Agenda item

The Committee received a report of West Leicestershire CCG and East Leicestershire CCG which provided an update on the 2018/19 Quality, Innovation, Productivity and Prevention (QIPP) programme for West Leicestershire CCG and East Leicestershire and Rutland CCG. A copy of the report, marked ‘Agenda Item 11’, is filed with these minutes.

 

Along with Dr Chris Trzcinski, the Committee welcomed Karen English, Managing Director at East Leicestershire and Rutland CCG, Paul Gibara, Chief Commissioning and Performance Officer and Caroline Trevithick, Chief Nurse, Quality Lead and Governing Body Nurse at West Leicestershire CCG to the meeting for this item.

 

In presenting the report the following information was given:

 

(i)        The CCGs received approximately £932 million per annum to commission health services in Leicester, Leicestershire and Rutland. Due to growth and inflationary pressures the CCGs were forecast to have a £42 million shortfall during 2018/19 therefore this figure needed to be made up from efficiency savings within the CCGs while ensuring that clinical outcomes were not affected. The money generated would be put towards the priorities for the CCGs which were:

·         ensuring primary care was safe and responsive;

·         mental health services;

·         ensuring waiting lists did not grow.

 

(ii)       QIPP schemes were explained to members using the Musculoskeletal service as an example. Whilst there was a triage process for the Musculoskeletal service, work was being carried out with partners and providers to make the system more efficient and triage patients earlier. A single point of access was being developed for patients with musculoskeletal issues where they would be identified early by GPs and referred for physiotherapy. Improving the self-referral system was also being looked at.

 

Arising from discussions the following points were noted:

 

(iii)      Before making changes to services Quality Impact Assessments were carried out and all schemes were signed off by the Chief Nurse to ensure they were safe.

 

(iv)      Members raised concerns that the CCGs would not have an idea whether the required savings were going to be achieved until half way through the financial year and by this time it may be too late to make the necessary adjustments. In response reassurance was given that monitoring took place on a weekly basis and there were contingency plans in place should it appear that the required savings would not be made. Alternative schemes would be implemented should the QIPP plan not produce the desired results. Reserves could also be used if necessary.

 

(v)       In response to a question from the Chairman it was explained that the CCGs had a fair amount of confidence that the savings could be achieved, however until the hidden implications were properly understood they could not have complete confidence. Usually the CCGs set themselves a higher savings target than was strictly essential therefore even if the target was not met it would not necessarily result in an overspend.

 

 

(vi)      Members sought reassurance that the transformation process would not affect frontline services and it was confirmed that the management structure and other back office functions were the main areas targeted for savings.

 

(vii)    A concern was raised regarding the housing growth particularly in the south Leicestershire area, the lack of equivalent growth in GP Surgeries and ineffective use of the process under Section 106 of the Town and Country Planning Act 1990. Members asked for reports on these issues for a future meeting of the Committee. The CCGs gave reassurance that they were fully engaged with the Strategic Growth Plan and were aware which areas of Leicester, Leicestershire and Rutland were to experience growth and therefore need to be prioritised by the CCGs.

 

(viii)   In response to a question from a Member it was confirmed that the biggest difficulties the CCGs faced related to the workforce rather than estates and buildings.

 

(ix)      A member raised concerns that patients were having difficulties returning Community Equipment to the NHS when they no longer needed it and that savings could be made if this equipment was reused. In response it was explained that contract penalties were in place if equipment was not collected and that the CCGs would look into this matter further.

 

(x)       Clarification was given that West Leicestershire CCG was bidding for £8 million of capital funding to invest in the Hinckley area of Leicestershire and this was a separate budget to the £932 million referred to above. West Leicestershire CCG asked for support from members for any bids for capital funding.

 

(xi)      In response to concerns regarding how the QIPP programme would apply to Continuing Healthcare where the aim was to support patients in their own homes as long as possible, it was explained that it was key to ensure that the National Framework for NHS Continuing Healthcare was applied correctly and people met the eligibility criteria. Liaison needed to take place with Local Authorities to ensure that the NHS was providing the elements of care that it was responsible for and not more. There were other efficiencies that could be made such as reviewing patients more regularly to ascertain whether the care they were receiving was still appropriate, and making sure that patients which had died were no longer being budgeted for.

 

RESOLVED:

 

(a)       That the update on the 2018/19 Quality, Innovation, Productivity and Prevention (QIPP) programme for West Leicestershire CCG and East Leicestershire and Rutland CCG be noted;

 

(b)       That officers be requested to produce a further report on the QIPP programme for the September 2018 meeting of the Committee.