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1 CCG Board Meeting Paper Summary Sheet DETAILS Part 1 (Open) X Part 2 (Closed) Agenda Item Title of Paper 2015/16 Operational Plan Deliverables Quarter 1 Assurance report 5.3 Meeting CCG Board Date 3 September 2015 Executive Lead Corinne Edwards Head of Commissioning Development Author Amanda Cook Head of Programme Management Office and Jo Gallaway Performance Manager Appendices Appendix 1: Summary Dashboard Appendix 2: Exceptions report for deliverables with Red status PURPOSE Approval X Discussion Information Assurance X EXECUTIVE SUMMARY Summary of Key This is the first report of a new assurance reporting process presented to Points the CCG Board, which outlines the quarterly progress against our delivery of the BaNES CCG Operational Plan. Agreement on the format of the new report and discussion on the progress of Quarter 1 is invited. Overall Quarter 1 progress Delivery Status: Overall of the 127 deliverables reported, 69% are rated Green, 25% are rated Amber and 6% rated Red. Timing Status: Also 78% of all items are completed or on plan. (See Summary Dashboard at Appendix 1). Transformational areas There are no Red-rated deliverables in the six transformational areas but 18% of them are behind plan. Strategic priorities There are three Red-rated deliverables in the Strategic Priorities: one in the Mental Health work area and two in Primary Care. These three are all behind plan with two not started. Other priorities There are four Red-rated deliverables in the Other Priorities category. The one Corporate deliverable and the two in Improving Commissioning are all behind plan. The Red-rated deliverable in Measures of Success is on plan in terms of timing in terms of monitoring but is set to Red because of failing to meet the A&E 4 hour target.

2 What is happening with the Red-rated deliverables The seven Red-rated deliverables can be seen in Appendix 2. Further information about what is happening with these deliverables is given below. Primary Care Residential home LES this scheme is unlikely to progress in 2015/16 as the 5 per head funding has been committed this year (as approved by JCC at the end of July 2015) and there is currently no other funding to support the initiative. However, we have started formulating our commissioning intentions which include support to residential care homes. But this will be subject to whether the PMS review identifies any uncommitted funding, which will not be established until later in the year. Primary Care funding: 5 per head funding The JCC approved the use of the 5 per head funding at the end of July 2015 as mentioned above. Six months nonrecurrent funding will be used to support urgent care capacity in practices and six months non-recurrent funding to support practice MDT engagement. PMS Reviews a meeting was held with practices on 14 July with NHSE and the CCG to provide more clarity about the process and timescales. At the Joint Primary Care Operational Group meeting on 6 August 15 NHSE provided further about the review process and timescales. PMS review panels are scheduled to take place week commencing 7 September Mental Health Mental Health Choice - a meeting will be arranged with our local AWP Primary Care Liaison Team to formulate their role in light of guidance following informal discussions. An has been sent to other CCG commissioners contracting with AWP to ascertain the approach they have taken in their localities and for cross border referrals. Liaison is taking place with other CCG commissioners to understand the interface with Choose and Book as well as referral management developments. Improving Commissioning Development of Red Cross assisted discharge model with the RUH Whilst we were aiming to commence this project sooner, in retrospect, insufficient financial detail in the original proposal and the delay in identifying whether funding was available have slowed the start. The benefit of this is that the service will be mobilised in advance of winter and tested through the winter before a decision needs to be made early next year on whether to continue. The provider is currently recruiting staff and has an agreed mobilisation plan with the RUH. The greatest risk to mobilisation is recruitment. However, the service will commence with a smaller team if necessary and increase as staff are recruited. Manage ORCP Funding for 2015/16 - Requests by providers for 2015/16 ORCP funding was over-subscribed by more than 0.5M in Q1. As a result Page 2 of 5

3 an assessment was undertaken to score each funding request using the South West s AHSN Impact Assessment Rating process which measures a number of criteria including the number of acute bed days saved per year, how easy the scheme is to implement, whether the scheme is in line with NHSE high impact interventions as well as assessing a value for money rating for each request. The CCG also considered the objective of supporting whole system flow with the aim of improving patient outcomes and whether any of the schemes are funded or part funded through other CCG monies. From this assessment, a list of schemes to be supported by ORCP funding was agreed in July Paperless board and virtual desktop - The paperless board and virtual desktop scope and timescales need to be redefined following a review of the first quarter. The initial work on the virtual desktop project identified that the pilot cannot proceed on our current domain infrastructure. Whilst exploring this way of working remains an ambition making a change to this infrastructure ahead of a decision on CSU support in 2016/17 would be unwise. The paperless board project has run significantly beyond the initial plan dates primarily due to the availability of technical support from the CSU and ultimately the amount of time it takes to get an individual device live. An implementation plan for the wider board members is being drafted based on more robust support from the CSU and a better understanding of the technical issues that require addressing. Measures of success Monitor and deliver NHS Constitution targets The A&E 4 hour target is not being met at the RUH. This is being managed through the System Resilience Group. There is an A&E 4 hour recovery plan focusing on admission avoidance and discharge support, due to current, below target, performance the recovery trajectory is being reviewed. RTT performance is managed through provider contracts. The three local Acute Trusts, RUH, UH Bristol and North Bristol Trust (NBT), are still developing / delivering recovery plans for management of RTT waiting lists. In Q1 both NBT and RUH have applied the IMAS modelling to understand the demand / capacity picture for planned care. NBT have just refreshed their plans and extended their recovery trajectory to March RUH are still developing their implementation plan based on the IMAS models but have made some recent appointments to secure additional capacity in the Autumn. Background Background to the process In June 2015 the JCC was presented with a draft process for setting up a new performance and quality reporting process. This process has been developed to provide assurance that the priorities listed in the BaNES CCG Operational Plan are being delivered. The framework for the reporting process was developed in partnership with the owners of each of the Page 3 of 5

4 deliverables listed in the plan. In the first instance, the deliverable owners articulated the benefits, the quarterly milestones and the QIPP savings (where appropriate) for each of their deliverables. This then became the baseline against which the quarterly progress is reported. It should be noted that some deliverables may not yet have all of their milestones for the whole year fully articulated. This is usually because a future milestone may depend on an action/approval in a previous quarter (i.e. a paper being approved by a Board or Committee) so we expect that as the year progresses, more milestones that are currently missing will be recorded and reported against. It should also be noted that business as usual tasks are not included in these deliverables. Nature of the quarterly updates and reports Each quarter, the deliverables owners (and those nominated to provide updates) are requested to provide three pieces of information about their deliverables: 1) the Timing Status of the deliverables, 2) the Delivery Status of the deliverables 3) the Quarter Update comprising a free text description of progress against the recorded Quarter milestones. From this information, a summary dashboard and a report showing the exceptions (i.e. deliverables of Red status) are produced see Appendices 1 and 2. Note: the JCC also see these reports/appendices as well as additional ones showing all Q1 deliverables and the Amber-rated ones. Risk High Medium Low X This Q1 report indicates that we are largely on track with the deliverables in the Operational Plan with only a minor number of them being (5%) Redrated and 19% behind plan at this early Q1 stage. The risks regarding delivery will be taken up with the deliverable owners during their quarterly performance review meetings. These meetings form part of the new joint performance management arrangements between BaNES CCG and Council and the meetings for Q1 are due to take place in late August and early September Impact on Quality Impact on Finance The quarterly reporting process has been developed to provide assurance for all items in the Operational Plan including those to improve quality outcomes. This reporting will therefore contribute to improve the quality of patients services. It is intended that progress in delivering QIPP savings are reported as part of this quarterly process but mainly in relation to the milestones required to be met to deliver the work area producing the QIPP savings. The quarterly reporting will provide more transparency regarding the performance of delivering QIPP. The figures for QIPP realisation are reported monthly by the Commissioning Support Unit in the BaNES CCG QIPP report. Page 4 of 5

5 Recommendation Approval: This is the first time these reports have been produced as part of the new Operational Plan Deliverables Assurance reporting process. They have been developed to provide clear summaries to the JCC, the CCG Board and other committees as appropriate. Therefore it is important that the information given is presented in a way that gives the appropriate assurance. The CCG Board is invited to either approve the reports or give feedback on the reports with regard to what they find helpful and what other things they might like to see. Assurance: This report is presented for assurance of delivery of the Operational Plan. OTHER INFORMATION Who has been This report was collated by the Programme Management Office and the involved/contributed Performance Management Team. All updates were provided by the deliverable owners (or nominated updaters ) from BaNES CCG and Council. If input from Clinical Leads, Finance, HR or the public is required for any of the deliverables, this will be sought by the owner of the deliverable and may form part of this report. Cross Reference to Strategic Objectives National Policy / Legislation Review This process provides assurance reporting regarding the delivery of all of the organisation s strategic objectives: Improving quality, safety and individuals experience of care Improving consistency of care and reducing variation of outcomes Providing proactive care to help people with complex care needs Creating a sustainable health system within a wider health and social care partnership Empowering and encouraging people to take personal responsibility for their health and wellbeing Reducing inequalities and social exclusions and supporting our most vulnerable groups Improving the mental health and wellbeing of our population The Operational Plan was based on: Everyone Counts: Planning for Patients 2014/15 to 2018/19 Five Year Forward View and supporting planning guidance Quarterly reports will be produced throughout the year on Progress against delivering the Operational plan. These will be brought to JCC and the Board for review. Reviews with the deliverable owners will also take place quarterly as part of the new joint performance management arrangements and actions will be agreed where delivery is not optimal. Equality & Diversity Applicable Not Applicable X This assurance process does not impact equality or diversity. Page 5 of 5

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