and forecast to be £279k under plan.

The most significant overspend within Acute YTD is against the ‘Acute QIPP not in contract’ where £1.85m negative budget to M05 exists. The full year value is £5.8m which includes West Norfolk CCGs share of the STP system support given to Cambridge and Peterborough CCG (£0.6m from West Norfolk of which £0.5m has been funded by a new unidentified QIPP, with the remaining £0.1m funded by a reduction in the Norfolk and Waveney STP transformation reserve).

QEH QIPP DeliveryThe CCG has secured QIPP savings of £1.324m in the contract signed with the QEH for 19/20.

In addition to these QIPP savings there are a further £4.1m, of the £5.8m shown, relating to Acute activity which are currently outside of the contract. The delivery of these QIPPs and the ability to access these savings presents a risk to the CCG for 2019/20. The negative budget is phased though the 19/20 year as the QIPPs are planned to deliver.

That risk has been mitigated in the financial plan by the creation of a £2.9m QIPP risk reserve. The CCG has used the entire of the QIPP risk reserve to balance its year to date ( YTD) position.

19/20 Acute QIPPS not in Contract

Project

CodeProgramme Schemes (19/20) Plan (£000) Investment

FRAIL FRAILTY Fraility Programme -802.0 0.0

FYE4Chronic Heart Disease -

Pathway re-deisgn-543.0 142.0

FYE5Respiratory - Pathway

re-design-463.6 159.0

LTC LTC Programme -882.0

DERMADay Case to OPPROC

Procedures-359.0

PLANCPlanned Care

Programme-287.0

REFMANReferal Management

(Advice and Guidance)-218.6

ACUTE&AC AEC -269.0

FREQFL Frequent Flyers -292.0

DISINVContractual/

Cross cuttingDisinvestments -1200.0

C&PSTP System

Support

Unidentified and Risk

for WNCCG-500

TOTAL -5816.2 301.0

LTC

Planned Care

SDEC

Descriptors Plan v FOT

QEH M04 Monitoring Report

30

Out of Hospital Variances

31

Key Financial Risks (Out of Hospital). (Table A: Detailed Finance Table)

32

Prescribing (£0.41m Ytd. Adverse Variance and £0.16m FOT variance)Forecasts are underpinned by data from the Pricing Prescriptions Department (PPD). The CCG has received April -June data and has put in estimated costs for July and Aug based on PPA profile calculated costs.

Both YTD and FOT include costs for NCSO and Category M drugs cost pressures.( known National risk and represents a risk to CCG Finances)The effect of Brexit is a financial risk to the Prescribing Costs.The CCG have agreed a contract variation with the CSU to enhance pharmacy support in practices and have a signed off escalation process. This will remain a major focus as the CCG moves into 2019/20 with a focus to achieve National Average prices.

The YTD QIPP budgets for prescribing is £1.2m and annual QIPP budget for Prescribing is £2.9m.

In addition to the CSU support ,WNCCG has also signed off additional schemes supported by NHS GY & Waveney CCG for Prescribing POD as well as an enhanced GP offer in order to deliver this key QIPP Plan in 19/20.

Mental Health (£212K Ytd. Adverse variance and £66K Adverse FOT Variance)The M05 YTD shows an net adverse variance of £212K due to ongoing Out of Area and Specialist Placements costs. These costs continue as a result of delays in county bed capacity despite CCG providing investments to do so. It is hoped that the beds will be available in quarter three however the CCG will not be able to recover this financial risk in 19/20 despite a 50:50 risk share basis with The Norfolk and Suffolk NHS Foundation Trust.

Community ( Including Intermediate Care Beds) (£357K Adverse YTD Position and £28K Adverse FOT position)The detailed Financial table clearly shows the components of Community Services and ICB ( Intermediate Care Beds) is one of them. There is a YTD adverse variance because of negative QIPP budgets profiled till September 2019. The QIPPs are the full year effect of 18/19 schemes. Budget will increase in October and additional bed savings are anticipated for QIPPs as a result of imminent changes to services such as Chatterton House.

Primary Care (£71K Adverse YTD and £35K Favourable FOT variance)The Detailed Finance Table clearly shows the components of Primary Care .Majority of Primary Care components are reporting to budget.

Co commissioning is overspent by £75 K YTD due to locum sickness in 2 surgeries. Please note that it is assumed that locum sickness would stop and the benefit of Co Commissioning reserve will lead to no adverse Forecast Variance.

There is a potential risk of list size increase and rent reviews.

Continuing Healthcare (£143K YTD Adverse Variance and £61k Adverse FOT variance)CCG forecasts are predicated on information provided by the NCCP Broadcare system for patients already on the CHC pathways, and a number of assumptions based on historical trend for patients eligible with no package, anticipated.

YTD M05 shows an adverse variance of £143K which is primarily driven by adult CHC cases. There is increasing cost pressure on existing packages and new patients joining the system, which is being compounded by supplier price rises.

The forecast outturn shows £61K FOT variance and includes an assumption that £1.1m of QIPP will be delivered by NCCP via high cost package reviews, this is therefore a risk if it is not achieved. Any QIPP already delivered is included in BAU

Financial Control

33

Statement of Financial Performance and Cash-flow

34

2019/20 Cashflows

Apr May June Jul Aug YTD

£k £k £k £k £k £k

Income

DOH Main Funding 20,800 27,950 22,475 22,580 25,875 119,680

Other Income 825 26 160 429 489 1,929

21,625 27,976 22,635 23,009 26,364 121,609

Expenditure

Healthcare -17,634 -23,868 -18,018 -19,845 -21,903 -101,268

Primary Care -3,275 -3,207 -3,852 -3,384 -3,288 -17,005

Better Care 0 -558 -558 0 -558 -1,674

Pay Costs -229 -227 -242 -250 -248 -1,196

-21,138 -27,860 -22,671 -23,479 -25,997 -121,144

Net Movement 488 117 -36 -471 367 465

Opening Balance 53 540 657 621 151 53

Closing Balance 540 657 621 151 518 518

As at

July 2019

As at

Aug 2019

2,376 Trade and Other Receivables 2,549

109 Cash and Cash Equivalents 519

2,485 Total current assets 3,068

(23,416) Trade and Other Payables incl provision (20,475)

(23,416) Total current liabilities (20,475)

(20,931) Current assets less current liabilities (17,407)

FINANCED BY TAXPAYERS EQUITY

(20,931) General fund (17,407)

(20,931) TOTAL TAXPAYERS EQUITY (17,407)

Statement of Financial Position

Analysis of Aged Debtors

35

Row Labels Now Due

Sum of AR

overdue 1-30

amount

Sum of AR

overdue 31-60

amount

Sum of AR

overdue 61-

90 amount

Sum of AR

overdue 91-120

amount

Sum of AR

overdue 121-

180 amount

Sum of AR

overdue 181-360

amount

Sum of AR

overdue 361+

amount

Sum of

Total AR

due and

overdue

% of Total

Debt

ASTRAZENECA UK LTD - - - - - - - 0 0 0%

BAYER PLC - - - - - - - 0 0 0%

BOEHRINGER INGELHEIM LTD - - - - - - 2,480 1,112 3,591 0%

ETHYPHARM UK LTD - - - 2,903 - 21,610- 6,162 12,369 175- 0%

FRESENIUS KABI LTD - - - - - - - 9,995 9,995 1%

NHS CAMBRIDGESHIRE AND PETERBOROUGH CCG - - - - - - 74,571 - 74,571 8%

NHS ENGLAND - 781 672 - - 300,000 - - 301,453 32%

NHS GREAT YARMOUTH & WAVENEY CCG 95,086 - - - - - - - 95,086 10%

NHS NEL CSU - - - - - - - 8,619 8,619 1%

NHS NORTH NORFOLK CCG 38,103 - - - - - - - 38,103 4%

NHS NORWICH CCG 2,540 - - - - - - - 2,540 0%

NHS SOUTH LINCOLNSHIRE CCG - - - - - - - 25,535 25,535 3%

NHS WALSALL CCG - - - - - - 53,002 - 53,002 6%

NORFOLK COUNTY COUNCIL - - - - - 12,694 12,031 332,155 356,881 38%

SANDOZ LTD - - - 1,865 - - - - 1,865 0%

SANOFI 7,351 - - - - - - 31,950 39,302 4%

(blank) - 160- 18,215- 23,850- - 31,200- - 7,500- 80,925- -9%

Grand Total 143,081 621 17,543- 19,082- - 259,885 148,246 414,235 929,444 100%

Summary M05 Aug 2019 ££ 143,702 ££ 36,625- ££ 822,367

% of Total Debt 15% % of Total Debt -4% % of Total Debt 88%

Summary M04 July 2019 ££ 85,281 ££ 19,514 ££ 811,960

% of Total Debt 8% % of Total Debt 2% % of Total Debt 99%

Movement (- Improvement/+Deteroration) ££ 58,421 ££ 56,139- ££ 10,407

% of Total Debt 7% % of Total Debt -6% % of Total Debt -11%

Better Payments Practice Code

36

The Public Sector is required to adhere to the 'Better Payments Practice Code' which is a requirement to pay all trade creditors within 30 calendar days of receipt of goods or a valid invoice (whichever is later) unless other payment terms have been agreed. The compliance target is at least 95% and is measured on both Number of Invoices, and Value of Invoices.

For August 2019, the cumulative measure passed for 'Value of Invoices' at 100%( BPPC is calculated as a % of Paid invoices to value of passed invoices invoices).Further for 'Number of Invoices' 99% was achieved.

The value of Invoices is achieving the monthly BPPC standard supported by the high value SLA invoices being paid in a routine scheduled manner.

Table A: Detailed Financial Position at Month 05

37

Directorate Sub DirectorateAnnual Budget

(off ISFE)

'YTD Budget

(off ISFE)

'YTD Actual

(off ISFE)

'YTD Variance

(off ISFE)

'FOT Actual

(off ISFE)

'FOT Variance

(off ISFE)

Acute Queen Elizabeth Hospital FT 112,760,199 46,489,914 47,521,055 1,031,141 113,960,199 1,200,000

EEAST Ambulance Trust 8,936,011 3,723,340 3,779,160 55,820 9,107,352 171,341

Norfolk & Norwich Univ Hosp FT 8,314,782 3,445,464 3,367,795 -77,669 8,292,303 -22,479

Cambridge Uni Hosp NHS FT 4,986,402 2,077,670 1,960,339 -117,331 4,706,617 -279,785

Royal Papworth Hosp NHSFT 3,231,831 1,344,160 1,304,128 -40,032 2,988,903 -242,928

Norfolk & Norwich Univ Hosp FT - Eastern Pathology Alliance 2,927,585 1,210,221 1,321,998 111,777 2,927,585 0

Non Contract Activity 2,761,067 1,150,445 906,938 -243,507 2,656,523 -104,544

Other Non NHS Acute Contracts 2,228,289 928,455 997,901 69,446 2,468,378 240,089

BMI Healthcare Ltd 1,939,111 807,965 758,148 -49,817 1,783,625 -155,486

W Suffolk Hosp NHS FT 1,407,401 575,121 592,316 17,195 1,383,705 -23,696

Anglia Community Eye Service 1,104,908 460,380 499,410 39,030 1,201,086 96,178

Other NHS Acute Contracts 973,185 405,495 415,929 10,434 998,230 25,045

Winter Resilience 420,620 172,833 216,505 43,672 420,620 0

High Cost Drugs 348,192 145,080 186,011 40,931 396,364 48,172

Acute QIPP Not In Contract -5,721,737 -1,847,170 117 1,847,287 -5,620,707 101,030

Acute Total 146,617,846 61,089,373 63,827,751 2,738,378 147,670,783 1,052,937

Community Norfolk Community Health & Care 17,396,958 7,123,315 7,064,158 -59,157 17,336,243 -60,715

Community Services 2,005,356 835,575 825,470 -10,105 1,915,527 -89,829

Palliative Care 1,654,745 677,373 697,883 20,511 1,665,154 10,409

Intermediate Care 1,354,271 300,295 664,223 363,928 1,472,688 118,417

Long Term Conditions 338,657 141,105 185,456 44,351 395,476 56,819

Hospices 120,123 50,050 47,492 -2,558 113,981 -6,142

Community Total 22,870,110 9,127,713 9,484,682 356,969 22,899,069 28,959

Continuing Health Adult Continuing Care 5,745,053 2,348,211 2,474,767 126,556 5,872,608 127,555

Funded Nursing Care 1,004,932 418,720 386,076 -32,644 894,889 -110,043

Adult Personal Health Budget 670,355 279,315 300,698 21,383 719,301 48,946

Children Continuing Care 328,433 136,845 164,351 27,506 321,936 -6,497

Children Personal Health Budget 0 0 363 363 912 912

Continuing Health Total 7,748,773 3,183,091 3,326,256 143,165 7,809,646 60,873

Mental Health Norfolk & Suffolk FT Main SLA 16,649,562 6,937,314 7,166,618 229,304 17,199,884 550,322

Mental Health Services - Other 2,759,707 718,055 788,174 70,119 2,580,855 -178,852

Norfolk & Suffolk FT IAPT SLA 2,074,428 864,345 864,345 0 1,874,428 -200,000

Child And Adolescent Mental Health 678,258 278,900 246,740 -32,160 678,258 0

Learning Difficulties 278,891 116,207 61,618 -54,589 173,536 -105,355

Mental Health Total 22,440,846 8,914,821 9,127,495 212,674 22,506,961 66,115

Table A: Detailed Financial Position at Month 05 (Continued)

38

Other Non Emergency Patient Transport 1,661,356 692,230 709,673 17,443 1,679,305 17,949

NHS 111 894,518 372,715 363,879 -8,836 882,138 -12,380

Commissioning - Non Acute 387,418 161,604 -701,911 -863,515 -2,899,969 -3,287,387

Looked After Children 13,261 5,525 3,926 -1,599 -16,540 -29,801

Counselling Services 607 255 253 -2 607 0

Other Total 2,957,160 1,232,329 375,820 -856,509 -354,459 -3,311,619

Better Care Fund Collaborative Commissioning (BCF) 7,612,160 2,810,655 2,938,764 128,109 7,601,172 -10,988

Better Care Fund Total 7,612,160 2,810,655 2,938,764 128,109 7,601,172 -10,988

Primary Care Primary Care Delegated Co-Commissioning 29,164,000 12,004,617 12,079,902 75,285 29,164,000 0

Local Enhanced Services 2,386,038 1,023,358 1,023,358 -0 2,386,038 0

GP Out Of Hours 1,547,117 631,470 631,470 0 1,516,614 -30,503

Gp Forward View 1,097,000 457,095 457,095 0 1,097,000 0

Primary Care IT 178,571 62,297 58,313 -3,984 174,427 -4,144

Primary Care Total 34,372,726 14,178,838 14,250,138 71,301 34,338,079 -34,647

Prescribing Gp Prescribing 29,790,239 12,483,095 12,970,571 487,476 29,656,300 -133,939

Other Prescribing 1,347,895 553,290 503,151 -50,139 1,380,213 32,318

Central Drugs 715,140 297,981 285,798 -12,183 692,851 -22,289

Oxygen 512,902 213,710 205,985 -7,725 476,132 -36,770

Medicines Management - Clinical 110,000 45,834 45,833 -1 110,000 0

Prescribing Incentives 64,071 26,695 26,747 52 64,336 265

Prescribing Total 32,540,247 13,620,605 14,038,085 417,480 32,379,832 -160,415

Corporate Costs Running Costs - Pay & Non Pay 2,603,455 1,081,812 1,020,398 -61,414 2,645,335 41,880

Continuing Healthcare Assessment & Support - NCCP 1,241,774 517,408 517,408 0 1,241,777 3

Transformational & Clinical - Pay and Non Pay 1,117,851 465,771 547,688 81,918 1,329,161 211,310

Running Costs - CSU 1,093,545 455,635 483,550 27,915 1,051,665 -41,880

Medicines Management - Clinical - CSU 728,822 303,677 306,547 2,870 735,712 6,890

STP Contributions 555,409 231,420 236,524 5,104 535,455 -19,954

Commissioning - CSU 499,494 208,122 208,535 413 500,484 990

West Norfolk Project Costs 231,003 71,253 113,812 42,559 380,506 149,503

Non Running Costs - Non Pay 0 0 614 614 0 0

West Norfolk Alliance Project Team 0 0 1,558 1,558 -7,737 -7,737

Corporate Costs Total 8,071,353 3,335,098 3,436,633 101,535 8,412,358 341,006

Reserves QIPP Delivery Reserve 2,874,984 2,874,984 0 -2,874,984 2,838,741 -36,243

Non Recurrent Reserve 1,196,190 0 0 0 830,399 -365,791

Contingency Reserve 1,485,559 1,286,456 0 -1,286,456 0 -1,485,559

FRP Reserve 1,349,046 193,329 0 -193,329 277,419 -1,071,627

Reserves Total 6,905,779 4,354,769 0 -4,354,769 3,946,559 -2,959,220

CCG Deficit Control Total Allocation - Cumulative Deficit 5,796,000 2,415,000 0 -2,415,000 0 -5,796,000

Cumulative Debt -4,156,000 -1,773,331 0 1,773,331 0 4,156,000

CCG Deficit Control Total Total 1,640,000 641,669 0 -641,669 0 -1,640,000

System Support System Support - Intra CCG 0 0 753,967 753,967 2,500,000 2,500,000

System Support Total 0 0 753,967 753,967 2,500,000 2,500,000

System Support Internal StretchSystem Support Internal Stretch 0 0 287,700 287,700 2,427,000 2,427,000

System Support Internal Stretch Total 0 0 287,700 287,700 2,427,000 2,427,000

Grand Total 293,777,000 122,488,960 121,847,291 -641,669 292,137,000 -1,640,000

Mental Health Investment Standard as at Month 05

39

The CCG is on plan to deliver the 2019/20 MHIS required investment of £26.5m which represents a growth of 6.8% over comparable spend in 2018/19.

The 6.8% level of growth was mandated by NHSE in the 19/20 planning guidance and is greater than the increase in allocation awarded to the CCG for the same period.

Table 2: Mental Health Spend by Category

Spend by Category 2019/20 Plan YTD Spend FOT FOT Variance 2019/20 Plan YTD Spend FOT FOT Variance 2019/20 Plan YTD Spend FOT FOT Variance

Children & Young People's Mental Health (excluding LD) 2,220 901 2,227 8 189 106 172 (16) 2,408 1,007 2,399 (9)

Children & Young People's Eating Disorders 362 167 406 44 - - - - 362 167 406 44

Perinatal Mental Health (Community) 145 71 170 25 - - - - 145 71 170 25

Improved access to psychological therapies (adult) 2,069 864 2,074 6 104 36 109 4 2,173 901 2,183 10

A and E and Ward Liaison mental health services (adult) 615 236 566 (49) - - - - 615 236 566 (49)

Early intervention in psychosis ‘EIP’ team (14 - 65) 834 316 758 (75) - - - - 834 316 758 (75)

Crisis resolution home treatment team (adult) 1,682 725 1,741 59 - - - - 1,682 725 1,741 59

Community Mental Health 2,679 1,007 2,417 (263) - - - - 2,679 1,007 2,417 (263)

Mental Health Act - 10 24 24 - - - - - 10 24 24

SMI Physical Health - 254 609 609 - - - - - 254 609 609

Suicide Prevention - - - - - - - - - - - -

Other adult and older adult - inpatient mental health (excluding dementia) 7,434 3,338 8,701 1,268 2,729 1,268 1,554 (1,174) 10,162 4,606 10,256 94

Other adult and older adult mental health - non-inpatient (excluding dementia) 2,818 683 1,639 (1,179) 148 101 238 90 2,966 783 1,877 (1,089)

Mental health prescribing - - - - 2,332 871 2,091 (240) 2,332 871 2,091 (240)

Mental health in continuing care - - - - 109 - 965 855 109 - 965 855

Sub-Total 20,856 8,572 21,333 477 5,611 2,382 5,130 (481) 26,467 10,954 26,463 (4)

Learning Disabilities 216 54 155 (61) 3,209 1,120 2,767 (442) 3,425 1,174 2,921 (504)

Dementia 1,332 501 1,202 (130) 2,560 783 1,870 (690) 3,892 1,284 3,072 (820)

Total 22,404 9,127 22,690 286 11,380 4,285 9,766 (1,614) 33,784 13,412 32,456 (1,328)

Core Mental Health Mental Health in Other Areas Total Mental Health

£'000s

West Norfolk CCGQIPP 19/20

Programme Board17/09/19

41

QIPP Executive SummaryWorking Well+ By M5 against a plan of £5248k, we have del ivered savings of £5357k which equates to 102.4% del ivery.

+The work being developed in the Fra i l ty and Dementia programme continues to be encouraging. The Fra i l ty Redes ign project (NEAT & Fra i l ty EIV

vehicle) i s reporting above plan by £346k. We expect this trend to continue through to the beginning of Q4.

+The Costal PCN pi lot has now started. Continues to progress wel l . With the Population Healthcare Team members determined, we are weeks

away from going l ive on the project.

+During the month a lot of work has gone in to de-risking and mitigating our QIPP del ivery. This has resulted in the identi fication of 5 FRP

schemes which has resulted in a recovery of our FOT from a shortfa l l of £928k in M4 to a shortfa l l of £291k. This equates to 97.8% del ivery – a 3.9%

improvement on Month 4.

+Signi ficant work has been undertaken which has resulted in a s igni ficant improvement in the management of the project plans . (Please see

analys is at the end of this report.)

Ones to Watch+ Within the LTC Programme the recruitment of the s taff for the CHD and Respiratory projects i s progress ing. The work s tream lead for this work is

leaving and we need to make sure that a ful l handover i s carried out so that we don't miss anything.

+ Within the SDEC programme, the Wel l Supported Cl inica l Decis ion Making scheme has been cancel led due to the planned resources being

pul led by the QEH. We have a programme deep dive planned for the fi rs t week in October to review progress to date.

Areas of Concern+With the current flex and change within the organisation, particularly at the decis ion making level , i t i s vi ta l that we do not a l low any

implementation to be held up through delayed decis ion making as we move forward with revised governance practices .

+ During phase 3 of the consultation uncerta inty for the s taff wi l l potentia l ly impact on del ivery.

42

QIPP 19/20 Financial Overview- Gross

At Month 4 against a plan of £5,164k, we have delivered savings of £5,357k which equates to 103.7% delivery. During Month 5 we have identified a number of FRP schemes which has resulted in a recovery of our FOT from a shortfall of £928k to a shortfall of £291k. This equates to 97.8% delivery – a 3.7% improvement on Month 4.

Sept 2019 Key to Finance Ratings - % of plan Key to Progress Ratings (from Monthly Reports/Review Meetings)

> = 95% Green Work Completed Blue

> = 75% and < 95% Amber Work on schedule Green

< 75% Red Work not yet due to start/some elements behind schedule Amber

Behind Schedule Red

Programme Scheme 2019/20 Plan (£)

YTD Planned

Savings (£)

YTD Actual Savings

(£) Variance (£)

Finance Rating

YTD FOT (£) Variance (£)

Finance

Rating FOT SRO Project Lead Progress Rating

Care Homes (829,000) (280,000) (365,000) 85,000 G (829,000) 0 G Ross Collett Sarah Taylor B

Frailty Pathway Re-design (61,000) (61,000) (407,205) 346,205 G (617,205) 0 G Ross Collett Fran Rose Smith G

Frailty PHM (802,000) (234,000) (168,000) (66,000) R (589,000) 213,000 R Ross Collett Fran Rose Smith A

Intermediate Care Beds (Not Inc Spots) (400,000) (166,667) (201,667) 35,000 G (435,000) (35,000) G Ross Collett Rob Jakeman G

Rationalisation of ICB's (Reduction in Spots) (1,071,000) (764,965) (764,979) 14 G (1,070,965) 35 G Ross Collett Rob Jakeman G

Dementia Programme 0 0 0 0 #DIV/0! 0 178,035 #DIV/0! Ross Collett Mark Payne G

(3,163,000) (1,506,632) (1,906,851) 400,219 (3,541,170) 356,070

Chronic Heart Disease - Pathway re-design (543,000) (166,000) (49,600) (116,400) R (249,800) 293,200 R Ross Collett Amanda Harries A

Respiratory - Pathway re-design (463,600) (180,200) (53,600) (126,600) R (287,700) 649,270 R Ross Collett Amanda Harries A

LTC Stretch Target (881,600) (270,833) (270,933) 100 G (882,100) (500) G Ross Collett N/A A

Diabetes - PHM 0 0 0 0 #DIV/0! 0 0 #DIV/0! Ross Collett Amanda Harries A

CHD - PHM 0 0 0 0 #DIV/0! 0 0 #DIV/0! Ross Collett Amanda Harries A

Respiratory - PHM 0 0 0 0 #DIV/0! 0 0 #DIV/0! Ross Collett Amanda Harries A

(1,888,200) (617,033) (374,133) (242,900) (1,419,600) 941,970

Planned Care Stretch Target (286,600) 0 0 0 #DIV/0! (257,000) 29,600 A Ross Collett N/A A

Ophthalmology 0 0 0 0 #DIV/0! (30,000) (30,000) #DIV/0! Ross Collett Cath McWalter G

Gastroenterology 0 0 0 0 #DIV/0! 0 0 #DIV/0! Ross Collett Sian Kendrick Jones G

Procedures of low clinical value (PoLCV) (13,000) (7,778) (7,778) 0 G (13,444) (444) G Ross Collett Sian Kendrick Jones B

Advice and Guidance and Triage (219,000) (88,125) (64,750) (23,375) R (195,250) 23,750 A Ross Collett Cath McWalter B

(518,600) (95,903) (72,528) (23,375) (495,694) 22,906

Well Supported Clinical Decision Making (172,000) (95,500) (95,500) 0 G (171,900) 100 G Ross Collett N/A B

GP Extended Access (68,600) (49,000) (48,000) (1,000) G (69,000) (400) G Ross Collett Gina Titman B

AEC (PHM) (269,000) (48,000) 0 (48,000) R 0 269,000 R Ross Collett Rebecca Quinton R

Patient 500 (Admission Avoidance) (180,000) (108,000) (110,500) 2,500 G (180,000) 0 G Ross Collett Rebecca Quinton B

High Intensity Service User (292,000) (84,000) (24,000) (60,000) R (24,000) 268,000 R Ross Collett Emma L'Angellier A

(981,600) (384,500) (278,000) (106,500) (444,900) 536,700

Running Costs (386,000) (160,833) (126,827) (34,006) A (351,994) 34,006 A Howard Martin Emma Kriehn-Morris B

Day Case to OPPROC Procedures (359,000) (149,000) (149,000) 0 G (359,000) 0 G Howard Martin Sharon Kidd B

Contractual efficiency (1,200,000) (500,000) (500,000) 0 G (1,200,000) 0 G Howard Martin Emma Kriehn-Morris B

ICES (STP Wide) (144,000) (60,000) (120,000) 60,000 G (288,000) 2,094,687 G Howard Martin Shaun Wilson Gottobed B

(2,089,000) (869,833) (895,827) 25,994 (2,198,994) 2,128,693

CHC (NCCP FYE) (353,600) (286,500) (357,906) 71,406 G (505,906) (152,306) G Sarah Jane Ward NCCP B

CHC (NCCP In Year) (750,000) (218,750) (95,500) (123,250) R (350,500) 399,500 R Sarah Jane Ward NCCP B

(1,103,600) (505,250) (453,406) (51,844) (856,406) 247,194

High Cost Drugs (Secondary Care) Avastin (450,000) (250,000) (250,000) 0 G (450,000) 0 G Sarah Jane Ward ARDENGEM B

Prescribing (1,000,000) (292,000) (335,000) 43,000 G (1,043,000) (43,000) G Sarah Jane Ward ARDENGEM B

CSU Prescribing Support (1,461,000) (608,625) (608,575) (50) G (1,460,650) 350 G Sarah Jane Ward ARDENGEM B

(2,911,000) (1,150,625) (1,193,575) 42,950 G (2,953,650) (42,650)

Support for C&P (500,000) #DIV/0! R N/A N/A R

Identified QIPP (13,155,000) (5,129,776) (5,174,320) 44,544 G (11,910,414) 1,244,586 A N/A N/A

CAS 0 (34,167) (34,167) 0 G (82,000) (82,000) #DIV/0! Ross Collett Rebecca Quinton B

Tapping House Bed Stock 0 0 (70,000) 70,000 #DIV/0! (70,000) (70,000) #DIV/0! Ross Collett Rob Jakeman B

Consultant Connect 0 0 0 0 #DIV/0! (49,000) (49,000) #DIV/0! Ross Collett Rebecca Quinton G

GP Streaming 0 0 0 0 #DIV/0! (500,000) (500,000) #DIV/0! Ross Collett Fran Rose Smith G

Stopping Stepping Out 0 0 (79,000) 79,000 #DIV/0! (79,000) (79,000) #DIV/0! Ross Collett Rob Jakeman B

CCNT 0 0 0 0 #DIV/0! (173,000) (173,000) #DIV/0! Ross Collett Cathy Butterfield G

0 (34,167) (183,167) 149,000 G (953,000) (953,000)

Identified QIPP (13,155,000) (5,129,776) (5,174,320) 44,544 G (11,910,414) 1,244,586 A N/A N/A N/A

FRP 0 (34,167) (183,167) 149,000 G (953,000) (953,000) #DIV/0! N/A N/A N/A

TOTAL (13,155,000) (5,163,943) (5,357,487) 193,544 G (12,863,414) 291,586 G

FRP

CHC

Prescribing

Fraility and Dementia

LTC

Planned Care

SDEC

Financial

43

QIPP 19/20 Financial Overview- GrossSept 2019 Key to Finance Ratings - % of plan Key to Progress Ratings (from Monthly Reports/Review Meetings)

> = 95% Green Work Completed Blue

1.037575053 > = 75% and < 95% Amber Work on schedule Green

< 75% Red Work not yet due to start/some elements behind schedule Amber

Behind Schedule Red

Programme Scheme 2019/20 Plan (£)

YTD Planned

Savings (£)

YTD Actual Savings

(£) Variance (£)

Finance Rating

YTD FOT (£) Variance (£)

Finance

Rating FOT SRO Project Lead Progress Rating

Care Homes (829,000) (280,000) (365,000) 85,000 G (648,000) 181,000 A Ross Collett Sarah Taylor B

Frailty Pathway Re-design (61,000) (61,000) (407,205) 346,205 G (615,205) 181,000 G Ross Collett Fran Rose Smith G

Frailty PHM (802,000) (234,000) (168,000) (66,000) R (589,000) 213,000 R Ross Collett Fran Rose Smith A

Intermediate Care Beds (Not Inc Spots) (400,000) (166,667) (201,667) 35,000 G (435,000) (35,000) G Ross Collett Rob Jakeman G

Rationalisation of ICB's (Reduction in Spots) (1,071,000) (764,965) (764,979) 14 G (1,070,965) 35 G Ross Collett Rob Jakeman G

Dementia Programme 0 0 0 0 #DIV/0! 0 178,035 #DIV/0! Ross Collett Mark Payne G

(3,163,000) (1,506,632) (1,906,851) 400,219 (3,358,170) 718,070

Chronic Heart Disease - Pathway re-design (543,000) (166,000) (49,600) (116,400) R (107,800) 435,200 R Ross Collett Amanda Harries A

Respiratory - Pathway re-design (463,600) (180,200) (53,600) (126,600) R (128,700) 1,153,270 R Ross Collett Amanda Harries A

LTC Stretch Target (881,600) (270,833) (270,933) 100 G (882,100) (500) G Ross Collett N/A A

Diabetes - PHM 0 0 0 0 #DIV/0! 0 0 #DIV/0! Ross Collett Amanda Harries A

CHD - PHM 0 0 0 0 #DIV/0! 0 0 #DIV/0! Ross Collett Amanda Harries A

Respiratory - PHM 0 0 0 0 #DIV/0! 0 0 #DIV/0! Ross Collett Amanda Harries A

(1,888,200) (617,033) (374,133) (242,900) (1,118,600) 1,587,970

Planned Care Stretch Target (286,600) 0 0 0 #DIV/0! (257,000) 29,600 A Ross Collett N/A A

Ophthalmology 0 0 0 0 #DIV/0! (30,000) (30,000) #DIV/0! Ross Collett Cath McWalter G

Gastroenterology 0 0 0 0 #DIV/0! 0 0 #DIV/0! Ross Collett Sian Kendrick Jones G

Procedures of low clinical value (PoLCV) (13,000) (7,778) (7,778) 0 G (13,444) (444) G Ross Collett Sian Kendrick Jones B

Advice and Guidance and Triage (219,000) (88,125) (64,750) (23,375) R (195,250) 23,750 A Ross Collett Cath McWalter B

(518,600) (95,903) (72,528) (23,375) (495,694) 22,906

Well Supported Clinical Decision Making (172,000) (95,500) (95,500) 0 G (171,900) 100 G Ross Collett N/A B

GP Extended Access (68,600) (49,000) (48,000) (1,000) G (69,000) (400) G Ross Collett Gina Titman B

AEC (PHM) (269,000) (48,000) 0 (48,000) R 0 269,000 R Ross Collett Rebecca Quinton R

Patient 500 (Admission Avoidance) (180,000) (108,000) (110,500) 2,500 G (180,000) 0 G Ross Collett Rebecca Quinton B

High Intensity Service User (292,000) (84,000) (24,000) (60,000) R (24,000) 268,000 R Ross Collett Emma L'Angellier A

(981,600) (384,500) (278,000) (106,500) (444,900) 536,700

Running Costs (386,000) (160,833) (126,827) (34,006) A (351,994) 34,006 A Howard Martin Emma Kriehn-Morris B

Day Case to OPPROC Procedures (359,000) (149,000) (149,000) 0 G (359,000) 0 G Howard Martin Sharon Kidd B

Contractual efficiency (1,200,000) (500,000) (500,000) 0 G (1,200,000) 0 G Howard Martin Emma Kriehn-Morris B

ICES (STP Wide) (144,000) (60,000) (120,000) 60,000 G (288,000) 2,740,687 G Howard Martin Shaun Wilson Gottobed B

(2,089,000) (869,833) (895,827) 25,994 (2,198,994) 2,774,693

CHC (NCCP FYE) (353,600) (286,500) (357,906) 71,406 G (505,906) (152,306) G Sarah Jane Ward NCCP B

CHC (NCCP In Year) (750,000) (218,750) (95,500) (123,250) R (350,500) 399,500 R Sarah Jane Ward NCCP B

(1,103,600) (505,250) (453,406) (51,844) (856,406) 247,194

High Cost Drugs (Secondary Care) Avastin (450,000) (250,000) (250,000) 0 G (450,000) 0 G Sarah Jane Ward ARDENGEM B

Prescribing (1,000,000) (292,000) (335,000) 43,000 G (1,043,000) (43,000) G Sarah Jane Ward ARDENGEM B

CSU Prescribing Support (1,461,000) (608,625) (608,575) (50) G (1,250,350) 210,650 A Sarah Jane Ward ARDENGEM B

(2,911,000) (1,150,625) (1,193,575) 42,950 G (2,743,350) 167,650

Support for C&P (500,000) #DIV/0! R N/A N/A R

Identified QIPP (13,155,000) (5,129,776) (5,174,320) 44,544 G (11,216,114) 1,938,886 A N/A N/A

CAS 0 (34,167) (34,167) 0 G (82,000) (82,000) #DIV/0! Ross Collett Rebecca Quinton B

Tapping House Bed Stock 0 0 (70,000) 70,000 #DIV/0! (70,000) (70,000) #DIV/0! Ross Collett Rob Jakeman B

Consultant Connect 0 0 0 0 #DIV/0! (49,000) (49,000) #DIV/0! Ross Collett Rebecca Quinton G

GP Streaming 0 0 0 0 #DIV/0! (500,000) (500,000) #DIV/0! Ross Collett Fran Rose Smith G

Stopping Stepping Out 0 0 (79,000) 79,000 #DIV/0! (79,000) (79,000) #DIV/0! Ross Collett Rob Jakeman B

CCNT 0 0 0 0 #DIV/0! (173,000) (173,000) #DIV/0! Ross Collett Cathy Butterfield G

0 (34,167) (183,167) 149,000 G (953,000) (953,000)

Identified QIPP (13,155,000) (5,129,776) (5,174,320) 44,544 G (11,216,114) 1,938,886 A N/A N/A N/A

FRP 0 (34,167) (183,167) 149,000 G (953,000) (953,000) #DIV/0! N/A N/A N/A

TOTAL (13,155,000) (5,163,943) (5,357,487) 193,544 G (12,169,114) 985,886 A

CHC

Prescribing

FRP

Fraility and Dementia

LTC

Planned Care

SDEC

Financial

44

All programmes are currently RAG’ed as green, with the exception of –- LTC – With a delay in commencing both the CHD & Respiratory projects, there is a M5 combined savings gap of £374k against a M4 Plan of £615k.- SDEC – Lack of engagement by the QEH is impeding AEC project scoping. The HIUS scheme has been impeded by Leadership changes and decision making. - CHC – The NNCP In Year scheme is showing a savings gap of £96k against a M5 Plan of £219k.Currently just over a quarter of our portfolio is RAG’ed red and therefore mitigations need to be put in place to de-risk these particular schemes.

Overview of QIPP 19/20 Schemes by ProgrammePlan (£000)

(Gross)

Investment

(£000)

Plan (£000)

(Net)

Gross QIPP

FOT (£000)

FOT

Variance% of Plan

-3163 183 -2980 -3541 378 -112.0%

-1888 301 -1587 -1420 -469 -75.2%

-519 0 -519 -496 -23 -95.6%

-982 0 -982 -527 -455 -53.7%

-2089 0 -2089 -2199 110 -105.3%

-1104 0 -1104 -856 -247 -77.6%

-2911 210 -2701 -2954 43 -101.5%

-500 0 -500 0 -500

FRG 0 0 0 -871 871

-13155 694 -12461 -12863 -292 -97.8%

R <75%

A 75%<>95%

G >95%

Programme RatingProgramme

Frailty and Dementia

Long Term Conditions

Planned Care

SDEC

Contractural

CHC

Prescribing

Grand total

SUPPORT FOR C&P

-3,487

-1,783

-7,594

Portfolio Value by RAG (M5)

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

11000

12000

13000

QIPP 19/20 Profiling

Plan

Actual

45

At Month 5, QIPP delivery maintains the trend of remaining higher than in any of the previous four years.

Historical QIPP DeliveryProgramme April May June July August September October November December January February March

15/16 303 550 821 1216 1663 2029 2407 2878 3382 3846 4564 5015

16/17 528 1065 1816 2678 3178 3501 4038 5393 7026 9482 10653 11579

17/18 357 817 1502 2551 3567 3929 4494 5491 6308 7001 7765 9173

18/19 501 909 1433 2385 3270 3783 4533 5258 6027 7094 8785 10424

19/20 1008 2010 3064 4112 5357

-500

500

1500

2500

3500

4500

5500

April May June July August

Axi

s Ti

tle

Monthy QIPP Delivery

15/16

16/17

17/18

18/19

19/20

46

Frailty and Dementia - FinanceM5 Plan (£000) M5 Actual (£000) % of Plan

Original Plan

(Gross)

Approved

Investment

Committed

Investment

Original Plan

(Net)FOT

%

Variance

-365 -365 100% -829 181 0 -648 -829 100% Sarah Taylor

-61 -407 668% -61 2 0 -59 -617 1012% Fran Rose Smith

-234 -168 72% -802 0 0 -802 -589 73% Fran Rose Smith

-167 -202 121% -400 0 0 -400 -435 109% Rob Jakeman

-765 -765 100% -1071 0 0 -1071 -1071 100% Rob Jakeman

0 0 0 0 0 0 0 Mark Payne

-1592 -1907 119.8% -3163 183 0 -2980 -3541 112%

SRO Ross Collett HEAD OF Rob Jakeman PMO SUPPORT Sharon Kidd CLINICAL LEAD Dr Tina Araffin QUALITY LEAD Sarah Taylor Rashmi Balakrishnan

BI SUPPORT Samantha Weston

PLAN FORECAST OUTTURN

Total Programme

FINANACE LEAD

PROGRAMME FINANCES

Frailty Pathway Re-design

Frailty PHM

Dementia Programme

Intermediate Care Beds (Not Inc Spots)

Rationalisation of ICB's (Reduction in Spots)

Frailty Pathway Re-designProgramme Phasing Care Homes (NEL Admission Avoidance)

Frailty & Dementia - FinancesMonthly Position (M5) Plan v FOT

Project Manager

Care Homes

Rationalisation of ICB's (Reduction in Spots)Frailty PHM Intermediate Care Beds (Not Inc Spots)

Dementia Programme

0

200

400

600

800

1000

1200

(£00

0K)

0

200

400

600

800

1000

1200

(£00

0K)

0

200

400

600

800

1000

1200

(£00

0K)

0

50

100

150

200

250

300

350

400

(£00

0K)

0

200

400

600

800

1000

1200

(£00

0K)

0

200

400

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800

1000

1200

(£00

0K)

0

500

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1500

2000

2500

3000

3500

4000

(£00

0K)

The Frailty Redesign project (NEAT & Frailty EIV vehicle) is reporting at 668% above plan, with savings at £407k. We expect this trend to continue through to the beginning of Q4. The Frailty Costal PCN pilot continues to progress well. The project has now gone live.

47

M5 Plan (£000) M5 Actual (£000) % of PlanOriginal Plan

(Gross)

Approved

Investment

Committed

Investment

Original Plan

(Net)FOT

%

Variance

-164 -50 30.2% -543 142 0 -401 -250 46% Amanda Harries

-180 -54 29.7% -464 159 0 -305 -288 62% Amanda Harries

-271 -271 100.0% -882 0 0 -882 -882 100% N/A

0 0 0 0 0 0 0 Amanda Harries



-615 -374 60.8% -1888 301 0 -1587 -1420 75%

SRO Ross Collett Programme Mang Amanda Harries PMO SUPPORT Tom Clare CLINICAL LEAD Dr Clare Hambling QUALITY LEAD Andy Hudson Daniel Abraham

BI SUPPORT Sam Weston


LTC Stretch Target Diabetes - PHM CHD - PHM

Respiratory - PHM

Long Term Conditions - FinancesMonthly Position (M5) Plan v FOT

Programme Phasing Chronic Heart Disease - Pathway re-design Respiratory - Pathway re-design

Project Manager

Chronic Heart Disease - Pathway re-design

PROGRAMME FINANCES

FINANACE LEAD

Respiratory - Pathway re-design

LTC Stretch Target

CHD - PHM

Respiratory - PHM

Total Programme

Diabetes - PHM

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

(£00

0K)

0

200

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1000

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(£00

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0

200

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1200


(£00

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200

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(£00

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0

20

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80

100

120


(£00

0K)

0

20

40

60

80

100

120


(£00

0K)

0

20

40

60

80

100

120


(£00

0K)

Long Term Conditions - Finance

Within the LTC Programme the recruitment of the staff for the CHD & Respiratory projects is underway. Considerable focus needs to be given around the identification and delivery of the new LTC opportunities to mitigate the savings (FYE £882k) linked to delayed PHM projects.

48


(Gross)

Approved

Investment

Committed

InvestmentOriginal Plan (Net) FOT

%

Variance

0 0 -287 0 0 -287 -257 N/A

0 0 0 0 0 0 -30 Cath McWalter

0 0 0 0 0 0 0 Sian Kendrick Jones

-8 -8 100.0% -13 0 0 -13 -13 Sian Kendrick Jones

-88 -65 73.5% -219 0 0 -219 -195 Cath McWalter

-96 -73 75.6% -519 0 0 -519 -496 96%

SRO Ross Collett Programme Mang Fran Rose Smith PMO SUPPORT Tom Clare CLINICAL LEAD Dr Mark Follows QUALITY LEAD Andy Hudson Rashmi Balakrishnan

BI SUPPORT Adrian Bellamy


Advice and Guidance and Triage

Project Manager

Planned Care Stretch Target

Gastroenterology Procedures of low clinical value (PoLCV) Advice and Guidance and Triage

Programme Phasing Planned Care Stretch Target Ophthalmology

Planned Care - FinancesMonthly Position (M5) Plan v FOT

100%

Procedures of low clinical value (PoLCV)

Ophthalmology

Gastroenterology

Total Programme

FINANACE LEAD

PROGRAMME FINANCES

0

100

200

300

400

500

600


(£00

0K)

0

25

50

75

100

125

150

175

200

225

250

275


(£00

0K)

0

25

50

75

100

125

150

175

200

225

250

275


(£00

0K)

0

25

50

75

100

125

150

175

200

225

250

275


-359

0

25

50

75

100

125

150

175

200

225

250

275


(£00

0K)

0

25

50

75

100

125

150

175

200

225

250

275


(£00

0K)

Planned Care - Finances

We continue to work with Ophthalmology & Gastroenterology through QIPP/CIP and TIFG. Additional schemes have been identified to support the Planned Care Transformational Group Blueprint to support the £287k FYE Plan. The Consultant Connect Service has been approved and is being implemented. What projects fall within LTC and Planned Care need further consideration.

49


(Gross)

Approved

Investment

Committed

InvestmentOriginal Plan (Net) FOT

%

Variance

-96 -96 100.0% -172 0 0 -172 -172 100% N/A

-48 -48 100.0% -69 0 0 -69 -69 101% Gina Titman

-48 0 -269 0 0 -269 0 0% Rebecca Quinton

-34 -34 100.0% 0 0 0 0 -82 N/A Rebecca Quinton

-111 -111 100.0% -180 0 0 -180 -180 100% Emma L'Angellier

-84 -24 28.6% -292 0 0 -292 -24 8% Rebecca Quinton

-420 -312 74.3% -982 0 0 -982 -527 54%

SRO Ross Collett Programme Mang Rebecca Mercer PMO SUPPORT Liz Thorne CLINICAL LEAD Dr Imran Ahmed QUALITY LEAD Andy Hudson Sarah Bamford



AEC (PHM)

CAS

Patient 500 (Admission Avoidance)

High Intensity Service User

Plan v FOT

Same Day Emergency CareMonthly Position (M5)

Project Manager

Well Supported Clinical Decision Making

GP Extended Access

Well Supported Clinical Decision Making GP Extended Access

Total Programme

FINANACE LEAD

High Intensity Service User

AEC (PHM) CAS Patient 500 (Admission Avoidance)

PROGRAMME FINANCESProgramme Phasing

0

200

400

600

800

1000

1200


(£00

0K)

0

25

50

75

100

125

150

175

200

225

250

275

300


(£00

0K)

0

25

50

75

100

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150

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275

300


(£00

0K)

0

25

50

75

100

125

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200

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275

300


(£00

0K)

0

25

50

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100

125

150

175

200

225

250

275

300


(£00

0K)

0

25

50

75

100

125

150

175

200

225

250

275

300

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20

(£00

0K)

0

25

50

75

100

125

150

175

200

225

250

275

300


(£00

0K)

SDEC - Finances

The Well Supported Clinical Decision Making scheme has been cancelled due to the QEH unable to resource the project – however savings are accounted for as part of the Block Contract. Lack of engagement by the QEH is impeding AEC project scoping. The HIUS scheme has been impeded by Leadership changes and decision making.

50

Contractual - Finances

The four schemes are planned to deliver through out the year.


(Gross)

Approved

Investment

Committed

Investment

Original Plan

(Net)FOT

%

Variance

-161 -127 78.9% -386 0 0 -386 -352 91% Emma Kriehn-Morris

-149 -149 100.0% -359 0 0 -359 -359 100% Sharon Kidd

-500 -500 100.0% -1200 0 0 -1200 -1200 100% Emma Kriehn-Morris

-60 -120 200.0% -144 0 0 -144 -288 200% Shaun Wilson Gottobed

-870 -896 103.0% -2089 0 0 -2089 -2199 105%

SRO Howard Martin Programme Mang Phil Riedlinger PMO SUPPORT SK/TC CLINICAL LEAD NA QUALITY LEAD NA EKM/EC/JB



FINANACE LEAD

Contractural - FinancesMonthly Position (M5) Plan v FOT

Project Manager

Running Costs

Day Case to OPPROC Procedures

Contractual efficiency

ICES (STP Wide)

Total Programme

PROGRAMME FINANCESProgramme Phasing Running Costs Day Case to OPPROC Procedures

ICES (STP Wide) Contractual efficiency

0

250

500

750

1000

1250

1500

1750

2000

2250


(£0

00

K)

0

50

100

150

200

250

300

350

400

450

500


(£0

00

K)

0

50

100

150

200

250

300

350

400

450

500


(£0

00

K)

0

200

400

600

800

1000

1200

1400


(£0

00

K)

0

50

100

150

200

250

300

350

400

450

500


(£0

00

K)

51

CHC and Prescribing - Finances

This year we have a programme target for CHC of £1,104K. Current projections from the NCCP team are conservative. However taking into account last years performance against plan the programme target is reasonable. However we will need to continue to closely monitor delivery. The Prescribing schemes continue to developed and mobilised.


(Gross)

Approved

Investment

Committed

Investment

Original Plan

(Net)FOT

%

Variance

-287 -358 124.9% -354 0 0 -354 -506 143% NCCP

-219 -96 43.7% -750 0 0 -750 -351 47% NCCP

-505 -453 89.7% -1104 0 0 -1104 -856 78%

-250 -250 100.0% -450 0 0 -450 -450 100% ARDENGEM

-292 -335 114.7% -1000 0 0 -1000 -1043 104% ARDENGEM

-542 -585 107.9% -1450 0 0 -1450 -1493 103%

SRO Sarah Jane Ward Programme Mang Christine Walton PMO SUPPORT Liz Thorne CLINICAL LEAD TBA QUALITY LEAD N/A Danny Abrahams



PROGRAMME FINANCES

CHC & Prescribing - FinancesMonthly Position (M5) Plan v FOT

Project Manager

CHC (NCCP FYE)

CHC (NCCP In Year)

Total Programme

High Cost Drugs (Secondary Care) Avastin

Prescribing

Total Programme

FINANACE LEAD

CHC Programme Phasing CHC (NCCP FYE) CHC (NCCP In Year)

Prescribing Programme Phasing High Cost Drugs (Secondary Care) Avastin Prescribing

0

200

400

600

800

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1200


(£0

00

K)

0

25

50

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(£0

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K)

0

50

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(£0

00

K)

0

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275

Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00

(£0

00

K)

0

25

50

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(£0

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0

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(£0

00

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52

QIPP 19/20 Project Teams

The programme and project teams are predominantly in place. The only area which will require constant monitoring and

review is the CCG Clinical Lead for the schemes as there is concern regarding capacity, especially in the LTC Programme.

CCG Clinical Lead Quality Lead Project Lead Programe Lead SRO PSO Support Finance Lead BI leadProject

CodeProgramme Area Schemes (19/20)

Dr Tina Araffin Sarah Taylor Sarah Taylor Rob Jakeman Ross Collett Sharon Kidd Rashmi Balakrishnan Samantha Weston FYE1 Care Homes

Dr Tina Araffin Sarah Taylor Fran Rose Smith Rob Jakeman Ross Collett Sharon Kidd Rashmi Balakrishnan Samantha Weston FYE2 Frailty Pathway Re-design

Dr Tina Araffin Sarah Taylor Fran Rose Smith Rob Jakeman Ross Collett Sharon Kidd Rashmi Balakrishnan Samantha Weston FRAIL Frailty PHM

NA NA Rob Jakeman Rob Jakeman Ross Collett Sharon Kidd Jessica Dack Adrian Bellamy INTCB Intermediate Care Beds (Not Inc Spots)

NA NA Rob Jakeman Rob Jakeman Ross Collett Sharon Kidd Jessica Dack Adrian Bellamy FYE3 Rationalisation of ICB's (Reduction in Spots)

Dr Tina Araffin Sarah Taylor Mark Payne Rob Jakeman Ross Collett Sharon Kidd Rashmi Balakrishnan Samantha Weston DEM Dementia Programme

Dr Clare Hambling Andy Hudson Amanda Harries Amanda Harries Ross Collett Tom Clare Daniel Abraham Sam Weston FYE4 Chronic Heart Disease - Pathway re-design

Dr Clare Hambling Andy Hudson Amanda Harries Amanda Harries Ross Collett Tom Clare Daniel Abraham Sam Weston FYE5 Respiratory - Pathway re-design

Dr Clare Hambling Andy Hudson N/A Amanda Harries Ross Collett Tom Clare Daniel Abraham Sam Weston LTC LTC Stretch Target

Dr Clare Hambling Andy Hudson Amanda Harries Amanda Harries Ross Collett Tom Clare Daniel Abraham Sam Weston DIAB Diabetes - PHM

Dr Clare Hambling Andy Hudson Amanda Harries Amanda Harries Ross Collett Tom Clare Daniel Abraham Sam Weston CHDPHM CHD - PHM

Dr Clare Hambling Andy Hudson Amanda Harries Amanda Harries Ross Collett Tom Clare Daniel Abraham Sam Weston RESPHM Respiratory - PHM

Dr Mark Follows Andy Hudson N/A Fran Rose Smith Ross Collett Tom Clare Rashmi Balakrishnan Adrian Bellamy PLANC Planned Care Programme

Dr Mark Follows Andy Hudson Cath McWalter Fran Rose Smith Ross Collett Tom Clare Rashmi Balakrishnan Adrian Bellamy OPTH Ophthalmology

Dr Mark Follows Andy Hudson Sian Kendrick Jones Fran Rose Smith Ross Collett Tom Clare Rashmi Balakrishnan Adrian Bellamy PAIN Gastroenterology

Dr Mark Follows Andy Hudson Sian Kendrick Jones Fran Rose Smith Ross Collett Tom Clare Rashmi Balakrishnan Adrian Bellamy FYE9 Procedures of low clinical value (PoLCV)

Dr Mark Follows Andy Hudson Cath McWalter Fran Rose Smith Ross Collett Tom Clare Rashmi Balakrishnan Adrian Bellamy REFMAN Advice and Guidance and Triage

Dr Imran Ahmed Andy Hudson N/A Gina Titman Ross Collett Sharon Kidd Sarah Bamford Samantha Weston FYE6 Well Supported Clinical Decision Making

Dr Imran Ahmed Andy Hudson Gina Titman Gina Titman Ross Collett Sharon Kidd Sarah Bamford Samantha Weston FYE7 GP Extended Access

Dr Imran Ahmed Andy Hudson Rebecca Quinton Gina Titman Ross Collett Sharon Kidd Sarah Bamford Samantha Weston ACUTE&AC AEC (PHM)

Dr Imran Ahmed Andy Hudson Rebecca Quinton Gina Titman Ross Collett Sharon Kidd Sarah Bamford Samantha Weston CAS CAS

Dr Imran Ahmed Andy Hudson Emma L'Angellier Gina Titman Ross Collett Sharon Kidd Sarah Bamford Samantha Weston FYE8 Patient 500 (Admission Avoidance)

Dr Imran Ahmed Andy Hudson Rebecca Quinton Gina Titman Ross Collett Sharon Kidd Sarah Bamford Samantha Weston FREQFL High Intensity Service User

NA NA Emma Kriehn-Morris Phil Riedlinger Howard Martin Sharon Kidd Emma Kriehn-Morris Adrian Bellamy RUNCST Running Costs

NA NA Sharon Kidd Phil Riedlinger Howard Martin Tom Clare Emma Kriehn-Morris Adrian Bellamy DERMA Day Case to OPPROC Procedures

NA NA Emma Kriehn-Morris Phil Riedlinger Howard Martin Sharon Kidd Emma Kriehn-Morris Adrian Bellamy DISINV Contractual efficiency

NA NA Shaun Wilson Gottobed Phil Riedlinger Howard Martin Sharon Kidd Jo Biggadike Adrian Bellamy ICES ICES (STP Wide)

Sarah Jane Ward Andy Hudson NCCP TBA Sarah Jane Ward Tom Clare Danny Abrahams Adrian Bellamy FYE10 CHC (NCCP FYE)

Sarah Jane Ward Andy Hudson NCCP TBA Sarah Jane Ward Tom Clare Danny Abrahams Adrian Bellamy CHC CHC (NCCP In Year)

TBA N/A ARDENGEM Christine Walton Sarah Jane Ward Liz Thorne Danny Abrahams Adrian Bellamy FYE11 High Cost Drugs (Secondary Care) Avastin

TBA N/A ARDENGEM Christine Walton Sarah Jane Ward Liz Thorne Danny Abrahams Adrian Bellamy PQS Prescribing

TBA N/A ARDENGEM Christine Walton Sarah Jane Ward Liz Thorne Danny Abrahams Adrian Bellamy PRESSUP CSU Prescribing Support

SDEC

Contractual

CHC

Prescribing

Frailty & Dementia

LTC

Descriptors

Planned Care Programme

53

PMO Summary Dashboard

Now that high quality plans are now in place across the portfolio, we are able to monitor progression against plan at a project and portfolio level. The next three slides details this analysis which is undertaken on a weekly basis.

The analysis is shared with the Associate Director of Planning & PMO, West Norfolk Locality Director and the Heads of, along with PMO.

This analysis is now being rolled out across Norfolk & Waveney.

54

West Portfolio Plan Delivery Analysis

Date :

Target 5% Target 5%

Frailty 5 4 (Frailty Pathway Redesign (FYE))

LTC 5 4 (DIABETES PROGRAM M E)

Planned Care 4 5 (---)

SDEC 5 2 (GP Extended Access (FYE), AEC, Pat ient 500)

Contractural 4 N/A

CHC 2 N/A

Prescribing 3 N/A

ProgrammeNumber of

Projects

Projects

Being

tracked

* 23/9/19 Removed Diabetes from monitoring as this is a

programme plan which is not being activly managed.

Improving Slipping

0.2%

This Week This Week

4.9% 1.3%

% of Portfolio with

the status Scoping

Last Week 5.4% Last Week

West Portfolio Plan Delivery Analysis 09/09/2019

% of Portfolio

requiring Immediate

Support

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

14 Ju

n

21 Ju

n

28 Ju

n

05 Ju

l

12 Ju

l

19 Ju

l

26 Ju

l

02 A

ug

09 A

ug

16 A

ug 23…

30 A

ug

06 S

ep

13 S

ep

20 S

ep

27 S

ep

04 O

ct

11 O

ct

18 O

ct

25 O

ct

01 N

ov

08 N

ov

Portfolio - Plan Analysis

On Hold

Completed

Immediate Support Required

Off Track with Mitigation

On Track

Scoping

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

14 Jun 21 Jun 28 Jun 05 Jul 12 Jul 19 Jul 26 Jul 02 Aug 09 Aug 16 Aug 23 Aug 30 Aug 06 Sep

Progression of key task status

Scoping

Immediate SupportRequired

Target 1/9/19

56

West Programme Plan Delivery Analysis

Date :

496 527

Varience Varience

-23 -537

519 1064

FOT FOT

378 -470

Plan Plan

West Programme Plan Delivery Analysis 09/09/2019

Plan Plan

Varience Varience

3163 1889

FOT FOT

3541 1420

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

14 J

un

21 J

un

28 J

un

05 J

ul

12 J

ul

19 J

ul

26 J

ul

02 A

ug

09 A

ug

16 A

ug

23 A

ug *

30 A

ug

06 S

ep

13 S

ep

20 S

ep

27 S

ep

04 O

ct

11 O

ct

18 O

ct

25 O

ct

01 N

ov

08 N

ov

Frailty - (Rob Jakeman)On Hold

Completed

ImmediateSupport Required

Off Track withMitigation

On Track

Scoping 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

14 J

un

21 J

un

28 J

un

05 J

ul

12 J

ul

19 J

ul

26 J

ul

02 A

ug

09 A

ug

16 A

ug

23 A

ug *

30 A

ug

06 S

ep

13 S

ep

20 S

ep

27 S

ep

04 O

ct

11 O

ct

18 O

ct

25 O

ct

01 N

ov

LTC - (Amanda Harries)On Hold

Completed



On Track

Scoping

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

14 J

un

21 J

un

28 J

un

05 J

ul

12 J

ul

19 J

ul

26 J

ul

02 A

ug

09 A

ug

16 A

ug

23 A

ug *

30 A

ug

06 S

ep

13 S

ep

20 S

ep

27 S

ep

04 O

ct

11 O

ct

18 O

ct

25 O

ct

01 N

ov

08 N

ovPlanned Care - (Fran Rose Smith)

On Hold

Completed



On Track

Scoping0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

14 J

un

21 J

un

28 J

un

05 J

ul

12 J

ul

19 J

ul

26 J

ul

02 A

ug

09 A

ug

16 A

ug

23 A

ug *

30 A

ug

06 S

ep

13 S

ep

20 S

ep

27 S

ep

04 O

ct

11 O

ct

18 O

ct

25 O

ct

01 N

ov

SDEC - (Gina Titman)On Hold

Completed



On Track

Scoping

57

West Project Plan Delivery Analysis

Date :Count of Status Column Labels

Row Labels Scoping On Track

Off Track with

Mitigation

Immediate Support

Required. Completed On Hold Total

LTC 131 13 7 74 126 86 437

CHD - Pathway Redesign 5 4 5 43 1 58

CHD - PHM 33 33

Diabetes 131 64 28 223

Respiratory - Pathway Redesign 8 3 5 55 3 74

Respiratory - PHM 49 49 Status %

Planned Care 5 74 4 7 72 162 Scoping 15.6%

Advice and Guidance (e-referal) 8 2 7 19 36 On Track 16.9%

Fertility L2 22 22 Off track 2.9%

Fertility L3 24 4 28

Opthalmology 2 2 22 26

Consultant Connect 5 40 5 50

SDEC 2 3 8 42 19 74 Completed 40.8%

High Intensity User Service 2 3 8 35 48 On Hold 13.1%

Well Supported Clinical Decision Making 7 19 26 Total Tasks 900

Frailty 4 63 12 8 127 13 227

Care Homes 1 6 7 6 29 49

Fraility - PHM 1 1 55 13 70

Rationalisation of ICBs (Not inc. Spots) 3 1 33 37

Childrens Community Nursing Team 3 56 2 10 71

Total 140 152 26 97 367 118 900

Immediate Support

Required10.8%

09/09/2019West Project Plan Delivery Analysis

0

10

20

30

40

50

60

70

80

CHD - Pathway

Redesign

CHD - PHM Diabetes Respiratory -

Pathway

Redesign

Respiratory -

PHM

Advice and

Guidance (e-

referal)

Fertility L2 Fertility L3 Opthalmology Consultant

Connect

High Intensity

User Service

Well Supported

Clinical Decision

Making

Care Homes Fraility - PHM Rationalisation

of ICBs (Not inc.

Spots)

Childrens

Community

Nursing Team

LTC Planned Care SDEC Frailty

On Hold

Completed

Immediate Support Required.

Off Track with Mitigation

On Track

Scoping

58

Integrated Finance and Performance Report. Body... · 3 Summary of Current Position • Month 5...

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