Integrated Governance Report 2016/17

Month 1 – April 2016

Thursday 21 July 2016

ENCLOSURE 4

Contents

Page Description Page Description Page Description

2 Contents Quality 54 Revenue Resource Limit Allocation

3 Introduction 28 Quality Report Summary 55 Revenue Budgets

Performance 29 Provider: Key Issues from Dashboards 56 Acute

5 Performance Summary 30 Provider Quality Dashboard – Kings 57 Non Acute

7 BCCG Performance Dashboard 31 Kings CQRG 58 Prescribing & Residual CCG Primary Care

9 BCCG 2016/17 Quality Premium 32 Provider Quality Summary - Oxleas 59 Running Costs, Reserves & Other Budgets

10 Better Care Fund 34 Oxleas CQRG 60 Better Care Fund – 16/17 Financial Plan

12 LAS Performance & Activity Analysis 36Provider Quality Summary – Bromley

Healthcare61

Better Care Fund – Financial

Arrangements

14Acute Provider Performance Dashboard –

Kings37 Bromley Healthcare CQRG 62 Year End Forecast

15 Acute Provider Contract Performance – Kings 39 Bromley CCG Quality Assurance Sub Committee 63 Acute Risk Assessment

16Acute Provider Performance Dashboard –

GSTT and L&G40 Quality Log – KCH Safety Issues - PRUH 64 Cash Position and Debtors Position

17 Bromley Healthcare Performance Summary 44 Quality Log – all providers 65 Better Payment Practice Code

20 Oxleas Performance Summary 46 Friends & Family 66 Statement of Financial Position

22 CAMHS Performance 50 NHS Choices 67 Financial Risks

24 Primary Care

26 BCCG QIPP Finance

52 National CCG Assurance Framework Summary

53 Summary

2

Introduction

This report provides an integrated view of the performance of Bromley Clinical Commissioning Group and its

main service providers, to ensure focus on the key issues. The report has been structured to reflect the NHS

Outcomes Framework, NHS Constitutional Standards and the statutory financial responsibilities of the

organisation. The report seeks to give assurance to the Committee that the CCG is aware of any issues and that

appropriate action is taken to understand the situation and improve performance wherever possible.

The report comprises:

Performance section – the first section of the report focuses on the performance of the CCG against the NHS

Outcomes Framework and NHS Constitutional Standards. The performance of the CCG’s main acute providers,

Oxleas NHS Foundation Trust (Mental Health) and Bromley Healthcare (Community), against national and local

indicators is also included within section one.

Quality section – the content held in this section of the IGC report is intended to highlight key quality issues

and areas of good practice identified for any of the CCG’s main providers by various sub-committees and

quality groups. This part of the report is under development and is likely to change over the coming months.

Finance section – this section of the report reflects the reported financial position and any issues and

mitigations.

Some data is only made available on a quarterly or annual basis. Where this is the case, the Performance Team

seek alternative reporting mechanisms, if possible, to ensure the organisation has a current view on its

performance against all monitored standards.

3

PerformanceAuthor: Sarah Osborn, Head of Planning & Performance

� Performance Summary Page 5

� BCCG Performance Dashboard Page 7

� BCCG 2016/17 Quality Premium Page 9

� Better Care Fund Page 10

� LAS Performance & Activity Analysis Page 12

� Acute Provider Performance Dashboard - Kings Page 14

� Acute Provider Contract Performance – Kings Page 15

� Acute Provider Performance Dashboard – GSTT and L&G Page 16

� Bromley Healthcare Performance Summary Page 17

� Oxleas Performance Summary Page 20

� CAMHS Performance Page 22

� Primary Care Page 24

� BCCG QIPP Page 26

Performance Summary (1 of 2)

5

CCG Performance Dashboard (slide 7 )

� The RTT incomplete target not was met in April 2016 with reported performance of 83.6% against the 92.0% target

� The deterioration in performance is predominantly due to the re-commencement of reporting by Kings

� Based on the current performance trajectory, it is unlikely that the CCG will achieve the RTT incomplete target throughout

2016/17

� Bromley has 24 long waiting patients at the end of April

� Additional assurance processes, with input from CCG clinical leads, are in place to clinically review long waiting patients

� The 6 week diagnostic wait target was not met in April with a performance of 95.0%, a slight deterioration on March’s position

� Ultrasound at Kings continues to have staffing problems and the Trust have increased agency staffing levels

� The Trust continues to outsource activity alongside increasing in-house capacity

� A&E performance remains below the 95% national standard in May at 83.4% at the PRUH site and 83.5% Trust wide

� Five 12 hour trolley waits were reported at Denmark Hill, all breaches were due to capacity for mental health patients

� All cancer wait targets were met in April apart from the 62 day standard

� This target was missed by 0.3% and relates to 11 breaches, 6 at KCH and 5 at GSTT

� Five breaches related to late inter trust transfers from Kings to GSTT

� One breach was categorised as avoidable due to capacity problems

� There was one reported breach against the zero tolerance mixed sex accommodation target in April recorded at GSTT, the breach

related to the Trust reporting patients on critical care step down, which is not a national requirement

� All three LAS response time targets were missed in April but there was a slight improvement evident for all measures compared with

reported performance in March

Performance Summary (2 of 2)

6

CCG Performance Dashboard (slide 7)

� The monthly target for IAPT access is 1.25%, the CCG is above that target in April with performance of 1.43% (based on local data)

� There has been a significant improvement in recovery rates, with the latest monthly reported performance (un-validated) at

54% vs the 50% target

� The new IAPT waiting time targets were delivered in March, achievement of these targets is expected to continue throughout

2016/17

� Dementia prevalence data is now publically available via the HSCIC website

� April performance was 67.5% against the 66.7% target - this represents a slight deterioration on March’s reported

performance of 69.1% in March

�The CCG now has a gap of 1,389 people who may benefit from access to support by way of a dementia diagnosis

� Investment in dementia continues in 2016/17 with the launch of the Dementia Support Hub in July. The hub will offer a single

source of access to all residents who have received a dementia diagnosis from either a GP or the Memory Clinic

� No MRSA cases were assigned to Bromley CCG in April

� The CCG has met the monthly target for C.Diff in April with 2 cases reported against a monthly target of 6 cases

� RCAs are been carried out on all acute identified cases

� Infection control colleagues carry out RCA investigations into the cases reported in a community setting

BCCG Performance Dashboard (1 of 2)

Indicator Description Month TargetCurrent

Month

Last

month

Quarter 4 2015/2016

CONSTITUTION MEASURES

Referral to Treatment Pathways - Incomplete Apr 92% 83.6% 83.3% 83.3%

Percentage of patients waiting 6 weeks or less for a diagnostic test Apr >99% 95.0% 95.6% 96.8%

Percentage of patients who spent 4 hours or less in A&E – Kings Apr 95% 83.5% 81.1% 83.3%

Cancer 2 Week Wait - All cancer Two week wait Apr 93% 95.1% 94.6% 94.5%

Cancer 2 Week Wait - Two week wait for Breast Symptoms Apr 93% 94.7% 97.0% 98.3%

Cancer 31 Wait - First definitive treatment within one month Apr 96% 98.5% 97.8% 98.1%

Cancer 31 Wait - 31 day standard for subsequent cancer treatments, surgery Apr 94% 97.5% 100.0% 94.4%

Cancer 31 Wait - 31 day standard for subsequent cancer treatments, drug Apr 98% 100.0% 98.3% 99.5%

Cancer 31 Wait - 31 day standard for subsequent cancer treatments, radiotherapy Apr 94% 97.9% 98.5% 96.8%

Cancer 62 Day Wait - Two month urgent (GP referral) Apr 85% 84.7% 88.9% 88.6%

Cancer 62 Day Wait - 62 day wait following referral from NHS cancer screening service Apr 90% 90.0% 93.8% 97.4%

Cancer 62 Day Wait - 62 day wait following consultant decision to upgrade Apr N/A 66.7% 100.0% 100.0%

Ambulance clinical quality – Category A (Red 1) 8 minute response time Apr 75% 68.4% 65.6% 65.8%

Ambulance clinical quality – Category A (Red 2) 8 minute response time Apr 75% 58.6% 57.9% 58.4%

Ambulance clinical quality - Category A 19 minute transportation time Apr 95% 94.7% 91.0% 91.6%

SUPPORTING MEASURES

Mixed Sex Accommodation (MSA) breaches Apr 0 1 1 3

Cancelled Operations – 28 day rule – Kings (Quarterly) Mar 5% N/A N/A 11.2%

Care Programme Approach (CPA) 7 day follow up (Quarterly) Mar 95% N/A N/A 100.0%

Number of RTT pathways waiting longer than 52 weeks Apr 0 24 28 28

A&E – 12 hour trolley waits – Kings (YTD) Apr 0 6 30 2

Urgent Operations cancelled for a 2nd

time – PRUH Apr 0 0 0 0

Ambulance Handover delays – 30 mins – PRUH Apr 0 145 140 433

Ambulance Handover delays – 60 mins – PRUH Apr 0 71 10 116

IAPT - Measures the proportion of people that enter treatment against the level of need in the general

population (the level of prevalence addressed or ‘captured’ by referral routes)Apr 15% 1.43% 1.40% 4.08%

IAPT recovery rate Apr 50% 54.0% 53.2% 53.2%

IAPT waiting time – 6 weeks Apr 75% 93.0% N/A N/A

IAPT waiting time – 18 weeks Apr 95% 100.0 N/A N/A

Dementia Diagnosis Rate Apr 66.7% 67.5% 69.1% 69.1%

Healthcare acquired infection – MRSA – YTD Apr 0 0 1 1

Healthcare acquired infection – C-Difficile - YTD Apr 76 2 84 11

7

BCCG Performance Dashboard (2 of 2)

8

Activity Line Month Annual Plan YTD Plan YTD Actual Variance

EM1. Total Referrals (All Specialties) Apr 165,446 13,787 13,698 -89

EM2. Consultant Led First Outpatient Attendances Apr 165,784 13,815 8,919 -4,896

EM3. Consultant Led Follow Up Outpatient Attendances Apr 200,712 16,726 15,945 -781

EM4. Total Elective Admissions Apr 48,600 4,050 4,227 177

EM5. Total Non Elective Admissions Apr 31,979 2,665 2,675 10

EM6. Total A&E Attendances Apr 72,858 6,072 5,880 -192

� The high level activity plan values have been extracted from the CCG’s operating plan submission

� The year to date actual figures have been extracted from SUS, using the prescribed methodology published in the 2016/17 planning

guidance

� SUS figures are sense checked against the published MAR data, for April the nationally reported figures are in line with locally

processed SUS data

� There is a query outstanding relating to consultant led first outpatient attendances as activity appears unusually low when compared

with previous months activity. All data sets, both local and national, reflect lower activity levels

� All other activity lines are very close (within the 5% threshold) to plan for April

RAG Rating

Variance +/- 0 - 5% Variance +/- 6 -10% Variance +/- 11%

BCCG Quality Premium 2016/17

9

� The value of the Quality Premium for Bromley CCG in 2016/17 is approximately £1.6m

� In order to earn the Quality Premium payment, which will be paid in 2017/18, CCGs must make improvements against a number of

indicators

� There are 4 national measures detailed in the table below:

Measure Value Responsible Group

Cancers diagnosed at early stage 20% (£320,000) BCCG Cancer Working Group

Increase in the proportion of GP referrals made by e-referrals 20% (£320,000) Primary Care Board

Overall experience of making a GP appointment 20% (£320,000) Primary Care Board

Antimicrobial resistance (AMR) Improving antibiotic prescribing in primary care

This Quality Premium measure consists of two parts (each worth 50% of the Quality Premium payment available for this indicator):

Part a) reduction in the number of antibiotics prescribed in primary care

Part b) reduction in the proportion of broad spectrum antibiotics prescribed in primary care

10% (£160,000)Prescribing & Medicines

Management Group

� In addition to the four national indicators, Bromley CCG has identified 3 local measures, which are worth 10% (£160,000) each:

� % diabetes patients where HbA1c is 64mmol/l

� % of COPD patients with a record of FEV1

� Mental Health Admissions

� The local indicators have been provisionally signed off by NHS England prior to the last submission on 29th April 2016

Better Care Fund (1 of 2)

� The BCF Programme is overseen by the Bromley Health and Wellbeing Board which has been developed in partnership between

Bromley CCG, the London Borough of Bromley and partners across the Health and Social Care community

� To ensure effective delivery of BCF and other initiatives, there is a Joint Integrated Commissioning Executive (JICE) with agreed terms of

reference and membership. The membership includes: the Chief Officer, Chief Finance Officer of the CCG; the Executive Director,

Education, Health and Care Services and the Assistant Director of Commissioning, Education, Care and Health from LBB; with

programme leads (management and clinical) in attendance

� Bromley’s BCF Plan was submitted to NHS England in June and the CCG is awaiting formal feedback

� The plan demonstrates how Bromley will meet the following national conditions:

� Plans to be jointly agreed

� Maintain provision of social care services

� Agreement for the delivery of 7-day services across health and social care to prevent unnecessary non-elective (physical and

mental health) admissions to acute settings and to facilitate transfer to alternative care settings when clinically appropriate

� Better data sharing between health and social care, based on the NHS number

� Ensure a joint approach to assessments and care planning and ensure that, where funding is used for integrated packages of

care, there will be an accountable professional

� Agreement on the consequential impact of the changes on the providers that are predicted to be substantially affected by the

plans

� Agreement to invest in NHS commissioned out-of-hospital services, which may include a wide range of services including social

care

� Agreement on local action plan to reduce delayed transfers of care

10

Better Care Fund (2 of 2)

� Within the BCF Plan Bromley has set targets in 2016/17 against the national performance metrics

11

Metric 2015/16 FOT 2016/17 Plan % Improvement Comments

Non-elective admissions

(General and Acute)26,583 25,758 3.10%

The plan seeks to support the reduction of 825

admissions against the 2015/16 FOT position for

Bromley. The planned reduction is phased over the

year to reflect the development of the Integrated

Care Networks (ICN) and their associated enabling

initiatives as they commence

Admissions to

residential and care

homes

279 283 1.43%

Analysis of 2015/16 performance has been

undertaken to ensure accuracy of local data due to

move across to SALT return from ASCOF. Bromley

plan to maintain robust performance against this

measure in 2016/17 by maintaining people at home

with domiciliary care where appropriate

Effectiveness of

reablement90.2% 93.6% 3.77%

Analysis of 2015/16 performance has been

undertaken to ensure accuracy of local data. In

2014/15 Bromley reported the highest performance

in South East London against this measure. Bromley

plan to further improve performance against this

metric in 2016/17

Delayed transfers of

care*329.7 2,65.6 19.5%

Historic performance analysis shows improvement

against this metric over the last year. Bromley is

planning a further reduction in the number of

delayed days (rate per 100,000) in 2016/17 and plans

are in place to support this across the health and

social care system predominantly driven by the

development of the Transfer of Care Bureau

LAS Performance & Activity Analysis (1 of 2)

� The LAS has breached all of the national targets for London in April; these targets have been breached every month since May 2014

� The table below compares Bromley CCG’s performance against London:

Indicator Target London Performance Bromley CCG Performance

Ambulance clinical quality – Category A (Red 1) 8 minute response time YTD 75% 70.0% 68.4%

Ambulance clinical quality – Category A (Red 2) 8 minute response time YTD 75% 64.6% 58.6%

Ambulance clinical quality - Category A 19 minute transportation time YTD 95% 94.2% 94.7%

12

� The first chart below shows the number of calls to the LAS and the number of emergency responses attending the scene of an incident.

The second chart shows the outcome of the LAS attended incidents

� Over the time period analysed an average of 93.2% of calls resulted in an emergency response arriving at the scene of an incident

� 69% of patients were conveyed to an Emergency Department

0

500

1000

1500

2000

2500

3000

3500

4000

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Se

p-1

4

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Fe

b-1

5

Ma

r-1

5

Ap

r-1

5

Ma

y-1

5

Jun

-15

Jul-

15

Au

g-1

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c-1

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Jan

-16

Fe

b-1

6

Ma

r-1

6

Ap

r-1

6

LAS Calls & Responses May 2014 to April 2016

Total Calls Emergency Responses

12%

5%

4%

69%

5%

2%3%

Outcome of LAS Responded IncidentsMay 2014 to April 2016

Patients Not Conveyed

Patients Referred & Not

Conveyed

Other Patients Not

Conveyed

Patients Conveyed to ED

Patients Conveyed to

Urgent ACP

Patients Conveyed to

Acute ACP

Other Conveyance

LAS Performance & Activity Analysis (2 of 2)

� The table below shows the location of Emergency Departments that patients were conveyed to:

13

� The final table shows a summary of crew referrals to GPs by CCG for both in and out of hours:

Emergency Department May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16

Princess Royal, Farnborough 1,775 1,727 1,627 1,596 1,552 1,693 1,625 1,708 1,699 1,461 1,617 1,562 1,618 1,643 1,689 1,661 1,723 1,769 1,775 1,817 1,829 1,698 1,705 1,699

Lewisham 197 191 225 175 200 199 199 181 216 150 166 209 157 173 149 157 163 141 163 184 193 164 161 168

Croydon University (Mayday) 86 64 59 91 78 70 67 84 83 84 74 73 81 69 80 80 87 89 88 91 108 115 110 114

Kings College 72 58 58 74 67 69 75 82 94 65 65 80 76 66 85 91 92 64 77 78 76 84 74 66

Queen Elizabeth II, Woolwich 54 60 45 29 27 30 38 41 36 24 39 56 36 37 26 36 48 49 32 38 27 28 37 41

St Thomas' 11 13 9 5 11 13 14 12 12 10 5 7 5 7 5 7 6 8 7 9 4 4 6 9

Darent Valley 2 3 4 2 4 0 1 1 2 3 3 1 2 0 4 2 5 1 2 6 0 5 3 2

St Georges, Tooting 4 3 4 3 1 2 3 2 0 4 1 0 1 2 2 1 3 1 1 0 2 3 2 1

Royal London (Whitechapel) 0 0 0 1 0 1 0 1 0 2 1 1 0 0 4 0 1 2 0 1 0 0 0

University College 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 0 0 1 1 0 1 1 0

St Helier 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 0

Barnet 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Royal Free 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Whittington 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Newham 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

King Georges, Ilford 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0

Charing Cross 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Chelsea & Westminster 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0

Whipps Cross 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1

Kingston 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0

St. Peters, Chertsey 1

2,202 2,121 2,031 1,976 1,941 2,077 2,023 2,115 2,146 1,804 1,971 1,989 1,977 1,997 2,046 2,035 2,129 2,126 2,146 2,224 2,243 2,104 2,098 2,102

Crew Referrals to GPs May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16

In Hours (0800 to 1830) 30 31 17 21 36 41 25 54 30 31 36 49 43 54 45 59 61 49 37 37 38 44 38 37

Out of Hours (Mon-Friday 1830 to

midnight and all day Sat & Sun)52 42 35 38 34 52 44 54 42 40 36 73 77 69 94 90 63 70 56 27 41 63 54 42

Acute Provider Performance Dashboard – Kings

Kings - Denmark Hill Kings - PRUHKCH (whole

Trust)

Indicator TitleMonth Target

Current

Month

Last

month

Current

MonthLast Month Month 1

CONSTITUTION MEASURES

Referral to Treatment Pathways – Incomplete Apr 92% Not Available Not Reporting Not Available Not Reporting 80.7%

Percentage of patients waiting 6 weeks or more for a diagnostic test Apr 99% 94.1% 93.3% 93.8% 95.3% 94.2%

Percentage of patients who spent 4 hours or less in A&E Apr 95% 86.1% 80.3% 81.0% 79.9% 83.5%

Cancer 2 Week Wait - All cancer Two week wait Apr 93% 93.4% 91.0% 93.9% 94.4% 94.4%

Cancer 2 Week Wait - Two week wait for Breast Symptoms Apr 93% 76.2% 90.0% 100.0% 100.0% 78.7%

Cancer 31 Wait - First definitive treatment within one month Apr 96% 98.9% 98.2% 99.0% 96.9% 99.5%

Cancer 31 Wait - 31 day standard for subsequent cancer treatments,

surgery Apr 94% 93.0% 100.0% 100.0% 100.0% 94.4%

Cancer 31 Wait - 31 day standard for subsequent cancer treatments, drug Apr 98% 100.0% 100.0% 100.0% 100.0% 100.0%

Cancer 31 Wait - 31 day standard for subsequent cancer treatments,

radiotherapy Apr 94% 100.0% 98.6% 100.0% - 100.0%

Cancer 62 Day Wait – 62 wait – GP Referrals Apr 85% 82.4% 95.1% 89.0% 92.3% 87.3%

Cancer 62 Day Wait – 62 wait – Screening Apr 90% TBC TBC TBC TBC 93.9%

Cancer 62 Day Wait - 62 day wait following consultant decision to

upgrade Apr

No current

operational

standard 97.1% 95.1% 80.0% 90.0% 88.0%

Mixed Sex Accommodation (MSA) breaches Apr 0 0 0 0 0 0

Cancelled Operations – 28 day rule (Quarterly) Mar 5% 21.3% 10.6% 11.2%

Number of RTT pathways waiting longer than 52 weeks Apr 0 Not Available Not Reporting Not Available Not Reporting 155

A&E – 12 hour trolley waits Apr 0 5 4 0 22 5

Urgent Operations cancelled for a 2nd

time Apr 0 0 0 0 0 0

Ambulance Handover delays – 30 minutes Apr 0 98 140 145 176 243

Ambulance Handover delays – 60 minutes Apr 0 6 51 71 500 77

14

Acute Provider Performance – Kings

Key Contract Issues

� Kings is no longer able to report RTT information by site owing to the implementation of the new PTL management system

� A 50:50 risk share has been agreed on the £6m acute based QIPP, this has been reflected in the activity and financial plan

� The CCG led risk has been included in the finance and activity plan

� A quarterly reconciliation process will take place to validate and accurately reflect the agreed QIPP position

� Norovirus at the PRUH and equipment failure at Denmark Hill which resulted in a second theatre closure (in addition to the planned

closure of one theatre), has caused a reduction in elective activity

15

Acute Provider Performance Dashboard – GSTT & L&G

Guy’s & St Thomas’ Lewisham & Greenwich

Indicator Title Target MonthCurrent

Month

Last

MonthQ4

Current

Month

Last

MonthQ4

CONSTITUTION MEASURESReferral to Treatment Pathways – Incomplete 92% Apr 92.1% 91.6% 91.6% Apr 91.5% 92.1% 92.1%

Percentage of patients waiting 6 weeks or more for a diagnostic test 99% Apr 98.5% 98.7% 98.5% Apr 99.8% 99.8% 98.8%

Percentage of patients who spent 4 hours or less in A&E 95% Apr 91.9% 87.9% 90.3% Apr 85.9% 82.4% 82.4%

Cancer 2 Week Wait - All cancer Two week wait 93% Apr 90.7% 91.6% 89.7% Apr 93.0% 70.4% 92.8%

Cancer 2 Week Wait - Two week wait for Breast Symptoms 93% Apr 92.9% 91.6% 91.9% Apr 89.9% 90.1% 91.6%

Cancer 31 Wait - First definitive treatment within one month 96% Apr 94.4% 94.9% 93.9% Apr 97.8% 100.0% 97.4%

Cancer 31 Wait - 31 day standard for subsequent cancer treatments,

surgery 94% Apr 88.7% 96.4% 91.3% Apr 88.9% 100.0% 88.9%

Cancer 31 Wait - 31 day standard for subsequent cancer treatments, drug 98% Apr 98.5% 97.7% 98.3% Apr 100.0% 100.0% 100.0%

Cancer 31 Wait - 31 day standard for subsequent cancer treatments,

radiotherapy 94% Apr 93.8% 97.9% 95.5%

Cancer 62 Day Wait - Two month urgent (GP referral) 85% Apr 70.9% 67.7% 69.9% Apr 79.0% 86.1% 84.5%

Cancer 62 Day Wait - 62 day wait (Screening service) 90% Apr 88.9% 81.8% 84.4% Apr 100.0% 100.0% 93.3%

Cancer 62 Day Wait - 62 day wait following consultant decision to upgrade No current

operational

standard Apr 54.5% 41.2% 57.1% Apr 100.0% 28.6% 71.4%

CONSTITUTION SUPPORTING MEASURESMixed Sex Accommodation (MSA) breaches 0 Apr 3 2 7 0 0 0

Cancelled Operations – 28 day rule (Quarterly) 0 Mar N/A 6.2% 6.2% N/A 2.0% 2.0%

Number of RTT pathways waiting longer than 52 weeks 0 Apr 9 11 11 0 0 0

A&E – 12 hour trolley waits 0 Apr 0 0 0 0 0 0

Urgent Operations cancelled for a 2nd

time 0 Apr 0 0 0 0 0 0

Ambulance Handover delays – 30 minutes 0 Apr TBC 2 3 TBC 199 580

Ambulance Handover delays – 60 minutes 0 Apr TBC 0 0 TBC 315 789

16

Bromley Healthcare Performance Summary (1 of 3)

� Activity within the block element of the BHC contract is showing a small over performance of 4.5%

� The CCG continues to query over and under performance with BHC at service level, via the Finance & Technical meetings

� The next F&T meeting is scheduled for Wednesday 6th July

� Activity for services outside of the block contract will be discussed, as there are concerns around baselines and

currencies

� Next month’s IGC report will include details of the agreed CQUINs for BHC in 2016/17

17

Bromley Healthcare Performance Summary (2 of 3)

2016/17 BHC Activity Performance – Block ContractService Area Annual Plan YTD Plan YTD Actual Variance 2015/16 Outturn

District Nursing 203,509 16,956 17,761 -805 204,166

COPD 6,831 530 522 5 6,541

Community Matron 4,277 358 405 -47 4,221

Leg Ulcer 5,469 455 426 29 5,367

Bladder & Bowel 4,025 335 395 -60 3,984

Adult Occupational Therapy 3,970 329 374 -45 4,088

Adult Physiotherapy 7,511 626 571 55 7,338

Podiatry 27,334 2,278 2,155 123 26,310

Dietetics (Adults & Children) 5,916 478 496 -18 6,030

Adult Speech & Language 3,995 333 396 -63 6,400

Wheelchair 2,116 176 100 76 1,997

Children's Occupational Therapy 2,597 191 150 41 2,304

Children's Physiotherapy 9,351 676 902 -226 9,340

Children's Speech & Language 22,160 1,578 1,666 -88 22,274

Community Paediatricians 6,969 458 606 -148 7,158

Audiology 2,448 202 171 31 2,397

Children's Community Nursing 13,009 891 977 -86 12,945

TOTAL 331,487 26,850 28,073 -1,223 332,860

RAG Rating

Variance +/- 0 - 5% Variance +/- 6 -10% Variance +/- 11%

18

Bromley Healthcare Performance Summary (3 of 3)

2016/17 BHC Activity Performance – Services Outside of Block ContractService Area Annual Plan YTD Plan YTD Actual Variance

Diabetes 4,881 418 741 -323

Diabetes – Education 591 50 58 -8

Falls 1,824 152 144 8

Hollybank (Bed Occupancy) 102 8.5 9.52 -1.02

Hollybank – Emergency Beds (Bed Occupancy) 12 1 0.7 0

IAPT – Referrals Entering Treatment 5,042 420 481 -61

MASS 362 362 293 69

Medical Response Team 34,261 2,855 2,458 397

Rehabilitation Service 2,052 171 136 35

Vasectomy 160 13 3 10

TOTAL 49,287 4,451 4,324 126

RAG Rating

Variance +/- 0 - 5% Variance +/- 6 -10% Variance +/- 11%

19

Bromley Healthcare CQUINs 2016/17

Local/National Indicator CQUIN % Value £

National Improving the uptake of flu vaccinations for all staff within providers 0.25% £63,000

Local 1 Identify and support for adult and young carers across Bromley & avoiding crisis 0.75% £189,000

Local 2 Case management for Integrated Care Networks 0.75% £189,000

Local 3 Health Promotion and Prevention – Making every contact count 0.75% £189,000

TOTAL 2.5% £630,000

Oxleas Performance Summary (1 of 2)

� Oxleas NHS Foundation Trust’s current Monitor ratings (as at 3rd June 2016) are:

� Continuity of Services - 3

� Governance Risk rating - Green - ‘No Evident Concerns’

� The table below sets out performance in April against the agreed contractual KPIs

20

1 New Referrals In Month Activity

Average Expected New

Referrals in Month In month variance YTD Total

Average YTD Expected

New Referrals YTD Variance

1.1 Working Age Adult Services 340 301 113% 340 301 113%

1.3 ALD Services 13 12 108% 13 12 108%

1.4 Older Adult Services 171 174 98% 171 174 98%

1.5 Totals 524 487 108% 524 487 108%

2a Caseloads - Open Referrals In Month Activity

Average Expected Total

Caseload in Month In month variance YTD Total

Average YTD Expected

Caseloads YTD Variance

2.1 Working Age Adult Services 2419 2330 104% 2419 2330 104%

2.3 ALD Services 425 345 123% 425 345 123%

2.4 Older Adult Services 1534 1955 78% 1534 1955 78%

2.5 Totals 4378 4630 4378 4630

2c Memory Service Caseload 850 1395 61% 860 1395 62%

Current Caseload Total Commissioned Variance YTD Average Caseload YTD Average

3 EIP Caseload 70 76 92% 70 92%

New Cases in Month

Average Expected New

Cases in Month In month varaince YTD Total

YTD Average Expected

Cases YTD Variance

3a EIP New Cases 5 3 167% 5 3 167%

3b EIP waiting times In Month Activity Target

In month

compliance YTD waiting times YTD expected YTD compliance

2 week access waiting time 70% 50% YES 70% 50% YES

In Month Activity

Average Expected Total

Episodes in Month In month variance YTD Total

Average YTD Expected

New Referrals YTD Variance

5 HTT Caseload 125 106 118% 125 106 118%

In Month Activity Target In month variance YTD Activity % YTD Target YTD Variance

5b HTT Gatekeeping 100% 95% 5% 100% 95% 5%

5c 7 day Follow Up 92% 95% -3% 92% 95% -3%

In Month Activity YTD Activity

6 Acute Inpatient Occupancy CBD OBD % YTD Total CBD YTD OBD % OBD vs CBD

6.1 WAA Bed Days GP in Borough 1200 1563 130% 1200 1563 130%

6.2 WAA No GP but resides in Borough 0 0 0 0

6.3 Totals 1200 1563 130% 1200 1563 130%

6.4 OA Bed Days GP in Borough 758 739 97% 758 739 97%

6.5 OA No GP but resides in Borough 0 0 0 0

6.6 Totals 758 739 97% 758 739 97%

7 7. Inpatient Rehab Bed Occupancy

7.1 IWH Open 510 450 88% 510 450 88%

7.2 IWH Closed 330 295 89% 330 295 89%

8 In month Target In Month Variance

8.1 Delayed Transfer of Care (Adults) 3.8% 7.5% 3.7%

8.2 Delayed Transfer of Care (Older Adults) 21.6% 7.5% -14.1%

8.3 Delayed Transfer of Care (ALD) 0.0% 7.5% 7.5%

8.4 CPA Review (12 months - Adults) 100.0% 95% 5.00%

8.5 CPA Review (12 months - Older Adults) 100% 95% 5.00%

8.6 CPA Review (12 months - ALD) 100% 95% 5.00%

8.7 CPA Review (12 months - CAMHs) 100% 95% 5.00%

Bromley Commissioner Pack Highlights (Quality)Key

95% - 105%

90% to 95% and 105% to 110%

Less than 90% More than 110%

Oxleas Performance Summary (2 of 2)

� Details of the agreed 2016/17 CQUINs for Oxleas are shown in the table below:

21

Local/National Indicator CQUIN % Value £

NationalImproving physical healthcare to reduce premature mortality in people with severe

mental illness (PSMI)

0.25% £75,179

Local 1Identify and support for adult and young carers across Bromley and avoiding crisis

1.0% £300,719

Local 2Case management for Integrated Care Networks

0.75% £225,538

Local 3 Health Promotion and Prevention – Making every contact count

0.50% £150,359

TOTAL 2.5% £751,975

Oxleas - CAMHS Performance (1 of 2)

CAMHS Referrals Wait from Referral to First Assessment

CAMHS Caseload Attended Contacts

22

0

20

40

60

80

100

120

140

160

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

2014/15 2015/16 2016/17

0

1

2

3

4

5

6

7

8

9

0

200

400

600

800

1,000

1,200

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

2014/15 2015/16 2016/17

0

200

400

600

800

1000

1200

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

2014/15 2015/16 2016/17

Oxleas - CAMHS Performance (2 of 2)

Tier 4 Admissions

23

0

1

2

3

4

5

6

7

8

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

2014/15 2015/16 2016/17

� The CAMHS data has been refreshed to April 2016

� The commissioning arrangements for Child and

Adolescent Mental Health Services changed from 1st

December 2014. The then CAMHs was disaggregated.

The London Borough of Bromley commissioned a new

service - a single point of access and brief intervention

service “Bromley Wellbeing Service” which has resulted

in reduced activity (referrals, caseload & contacts) in

CAMHs

� It is noted, however, that CAMHs case loads have

increased over the corresponding time frame. This may

be a result of an increase in severity of presenting need

and/or risk. We are anticipating a steady reduction in

case loads over the coming year.

� Until end November 2014 activity reported by Oxleas

was combined Tier 2 and Tier 3 activity commissioned

from CCG and LBB. Activity from 1st December, now

only reflects CCG activity (Tier 3), hence the reduction in

reported referrals from that date. This report does not

include activity occurring within the new service,

commissioned via LBB, so is difficult to make year on

year comparisons as presented in the report, especially

as the pre-December data does not include old Bromley

Y data.

� Tier 4: Tier 4 (inpatient) CAMHS services are not

provided by Oxleas, and are commissioned by NHS

England at a National level. The data shown in this

report is for information only.

Primary Care (1 of 2)

Primary Care Overview

24

� Implementation preparation for Integrated Care Networks continues and has included a second clinical round table to shape the pathways

and several provider development and collaboration workshops

� The operating model is now in the final stages of development, covering the three pathways of patient access, proactive care and reactive

care, as well as a frailty workstream. The frailty work was launched in May with a multidisciplinary workshop

� Bromley providers have now all signed up the MoU for ICNs and are working together on bids for the transformation funding to implement

ICNs

� The number and geographies of ICNs have now been formally approved by the GP membership and CCG governing body, and we are

engaging on migrating the existing cluster structure to reflect the Networks

� The service specification for Integrated Case Management is being finalised and will be implemented in practices through the new PMS

contract and GMS equalisation offer from October 2016. A business case for utilising the AUA DES funding for integrated case

management in Bromley is being developed and discussion with NHSE about this will commence in July

� Voluntary sector provision has been supported in Bromley through the Voluntary Sector Enterprise (VSE) as organisations federate in order

to provide services as a voluntary sector at scale within the ICNs. This work continues and the voluntary sector reps are members of the

ICN Board and involved in tranformation funding bids

� Improved GP engagement and partnership working will be critical for delivering primary care improvement and transformation in 2016

and beyond. This has been reflected in the primary care team’s role going forward, building relationships with practices that will be

mutually productive and getting practices on board with short and longer term CCG priorities. New ways of working began from April 2016

following successful recruitment into longstanding vacancies within the team and we now have a named team member for each practice.

32 of the 45 (71%) practices were visited with a topical agenda by the team for the May/June round of practice visits. We are already

starting to see stronger relationships and mutual benefits between practices and the primary care team following this approach

� Winter resilience planning for 2016/17 began in June and will see a co-design approach with practices to identify a small number of high

impact schemes that practices will be asked to choose from. The approach will include LMC engagement from early on

Primary Care (2 of 2)

Primary Care Overview cont.

25

� Primary care is working closely with Bromley healthcare as the current provider of the Bromley locum bank, and the GP Alliance, to

explore options for better models of locum provision in the future. The current model is flawed and improvement will support our

strategic workforce aims to deliver ICNs and primary care improvement more generally

� Dementia friends training is being rolled out in general practice to support practice staff to recognise and manage dementia sufferers

and their carers in the practice

� Re-launch of information packs to assist practices by giving them their emergency care, outpatient referral and community service

usage data is planned for late July. Analysis and support from the CCG will help practices to actively consider where and why they are

outliers

� The DXS clinical support tool is being piloted in 8 GP practices and full roll out is planned for autumn 2016. this will ensure referrals

forms, guidelines, pathways and hotlines are uploaded once centrally and then available to all Bromley practices

Out of Hours Primary Medical Services

� Primary care access hubs continue to offer additional access and capacity in the evenings and weekends. An evaluation of the hubs in

spring 2016 has found high levels of satisfaction with the service by both GP practices and patients. Referral routes have been

extended to include emdoc, the UCC and NHS 111 as well as GP practices. Long term commissioning arrangements of the hubs are

being considered following the success of the pilot

Bromley’s current Out of Hours service runs from 6.30 pm to 8 am, with 24 hour cover at weekends and bank holidays, to ensure access to

Primary Care is available

E-Referrals – Outpatient Utilisation � The table below sets out Bromley’s outpatient e-referral utilisation rates over recent months

Nov-2015 Dec-2015 Jan-2016 Feb-2016 Mar-2016 Apr-2016

69.0% 61.0% 61.0% 66.0% 66.0% 66.0%

BCCG QIPP

Scheme Annual Plan YTD Plan YTD Actual YE Forecast

CVD- Anti-coag 1,008 patients (Planned Care) £155,000 £12,917 £12,917 £155,000

CVD- Anti-coag 3,000 patients (Planned Care) £77,500 £6,458 £6,458 £77,500

CVD – Primary Care Support & Management (Planned Care) £132,339 £11,028 £11,028 £132,339

CVD – Primary Care Diagnostics (Planned Care) £97,496 £8,125 £8,125 £97,496

Ophthalmology (Planned Care) £25,000 £2,083 £2,083 £25,000

Prescribing - Medicines Management (Primary Care) £1,000,000 £83,333 £83,333 £1,000,000

Admission Prevention (Emergency Care) £3,168,922 £264,077 £264,077 £3,168,922

Re-procurement of Audiology (Community Services) £150,000 £12,500 £12,500 £150,000

Care Treatment Reviews (Community Services) £200,000 £16,667 £16,667 £200,000

UCC – Redirects to Primary Care (Community Services) £300,000 £25,000 £25,000 £300,000

Mental Health Shared Care (Community Services) £150,000 £12,500 £12,500 £150,000

Acute Efficiencies (Acute) £2,481,079 £206,757 £206,757 £2,481,079

SUB TOTAL £7,937,336 £661,445 £661,445 £7,937,336

2016/17 QIPP REQUIRED £8,600,000

CURRENT GAP £662,664

� The table below sets out the CCG’s QIPP Plan for 2016/17 and shows the reported month 1 position

26

Overall Achievement 95% and above

Overall Achievement between 75% and 94%

Overall Achievement between 50% and 74%

Overall Achievement below 50%

QIPP – Key Issues

� The month 1 reported position shows breakeven

� Full monitoring of activity schemes will commence in month 2

� The CCG has secured a 50:50 risk share agreement on acute based QIPP with Kings

� Delivery of Planned Care and Admission Prevention schemes are predicated on reduction of / shifts in activity

QualityAuthor: Sonia Colwill Director of Quality, Governance & Patient Safety

Sarah Osborn, Head of Planning & Performance

� Quality Report Summary Page 28

� Key Issues from Provider Dashboards Page 29

� Kings – Quality Dashboard Page 30

� Kings CQRG Page 31

� Oxleas – Quality Dashboard Page 33

� Oxleas CQRG Page 34

� BHC - Quality Dashboard Page 36

� BHC CQRG Page 37

� Bromley CCG QAS Page 39

� Quality log PRUH Safety Issues Page 40

� Quality log concerns – all providers Page 44

� Friends & Family Page 46

� NHS Choices Page 50

Quality Report Summary

29

Bromley CCG’s primary responsibility is to ensure providers are delivering safe, high quality, clinically effective

services, whilst providing patients with the most positive experience possible.

Each provider is required to attend a Clinical Quality Review Group (CQRG) run by the CCG and in Bromley,

supported by the SEL Commissioning Unit for acute providers. The CQRG is responsible for receiving data and

information from the Trust for scrutiny and challenge. This data is triangulated with information available to

the CCG about the provider in the form of complaints or themes via our Quality alert system and also with

soft intelligence from patient feedback or through external agencies such as Healthwatch. External scrutiny is

provided through CQC inspections, and in the case of Foundation Trusts, through Monitor.

Data for this part of the report is taken from: NHS Choices website, KCH Board reports, KCH website, Oxleas

NHS FT, Bromley Healthcare, FFT, CQC and Monitor.

There is a vast amount of quality data available and this report seeks to include relevant, up to date and

useful information. The report will be developed further to provide a comprehensive picture of quality within

our provider services.

The committee is asked to consider any other data and analysis they would like to have present in the quality

section of this report.

A Provider Quality Log has been included in this section of the report to give the Committee assurance that

quality issues are identified and rectification measures agreed and monitored through the Quality Assurance

sub-committee.

Provider Quality Dashboard KCH April 2016

30

Kings - Denmark Hill Kings - PRUH

Clinical Effectiveness Target Latest month Last month Target Latest month Last month

Summary Hospital Level Mortality Indicator (SHMI) – TRUST WIDE 100 83 84 100 89 91

Unplanned Admissions to HDU/ITU 37 58 72 - 59 46

Emergency Re-admissions within 30 days (YTD) 5.9% 5.4% 5.4% 8.5% 8.5% 8.9%

Patient Safety

MRSA – Number of Cases (YTD) 0 0 4 0 0 0

C-Difficile – Number of Cases (YTD) 5 4 60 2 1 22

Never Events 0 0 0 0 0 0

Red Adverse incidents (inc. medication errors) 0 8 14 0 12 10

Serious Incidents 0 4 5 0 6 7

Pressure Ulcers (Hospital Acquired) 2 23 21 - 2 6

Falls 1 2 4 - 0 0

VTE Risk Assessments 95% 97.5% 97.2% 95% 96.0% 97.1%

Patient Experience

Cancelled Operations – 28 day rule 5.0% 17.3% 21.3% 5.0% 7.7% 10.6%

Number of Cancelled Operations 0 41 52 0 29 52

Outpatient Cancellations < 6 weeks notice 0 6531 6221 0 2438 2024

Complaints 45 52 40 - 26 24

Complaints – Response > 25 working days 0 19 22 0 14 21

Staffing

Staff Vacancy Rate 5.0% - 8.0% 10.6% 10.8% 5.0% - 8.0% 17.3% 15.8%

Mandatory & Statutory Training & Induction 80% 80.0% 81.0% - No data No data

Governance

MONITOR – Governance Risk Rating (September 2014) – TRUST WIDE 4 – No evident

concerns

2 – Subject to

enforcement action

2- Subject to

enforcement action

4-No evident

concerns2-Subject to

enforcement action

2-Subject to

enforcement action

CQC – Warning Notices 0 0 0 0 0 0

Note: This dashboard shows a selected number of indicators, however, the Trust do report on many others. Indicators for clinical effectiveness are reported

in the performance section of this report as they relate to constitutional standards e.g. cancer & diagnostics waits and Referral to Treatment times

KCH CQRG May 2016 (1 of 2)

Matters Arising

• Urology audit update: discussions ongoing in regards to the service transfer; the review at DH is still to be completed.

• The pathway for the under 5’s has been clarified and communicated to GPs

Spotlight on:

Safeguarding

There were discussions between the Trust and CCG commissioners on safeguarding with regards to safeguarding arrangements within

the Trust. CCG commissioners expressed concerns regarding a number of areas, however, key Trust staff were not at the meeting to

respond. Subsequent to the meeting it was decided that a task and finish group would be set up to look at these areas in more depth

and report back to the CQRG.

Standing Items

� Finance and Performance report

• Commissioners queried the availability of mandatory and statutory staff training data available for PRUH which had been missing

for a number of months

• Ophthalmology patients experiencing problems getting follow up appointments in advised timescales and get hold of an

administrative problems leading to DNAs

• Query into the position in relation to >52 week waiters particularly in neurosurgery: work underway across London in this area

� Workforce scorecards

Trust are doing well with recruitment but proving more challenging at PRUH as there are fewer specialties so less attractive than

DMH. There is also the issue of London Weighting. The Trust do aim to rotate staff between DH and PRUH. The agency cap had not

caused too much of an issue and the Trust is meeting the NHSE target.

31

KCH CQRG May 2016 (2 of 2)

� Infection scorecards

• Zero MRSA cases at PRUH in April

• 3 cases of VRE bacteria reported in April and 4 cases of C-diff (Trustwide)

• WRE bacteria cases and C-Diff lower at PRUH than DMH but two outbreaks of norovirus

� Trust Harms scorecard

The Trust were congratulated on the increased level of green indicators at PRUH.

Q4 reports

� Patient Outcomes Report

• A number of SI’s related to oxygen administration; work underway to ensure oxygen prescribed in line with best practice

guidance and administration reviewed by senior staff.

AOB

• “Fit note” issues to be taken back to the Clinical Directors meeting and feedback at the next CQRG

Date of next meeting: 21st June 2016

32

Provider Quality Summary Oxleas April 2016

Quality & Safety Indicator Description TargetCurrent

MonthLast Month

Serious Incidents 0 16 6

Never Events 0 0 0

Complaints 0 20 19

Carer details on RiO for those on new CPA - no data 93.1%

Number of Carers on RiO offered an assessment - no data 78

New CPA patients with a care plan on RiO no data no data

New CPA patients with a crisis plan on RiO 95% 96.7% 96.8%

New CPA reviews every 6 months 95% 95.1% 95.2%

Patient Experience surveys across services no data no data

7 Day follow ups – patients discharged on new CPA 95% 95.6% 100.0%

48hr follow ups – patients with a history of self harm 100% 98.1% 95.0%

Number of MRSA reportable infections 0 0 0

Number of C-Difficile infections - 0 0

Transition planning between children and adult services no data no data

Recording primary diagnosis for discharged inpatients no data no data

Recording other diagnosis (Learning Disability) no data no data

Compliance with S132 of the Mental Health Act 100% 100.0% 100.0%

Compliance with S58 of the Mental Health Act 100% 100.0% 100.0%

Goal Based Outcome assessment recorded on RiO no data no data

Goal Based Outcome Review recorded on RiO (Trajectory Q1 15%, Q2 30%) no data no data

Delayed Discharges <7.5% 4.2% 5.3%

Recording of smoking status of patients no data no data

33

Oxleas CQRG May 2016 (1 of 2)

The Oxleas CQRG meeting took place on 11th May

Healthwatch Audit presentation – Oxleas House

Enter and View visit of Oxleas House was conducted by Healthwatch Greenwich, Bromley and Bexley in Feb 2016. Overall it was a

positive experience and Healthwatch were impressed by how caring and open the staff were. Recommendations will be formally

shared when finalized by the three Healthwatch Boards. Oxleas will formally respond to actions in September CQRG. Healthwatch

intend to conduct a review of each adult in-patient facility across the 3 CCGs and an action plan will be drawn up addressing issues

identified across the patch.

AOB:

Feedback was given on the recent CQC inspection which was thought to have gone well. Some of the main points from the discussion

were as follows.

• Broad coverage of all services

• Inpatient wards – older people/community/LD/DN services

• End of life care

• Initial Feedback from lead inspector on the whole was good

• Some areas picked up on: ligature assessment, risk assessments in communal areas, line of sight issues on wards, user restraint

(benchmarked with other MH Trusts) section 136 privacy and dignity

Oxleas Q4 quality report

Review of Q4 Quality report, SI report, PU summary report and Executive summary of “Preventing suicide in the community”. Some of

the main points of the discussion were:

• 209 issues raised

• Complaint letter– 10 issues raised

• Discussion regarding the apparent rise in complaints which is due largely to the change in reporting to incorporate all concerns.

Oxleas to consider how best to report in order that the indicator is not always red.

34

Oxleas CQRG May 2016 (2 of 2)

Oxleas Q4 quality report cont.

• Bromley CCG commented it would be helpful to have a regular report on learning and changes had come from the SI reports and

action plans. It was agreed that themes identified/lessons learned be included in future quarterly Trust reports.

2016/17 Audit Plan

The Trust wide Quality and Clinical Audit Programme 2016-17 was presented.

Oxleas’ Trust wide quality priorities were explained and the main points from the discussion were:

• Quality and Clinical Lead expertise utilised

• HQIP national audits included

– Priority A clinical audits (national audit programme and Trust wide audits) to come to the CQRG

– Priority B clinical audits (Directorate audits) shared via each clinical directorate

– Trust wide audits and action plans are presented to the CEG and monitored by CEG and by Directorates

– Audits are also presented in the Quality annual conference to showcase audits/ensure embedded learning from these

– Some are highlighted in the annual Quality Account.

Date of next meeting: 1st June 2016

35

Provider Quality Summary BHC April 2016

36

Key Performance Indicator Description Target Current Month Last month

Serious Incidents 0 3 5

Never Events 0 0 0

Complaints 0 10 8

Percentage of complaints resolved 90% 50% 100.0%

DNA rate 5% 2.8% 2.8%

Patient Experience surveys across services 85% 98.8% 99.2%

Newborn blood spot screening – timeliness of results – Quarterly no data no data

RTT 18 weeks – complete pathways no data 99.0%

RTT 18 weeks – incomplete pathways 95% 99.6% 99.9%

6 week diagnostics 95% 100.0% 100.0%

Staff Vacancy - 1.2% 1.5%

Staff with Appraisal 85% 84.0% 83.0%

Sickness Absence 3% 4.3% 4.9%

Child Safeguarding – Level 1 80% 98.0% 99.0%

Child Safeguarding – Level 2 80% 86.0% 83.0%

Child Safeguarding – Level 3 80% 97.0% 83.0%

Formulary published on website Y no data Y

Duty of candour 0 0 0

Bromley Healthcare CQRG May 2016 (1 of 2)

BHC CQRG meeting took place on 19th May.

Podiatry Review

A comprehensive review has been received and the CCG welcomed the robust, board level enquiry. There are challenges on the

pathway regarding BHC’s access to Kings specialist services and a draft pathway has been worked on. Direct access to vascular care is

the main challenge with pathways between diabetes and vascular that need to be reviewed. BHC advised that patients requiring

review by the diabetic foot clinic need to be seen at Denmark Hill as there is no vascular service at the PRUH. There is work to be done

to join up services and to work out an action plan to improve the pathway for diabetic patients.

MRT Report

• QR2 – Compliance 99%

• QR3 – 165 CmC and palliative care special patient notes were added to the database in Q4, 19 patients removed from the SPN

records.

• QR4 no particular trends

• QR5 – Patient satisfaction questionnaires achieved a positive rating of 89%

• QR6 – three complaints received, communication related rather than clinical which BHC are trying to address

• DX codes – compliance 97% and 99%

• QR12 – compliance 96% and 100%

• Activity against call type – advice calls were 82% of total activity – a rise of 1%, home visits dropped from 19% in this quarter to

18%, 16.5% undertaken by GP’s and 1.5% by ANPs – BHC are trying to pull MDT approach together and balance out who visits.

BHC SI Review

BHC have put a new governance structure in place where all SI reports are discussed within the Safer Care Group. BCCG need to feel

assured around the process for signing off SI’s. Several options for meetings were discussed to enable sign off. The CCG were aware of

the difficulties in schedules on both sides to ensure appropriate attendance at quality meetings. It was agreed that meeting papers will

be assessed and comments provided for meetings, however, this means papers and RCA reports need to be shared well ahead of

meetings and, in more complex cases, CCG quality lead will try to attend the Safer Care Group meetings or a separate meeting will

need to be scheduled.

37

Bromley Healthcare CQRG May 2016 (2 of 2)

Quality Report

• Patient Experience – FFT score remains high and BHC continue to have high compliments. The complaints procedure is under review

and will be sent to BCCG once complete.

• School Nursing – BHC has raised concerns with the decommissioning of the service, it is on the risk register and BHC are in

correspondence with the Chief Nurse for England and for Public Health. BHC have highlighted that their major concern is around

health representation for vulnerable children. BHC and the CCG are both escalating the issue appropriately.

• Patient Safety – BHC has a good culture of reporting and the latest staff survey validated this clearly. The safeguarding dashboard

was noted and will be going through CCG safeguarding exec meeting

• Clinical Effectiveness – a summary of audits performed was provided and BHC updated that they would be taking part in diabetes

and COPD national audits this year

KPI Dashboard

• Staff with appraisal – is down, however many have completed appraisals, the dashboard reports those who have had their appraisal

signed off and submitted their PDP

• Sickness – increased in Q4 due to flu, colds and norovirus

Waiting Times

• Podiatry – there is no challenge on waiting times for high risk patients, patients waiting have been risk assessed and the high risk

patients have all been reviewed since February, this is positive assurance

• Child OT – there are capacity issues and hard to recruit to a speciality in child OT, BHC are working hard to amend this and also

working to improve their triage system in order to mitigate risk

• Adult SLT – improvement in the next few months

AOB – Quality Accounts

The draft is going to Board next week and should be ready at the end of the month for CCG comments. Quality priorities would be

expected to reflect the things the CQRG have spoken about over the past year and the CCG would welcome working with BHC to

develop priorities for the next year.

The CCG welcomed the robust feedback and assurance provided by BHC at this meeting.

Date of next meeting – 15th June 2016

38

Bromley CCG QAS May 2016

The BCCG QAS meeting took place on 26th May

Minutes are provided for IGC Review

39

Friends & Family Test (1 of 4)

February 2016 March 2016 April 2016

TrustTotal

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Kings College – Denmark Hill 860 77% 14% 798 74% 16% 531 79% 11%

Kings College - PRUH 521 85% 9% 531 81% 11% 304 81% 11%

Guy’s & St Thomas’ 1544 84% 9% 1494 82% 12% 1260 83% 9%

Lewisham & Greenwich 1425 93% 3% 1182 93% 3% 1112 94% 2%

A&E

Inpatient February 2016 March 2016 April 2016

TrustTotal

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Kings College – Denmark Hill 902 91% 2% 928 96% 2% 857 96% 1%

Kings College - PRUH 411 95% 1% 292 97% 2% 377 96% 1%

Guy’s & St Thomas’ 2789 95% 2% 2779 97% 1% 2400 96% 1%

Lewisham & Greenwich 1170 93% 2% 1213 94% 2% 1268 94% 2%

40

Friends & Family Test (2 of 4)

February 2016 March 2016 April 2016

TrustTotal

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Kings College – Denmark Hill 44 68% 11% 22 86% 9% 26 96% 4%

Kings College - PRUH 41 73% 15% 22 91% 5% 17 100% 0%

Guy’s & St Thomas’ 7 100% 0% 7 100% 0% 38 97% 3%

Lewisham & Greenwich 83 96% 0% 83 99% 0% 225 95% 1%

February 2016 March 2016 April 2016

TrustTotal

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Kings College – Denmark Hill 15 87% 7% 37 86% 5% 19 95% 0%

Kings College - PRUH 90 91% 4% 162 95% 2% 58 95% 3%

Guy’s & St Thomas’ 150 96% 1% 132 96% 2% 128 96% 2%

Lewisham & Greenwich 336 93% 3% 211 91% 3% 198 92% 3%

Maternity - Antenatal

Maternity - Birth

41

Friends & Family Test (3 of 4)

February 2016 March 2016 April 2016

TrustTotal

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Kings College – Denmark Hill 12 92% 8% 35 91% 6% 19 95% 0%

Kings College - PRUH 80 90% 5% 140 86% 4% 35 89% 3%

Guy’s & St Thomas’ 148 87% 3% 112 85% 6% 126 83% 6%

Lewisham & Greenwich 254 85% 5% 211 86% 5% 124 85% 6%

February 2016 March 2016 April 2016

TrustTotal

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Total

Responses

% age

Recommended

% age Not

Recommended

Kings College 15 87% 7% 26 96% 0% 17 94% 0%

Guy’s & St Thomas’ 0 * * 17 100% 0% 35 94% 0%

Lewisham & Greenwich 113 95% 0% 75 97% 0% 50 98% 0%

Maternity - Postnatal

Maternity – Postnatal

Community

42

Friends & Family Test – Staff (4 of 4)

Quarter 1 Trust No.

Responses

Headcount Recommend as a

place to work

Not recommend as

a place to work

Recommend

care

Not

recommend

Kings 294 11703 66% 15% 85% 4%

GSTT 1690 13307 77% 10% 91% 3%

Lewisham & Greenwich 509 6080 66% 16% 75% 9%

� The Staff Friends & Family Test was introduced in April 2014

� The survey is conducted on a quarterly basis, excluding quarter 3 when the existing staff survey takes place

� Staff are asked to respond to two questions:

� How likely staff are to recommend the NHS services they work in to friends and family who need similar treatment or care?

� How likely staff would be to recommend the NHS services they work in to friends and family as a place to work?

43

Trust No.

Responses

Headcount Recommend as a

place to work

Not recommend as

a place to work

Recommend

care

Not

recommend

Kings 226 11630 64% 19% 86% 5%

GSTT 1474 13563 76% 11% 92% 2%

Lewisham & Greenwich 528 6062 63% 19% 72% 11%

Quarter 2

Trust No.

Responses

Headcount Recommend as a

place to work

Not recommend as

a place to work

Recommend

care

Not

recommend

Kings 967 11244 48% 31% 78% 7%

GSTT 1319 13845 79% 10% 94% 2%

Lewisham & Greenwich 685 5839 66% 16% 77% 8%

Quarter 4

NHS Choices� The NHS Choices website details star ratings for each provider site based on patient/service user reviews

� Each respondent is asked to rate six areas, five of which are included in the graphs set out below:

� Involvement in decisions

� Dignity and respect

� Staff co-operation

� Cleanliness

� Same sex accommodation (assessed via national standard)

� How likely are you to recommend this service to friends and family if they needed similar care or treatment?

� The overall star rating is based on the average of all ratings awarded to the friends and family question in the past two years

� The information in this report was extracted from NHS Choices on 30th June 2016.

44

0 1 2 3 4 5

CLEANLINESS

STAFF CO-OPERATION

DIGNITY AND RESPECT

INVOLVEMENT IN DECISIONS

St Thomas'(based on 139 ratings)

0 1 2 3 4 5

CLEANLINESS

STAFF CO-OPERATION

DIGNITY AND RESPECT

INVOLVEMENT IN DECISIONS

Kings - Denmark Hill(based on 117 ratings)

0 1 2 3 4 5

CLEANLINESS

STAFF CO-OPERATION

DIGNITY AND RESPECT

INVOLVEMENT IN DECISIONS

Lewisham(based on 155 ratings)

0 1 2 3 4 5

CLEANLINESS

STAFF CO-OPERATION

DIGNITY AND RESPECT

INVOLVEMENT IN

DECISIONS

Kings – PRUH(based on 4 ratings)

0 1 2 3 4 5

CLEANLINESS

STAFF CO-OPERATION

DIGNITY AND RESPECT

INVOLVEMENT IN DECISIONS

Queen Elizabeth

(based on 75 ratings)

0 1 2 3 4 5

CLEANLINESS

STAFF CO-OPERATION

DIGNITY AND RESPECT

INVOLVEMENT IN

DECISIONS

Guy's(based on 122 ratings)

Finance Report – Month 2 – May 2016Author: Mark Cheung, Chief Finance Officer

� National CCG Assurance Framework Summary Page 52

� Summary Page 53

� Revenue Resource Limit Allocation Page 54

� Revenue Budgets Page 55

� Acute Page 56

� Non Acute Page 57

� Prescribing & Residual CCG Primary Care Page 58

� Running Costs, Reserves & Other Budgets Page 59

� Better Care Fund – 16/17 Financial Plan Page 60

� Better Care Fund – financial arrangements Page 61

� Year End Forecast Page 62

� Acute Risk Assessment Page 63

� Cash Position and Debtors Position Page 64

� Better Payment Practice Code Page 65

� Statement of Financial Position Page 66

� Financial Risks Page 67

National CCG Assurance Framework SummaryThe CCG Assurance Balanced Scorecard approach includes a domain to assess the CCGs ability to commission services within their

financial allocations. The table below details Bromley CCG’s 2016/17 performance against the indicators issued by NHS England.

47

Month 2

Indicator Plan £'000 YTD £'000

Year End

£'000 Rating

In Month

Change

1 Underlying recurrent surplus - forecast outturn 5,911 5,911

2 Surplus - year to date 985 985

3 Surplus - forecast outturn 5,911 5,911

4 Management of 1% non-recurrent funds 4,215

5 QIPP - Year to date 1,122 1,122

6 QIPP - Forecast outturn 8,600 8,600

7 Activity trends - year to date

8 Activity trends - forecast outturn

9 Running costs - year to date 7,257 1,209 7,257

10

Our cash balances are a maximum of 1.25% of

drawdown at month end

11

We pay our bills in line with Better Payment

Practice Code

Key - Rating Key - In month change

On track No material change from last month

Moderately off track Deteriorated from last month

Materially off track Improvement from last month

See Performance Report

Summary

Performance Against Statutory Targets

1. Revenue Resource Limit (RRL)

2. Cash Limit (CL)

3. Capital Funding – Month 2

No capital monies have been received to date.

Revenue Resource Limit:

� The CCG is reporting a year end surplus of

£5.911m (1.4%)

Cash Limit:

� The CCG is currently forecasting a breakeven

position against its forecast cash limit.

Capital Limit:

� The CCG has not received any capital

allocations to date. Capital allocations are

usually received in the second half of the year.

QIPP:

� The CCG has a QIPP target of £8.60m.

Cash Limit

Actual YTD

Cash Limit

Full Year

% Drawn

Down YTD

£'million £'million %

Cash Drawings against plan 62.8 380.1 16.5

Cash Drawings –actual and forecast outturn 62.4 380.1 16.4

Actual under-spend against cash limit 0.4 0.0

£'000 £'000 £'000

Month 2

Year to date

Year End

Expenditure

Previous

Month YTD

Total Budget 72,421 434,659 0

Total Expenditure 71,436 428,748 0

Total (Over)/Underspend 985 5,911 0

1.4% 1.4% 0.0%

Planned Surplus 985 5,911 0

Variance against planned Surplus 0 0 0

48

Revenue Resource Limit Allocation

� The annual revenue resource limit

allocation at Month 2 is £434.659m

� The notified allocation comprises of three

elements:

� Programme Allocation (£421,490k)

� Running Cost Allocation (£7,257k)

� Surplus carried forward from

2015/16 (£5,912k)

49

£'000

Annual allocation per 2016/17 Operating Plan 434,659

- submitted on 16th May 2016

Annual allocation per Month 2 Finance Report 434,659

Revenue Budgets

This table shows the overall CCG position by

area of spend. The key messages are:

� The CCG is forecasting that it will

achieve its planned surplus target of

£5.911m

� The CCG is forecasting that it will

achieve its QIPP target of £8.60m.

YEAR TO DATE ANNUAL FORECAST

PREVIOUS

MONTH FYE

EXPENDITURE Budget Actual Variance Budget Actual Variance Variance

Summary £000's £000's £000's £000's £000's £000's £000's

Acute Commissioning 40,307 40,277 31 238,887 238,887 (0) 0

Non Acute

Commissioning 16,994 17,085 (90) 101,965 101,965 0 0

Primary Care 8,488 8,485 3 50,925 50,925 (0) 0

Running Costs 1,209 1,209 (0) 7,257 7,257 0 0

Other Budgets and

Reserves 4,437 4,380 57 29,714 29,713 1 0

Sub Total 71,436 71,436 0 428,748 428,748 0 0

Surplus 985 0 985 5,911 0 5,911 0

Total 72,421 71,436 985 434,659 428,748 5,911 0

50(80)

(60)

(40)

(20)

0

20

40

60

80

100

1 2

Va

ria

nce

£0

00

Month

Overall Revenue Budgets Month 2

Cumulative Monthly Variance

Acute Commissioning

Non Acute

Commissioning

Primary Care

Running Costs

Other Budgets and

Reserves (exc.Surplus)

Acute

The year end forecast position is reported as

breakeven as it is to early in the financial year

to accurately assess trends. The following

should be noted:

� From next month an risk assessment will be

used to forecast the likely, best and worst

case forecast position for acute contracts.

� The acute QIPP figure is £6m and is allocated

50:50 between the Trust and CCG.

� The year to date underspend of £32k relates

to the Urgent Care Centres at the PRUH and

Beckenham Beacon.

YEAR TO DATE ANNUAL FORECAST

PREVIOUS

MONTH

FYE

EXPENDITURE Budget Actual Variance Budget Actual Variance Variance

£000's £000's £000's £000's £000's £000's £000's

Acute

Kings (PRUH & DH) 28,431 28,431 (0) 170,586 170,588 (1) 0

Guys & St Thomas' 3,716 3,716 0 22,298 22,297 1 0

UHL / QEH 1,776 1,776 (0) 10,657 10,657 (0) 0

Croydon 558 559 (0) 3,350 3,351 (2) 0

St Georges 190 191 (0) 1,141 1,144 (3) 0

London Ambulance 1,663 1,663 (0) 9,975 9,976 (1) 0

Other Acute Service

Agreements 3,135 3,135 (0) 15,850 15,844 6 0

Sub Total 39,469 39,470 (1) 233,858 233,858 (0) 0

Locally managed acute

budgets 838 806 32 5,029 5,029 (0) 0

Total - Acute 40,307 40,277 31 238,887 238,887 (0) 0

51(35)

(30)

(25)

(20)

(15)

(10)

(5)

0

1 2

Va

ria

nce

£0

00

Month

Acute Month 2

Cumulative Monthly Variance

Kings (PRUH & DH)

Guys & St Thomas'

UHL / QEH

Croydon

Dartford and Gravesham

London Ambulance

Other Acute Service

Agreements

Locally managed acute

budgets

Non-Acute

The Non-Acute year to date position is £90k

overspent.

The key variances are:

� The community services budget is

overspent by £61k. This is due to over-

performance of £27k within Bromley

healthcare non-contacted activity and

£34k in other cost and volume community

contracts.

� Other budget are overspent by £57k due

to an overspend within the Long Term

Conditions budget of £57k. This variance

has been reviewed and related to 15/16

expenditure which had been accrued for

at year end. This will be corrected next

month and there will not be an overspend

against this budget.

The year end forecast has been reported as

breakeven as it is to early in the year to identify

trends and accurately predict the year end

position.

YEAR TO DATE ANNUAL FORECAST

PREVIOUS

MONTH

FYE

EXPENDITURE Budget Actual Variance Budget Actual Variance Variance

£000's £000's £000's £000's £000's £000's £000's

Non Acute

Oxleas Mental Health 5,160 5,160 (0) 30,962 30,962 (0) 0

Other Mental Health 1,103 1,099 5 6,621 6,620 0 0

Learning Disability 839 839 (0) 5,034 5,034 0 0

Continuing Healthcare 2,200 2,200 (0) 13,198 13,198 (0) 0

Funded Nursing Care 604 604 0 3,623 3,622 1 0

Community Services 6,443 6,504 (61) 38,658 38,659 (1) 0

Palliative Care (Hospices) 518 494 24 3,107 3,107 0 0

Other 127 184 (57) 762 762 0 0

Total - Non Acute 16,994 17,085 (90) 101,965 101,965 0 0

52-40

-20

0

20

40

60

80

1 2

Va

ria

nce

£0

00

Month

Non-Acute Month 2

Cumulative Monthly VarianceOxleas Mental

HealthOther Mental

HealthLearning Disability

Continuing

HealthcareFunded Nursing

CareCommunity Services

Palliative Care

(Hospices)Other

Prescribing and CCG Primary Care

� The services are being reported as

breakeven as it is to early in the year

to accurately forecast the financial

position.

� The Prescribing budget has been

uplifted by 5.5% (£2.5m) compared

to last year and a £1m savings target

has been allocated.

� Other budgets relate to Primary

Care IT £848k, Primary Care

Investments £1,252k, Oxygen £467k

and Commissioning schemes £428k.

YEAR TO DATE ANNUAL FORECAST

PREVIOUS

MONTH

FYE

EXPENDITURE Budget Actual Variance Budget Actual Variance Variance

£000's £000's £000's £000's £000's £000's £000's

Primary Care

Prescribing 7,735 7,731 4 46,410 46,410 (0) 0

Out of Hours 0 0 0 0 0 0 0

Local Enhanced Services 151 151 0 906 906 0 0

Medicines Management - Clinical 102 102 (0) 614 614 0 0

Other 499 500 (1) 2,995 2,995 (0) 0

Total - Prescribing and Primary Care 8,488 8,485 3 50,925 50,925 (0) 0

53(5)

(4)

(3)

(2)

(1)

0

1

2

1 2

Va

ria

nce

£0

00

Month

Primary Care Month 2

Cumulative Monthly Variance

Prescribing

Out of Hours

Local Enhanced

Services

Medicines

Management -

ClinicalOther

Running costs, reserves & other budgets

� The CCGs running cost target

for 2016/17 is £7,257k which is

a £4k increase compared to last

year.

� The Better Care Fund [BCF]

allocation is £21,535k of which

the LBB receive £1,605k of

grant funding direct, the net

CCG budget is therefore

£19,930k. The 2016/17 CCG

uplift was £698k. Additional

detail is set out later in this

report.

YEAR TO DATE ANNUAL FORECAST

PREVIOUS

MONTH

FYE

EXPENDITURE Budget Actual Variance Budget Actual Variance Variance

£000's £000's £000's £000's £000's £000's £000's

Running Costs & Other Budgets

Running Costs - CCG direct 960 960 (0) 5,763 5,763 0 0

Running Costs - CSU recharge 249 249 (0) 1,494 1,494 0 0

1.0% Reserve (unallocated) 0 0 0 898 898 0 0

Contingency - 0.5% 0 0 0 2,088 2,088 0 0

Better Care Fund 3,322 3,322 0 19,930 19,930 0 0

Other earmarked & reserves 1,116 1,058 57 6,798 6,797 1 0

Sub Total 5,647 5,590 57 36,971 36,970 1 0

Surplus Target 985 0 985 5,911 0 5,911 0

Total - Running Costs & Other 6,632 5,590 1,043 42,882 36,970 5,912 0

54

(60)

(50)

(40)

(30)

(20)

(10)

0

1 2

Va

ria

nce

£0

00

Month

Running Costs - CCG

direct

Running Costs - CSU

recharge

1.0% Non recurrent

reserve (unallocated)

0.5% Contingency

reserve

Better Care Fund

Other earmarked &

reserves (exc.Surplus)

Running costs & other budgets - Month 2

Better Care Fund – financial position

55

� The table sets out the draft 2016/17 budget

� The 2016/17 uplift was £698k and

represents the minimum uplift requirement

as notified by NHS England

� The total of £21,535k reconciles with the

2016/17 BCF submission to NHS England

made on the 15th June 2016

BCF Investment schemes 2016/17 budget £

Reablement capacity 809,000

Winter Pressures (Oxleas) 200,000

Winter Pressures (LBB) 974,000

Winter Pressures (BHC) 412,000

Integrated care record and MAV 410,000

Intermediate care 449,000

Community Equipment 400,000

Dementia universal support service 493,000

Dementia diagnosis 588,000

Extra Care Housing 397,000

Health Support into Care Homes 245,000

VMO support into ECH 52,000

Self management (contract termination and asset mapping) 993,000

Carers support 600,000

Risk against acute performance 2,000,000

Protecting Social Care 4,250,000

Carers Funding 500,000

Reablement Funds 1,200,000

DoH Social Care grant 4,260,000

Sub Total 19,232,000

ASC Capital Grants 663,000

Disabled Facilities Grants 942,000

Sub Total 20,837,000

2016/17 Uplift 698,000

Total Recurrent Budget 2016/17 21,535,000

Better Care Fund – financial arrangements

� The total Better Care Fund [BCF] allocation is £21,535k of which the LBB receive £1,605k of

grant funding direct. The net CCG budget is £19,930k.

� The LBB manage the BCF and invoice the CCG on a quarterly basis (£4,982k per quarter).

� The CCG recharges BCF costs that it directly incurs to the LBB on a quarterly in arrears basis.

� The quarterly BCF financial position is reported on a regular basis at the Joint Integrated

Commissioning Executive meeting.

56

CCG Forecasting – Best, Likely and Worst

The CCG has carried out a risk assessment and quantified the potential risks that will need to be managed in 2016/17. Initial best, likely

and worst case positions have been set out, which will be refined as more information is available.

� At this point, the CCG has recorded a best and likely position that can be managed within existing budgets and plans

� The table above shows that a worst case scenario would result in the CCG not achieving it’s surplus target and therefore not meet

it’s financial targets for the year57

Forecast Methodology

YEAR END FORECAST

2016/17Best Case Likely Case Worst Case Best Case Likely Case Worst Case

£'000 £'000 £'000

Acute Commissioning 497 0 -5,876 see next slide see next slide see next slide

Non Acute

Commissioning 510 0 -1,020 0.50% underspent breakeven 1% overspent

Primary Care 255 0 -509 0.50% underspent breakeven 1% overspent

Running Costs 36 0 -73 0.50% underspent breakeven 1% overspent

Other Budgets (excluding

Reserves) 117 0 -234 0.50% underspent breakeven 1% overspent

Sub Total 1,415 0 -7,712

1.0% non recurrent 90 0 0 fully utilised fully utilised fully utilised

0.5% contingency 209 0 0 partially utilised (75%) fully utilised fully utilised

Other

Sub Total 299 0 0

Total after utilisation of

reserves 1,714 0 -7,712

Add planned surplus 5,911 5,911 5,911

Total 7,625 5,911 -1,801

Acute Risk Assessment – Best, Likely and Worst

� The risk assessment sets out

three potential scenarios – a

likely, best and worst case, noting

that both the risk assessment and

the scenarios will be further

refined and updated during

2016/17

� The underlying growth and other

assumptions used in the risk

assessment are set out in the 1st

table

� For Month 2 reporting the likely

case position has been reported

as breakeven as it is to early to

forecast trends emerging from

contract monitoring information.

� In applying these assumptions,

these give a range of forecast

acute budget expenditure

positions as set out in the 2nd

table. This shows an underspend

of £0.497m in the best case and

an overspend of £5.876m in the

worst case.58

Forecast (Over)/ Under-spend Likely Case Best Case Worst Case

King's College Hospital NHS Foundation Trust

underlying growth in activity against 16/17 forecast outturn breakeven breakeven 1.00%

marginal rate payable for activity over contract re-opener breakeven breakeven 100.00%

CCG led QIPPs - proportion delivered breakeven breakeven 25.00%

Guy's and St Thomas' NHS Foundation Trust

underlying growth in activity against 16/17 forecast outturn breakeven -1.00% 3.00%

marginal rate payable for activity over contract re-opener breakeven 100.00% 100.00%

Lewisham and Greenwich NHS Trust breakeven breakeven 4.00%

Dartford and Gravesham NHS Trust breakeven breakeven 4.00%

Other Acute Service Agreements breakevensmall

underspend4.00%

Non Contracted Activity breakeven breakeven 4.00%

Locally managed acute services breakeven breakeven 2.00%

Forecast (Over)/ Under-spend Likely Case Best Case Worst Case

£'000 £'000 £'000

Guy's and St Thomas' NHS Foundation Trust 0 199 -731

King's College Hospital NHS Foundation Trust 0 0 -3,166

Lewisham & Greenwich 0 0 -426

Dartford and Gravesham 0 0 -67

London Ambulance Service 0 0 0

Other Contracts 0 0 -692

Total Contracts 0 199 -5,082

Non Contracted - Cost Per Case and Exclusions to Contracts 0 0 -173

Other Earmarked Acute Reserves 0 298 -520

Locally managed acute services 0 0 -101

TOTAL ACUTE FORECAST 2015/16 0 497 -5,876

Cash Position and Debtors Position

� The cash drawings position of the CCG is shown in the

first table

� The maximum cash drawdown figure for

2016/17 was £380,051k

� The CCGs actual month end cash balances

were within the 1.25% target.

� The second table shows the receivables position.

Please note the following:

� Approximately 75% of the NHS prepayments

and accrued income total relates to maternity

work in progress adjustments with acute

hospitals.

� The non-NHS prepayments and accrued

income primarily consist of Bromley

Healthcare £2.1m and London Borough of

Bromley £1.9m.

� The third table is the aged debtors summary

� The value of invoices that are overdue by

more than 180 days totals £542k. £270k

relates to Kings College Hospital and relates

to a recharge for a joint project. £270k

relates to the London Borough of Bromley

and the outstanding invoices have been

escalated within their finance team.

59

Accounts Receivable

Summary NHS Non-NHS Total

£’000 £’000 £’000

Trade Debtors 459 1,620 2,079

Prepayments and accrued

income2,456 4,397 6,853

VAT receivables 0 240 240

Other receivables 47 -358 -311

TOTAL Receivables 2,962 5,899 8,861

Aged Debtors Summary

Overdue by: 0-90 days 90-180 days 180+ days Total

£'000 £'000 £'000 £'000

Total 911 625 542 2,079

Cash Drawdown

Monthly

Drawdown

£000s

Cumulative

Drawdown

£000s

Proportion

of Annual

Cash

Resource

Limit

KPI – 1.25%

of cash

balance as

drawdown

£000s

Actual

month end

cash

balance

£000s

Apr-16 £30,250 £30,250 8.0% £378 £239

May-16 £32,500 £62,750 16.5% £406 £351

Jun-16 £31,000 £93,750 24.7% £388

Jul-16 £31,250 £125,000 32.9% £391

Aug-16 £29,750 £154,750 40.7% £372

Sep-16 £30,000 £184,750 48.6% £375

Oct-16 £30,000 £214,750 56.5% £375

Nov-16 £30,000 £244,750 64.4% £375

Dec-16 £30,000 £274,750 72.3% £375

Jan-17 £30,000 £304,750 80.2% £375

Feb-17 £30,000 £334,750 88.1% £375

Mar-17 £45,301 £380,051 100.0% £566

Annual Total £380,051

Better Payment Practice Code

� Under the Better

Payments Practice

Code (BPPC), CCGs are

expected to pay 95%

of all creditors within

30 days of the receipt

of invoices. This is

measured both in

terms of the total

value of invoices and

the number of invoices

by count.

� The CCG achieved the

BPPC target in both

April and May.

60

BETTER PAYMENT PRACTICE CODE

2016-17

NHS NON-NHS TOTAL NHS NON-NHS TOTAL

NUMBERS FOR THE MONTH

Tota l number of invoices paid in the month 274 964 1,238 187 795 982

Number of invoices pa id within target 273 952 1,225 187 783 970

Numbers %age for the month 99.64% 98.76% 98.95% 100.00% 98.49% 98.78%

VALUES FOR THE MONTH (£000s)

Tota l value of invoices paid in the month 23,800 8,355 32,155 21,969 12,122 34,091

Value of invoices paid within target 23,800 8,139 31,939 21,969 11,864 33,833

Value %age for the month 100.00% 97.41% 99.33% 100.00% 97.87% 99.24%

CUMULATIVE NUMBERS TO THE MONTH

Tota l number of invoices paid YTD 274 964 1,238 461 1,759 2,220

Number of invoices pa id within target 273 952 1,225 460 1,735 2,195

Numbers %age Cumulative 99.64% 98.76% 98.95% 99.78% 98.64% 98.87%

CUMULATIVE VALUES TO THE MONTH (£000s)

Tota l value of invoices paid YTD 23,800 8,355 32,155 45,770 20,477 66,247

Value of invoices paid within target 23,800 8,139 31,939 45,769 20,003 65,772

Value %age Cumulative 100.00% 97.41% 99.33% 100.00% 97.69% 99.28%

May-16Apr-16

Statement of Financial Position

� The table sets out the May

2016/17 and 2015/16 year end

positions.

61

31-May-16 31-Mar-16 Movement

£'000 £'000 £'000

Non-current Assets

Property, Plant &

Equipment 192 207 -15

Total Non-current Assets 192 207 -15

Current Assets

Trade & Other

Receivables 8,861 8,197 664

Cash & Cash Equivalents -389 41 -430

Total Current Assets 8,472 8,238 234

Total Assets 8,664 8,445 219

Current Liabilities

Trade & Other Payables -22,367 -21,413 -954

Provisions & Other

Liabilities -421 -699 278

Total Current Liabilities -22,788 -22,112 -676

Total Assets less Current

Liabilities -14,124 -13,667 -457

Non-current Liabilities

Provisions 0 0 0

Total Non-current

Liabilities 0 0 0

Total Assets Employed -14,124 -13,667 -457

Financed by Taxpayers’

Equity

General Fund -14,124 -13,667 -457

Revaluation Reserve 0 0 0

Other Reserves 0 0 0

Total Taxpayers’ Equity -14,124 -13,667 -457

Financial Risks

Acute Contracts – QIPP

� The QIPP savings target relating to acute services totals £6.0m. The plan has been signed off with

providers and risks are being jointly managed. There is a risk that the savings will not be fully achieved.

Prescribing - QIPP

� A QIPP target of £1.0m has been applied to the prescribing budget. Over the past few years the

prescribing savings target has been achieved in full.

Acute Contracts

� In previous years acute contract over-performance has worsened towards year end, seasonality is built

into forecasts but there is a risk that contracts will overspend at a higher rate.

Continuing Care

� There has been growth in this area over the last few years. The 2016/17 budget has been increased in

line with the suggested percentage uplift based upon the national planning guidance. There is a risk that

expenditure will increase in excess of the uplift applied to the budget.

Mental Health and Learning Disability placements

� These placements are usually high cost and a small increase in the number of clients will have an adverse

impact upon the financial position.

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