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NHS KIRKLEES

Minutes of the Finance & Performance Committee held on 19 May 2010 in the Boardroom, St Luke’s House Present

Steve Brennan, Deputy Director of Finance Peter Flynn, Director of Performance & Information Tony Gerrard, Non-Executive Director Judith Hooper, Director of Public Health Carol McKenna, Director of Commissioning Bryan Machin, Director of Finance (Chair) Rob Millington, Non-Executive Director Terry Service, Deputy Director of Corporate Services Samantha Williamson, Programme Officer David Wood, PEC member

In Attendance

Amanda Bryson, PA to Bryan Machin (Minute Taker)

FPC/36/10

Apologies for Absence Helena Corder, Sheila Dilks, Mike Potts, Alex Wilson

FPC/37/10

Minutes of the Last Meeting & Action Checklist The minutes were agreed as an accurate record. The Action Checklist was modified as follows: FPC/60/09 Finance Reporting Pack - Ongoing

FPC/38/10

Matters Arising There were none.

FPC/39/10

Performance Report Peter Flynn presented the year end Performance Report to the Committee and commented that the year end position is now known for most performance areas. Peter explained that the performance for YAS has improved and Cat A calls had achieved over 70%. David Wood raised concern that the Denby Dale & Kirkburton areas were only achieving 30%. Peter noted that overall demand for YAS was 2.3% above plan, however, Kirklees was 1.5% below plan for the year. A discussion took place about the regional approach to the 2010/11 YAS contract. Rob Millington asked that it should be highlighted to the Board. ACTION – PCT Board to be kept informed regarding YAS 1


contractual arrangements. Peter explained that the diabetic retinopathy screening, which had previously been showing as likely to achieve the year end target, was now showing as not achieved. This is mainly due to a new system of how the figures are calculated. Most specialities are achieving the 18 week target. However, cardiothoracic and neurosurgery at Leeds have been unsuccessful in seeing 4 patients within 18 weeks. David Wood asked what work was being undertaken with these specialities to try and elicit an improvement. Peter confirmed that specific actions had and were being taken with neurosurgery but was unsure of actions relating to cardiothoracic surgery. Peter explained that the target number of patients with access to dental services had been unknowingly changed following the publication of a DoH toolkit in October 2009. David Wood advised that there is due to be another DoH toolkit to be published following the GP survey which will include questions on dentists. He also commented that there were still a high proportion of patients having access to dental services and that access to dentists in Kirklees has always been high so it is difficult to highlight an increase in access. All cancer indicators have achieved their year end target. Following action taken in the last few months, there has been a slight rate of improvement in Chlamydia screening but the PCT will still underachieve on this target. Peter commented that there would be a challenge for the coming year as the target had increased by 10%. The Committee discussed in length the reasons why the target was not being achieved and various ways in which it could be improved. It was apparent there were clear variations in primary care/ GP performance. Carol McKenna informed the Committee that a performance matrix was currently being worked on for presentation to the LMC in June. Bryan commented that the development of a quality matrix should be a priority piece of work for the PCT. Tony agreed and stated that it should form part of the PCTs strategic plan. It was agreed that it should be discussed at Board level. ACTION: Variation in quality of healthcare to be discussed at next Board Workshop (28 July). Carol McKenna to update the Committee regarding progress at the June meeting of F&P (23 June). Although the PCT have failed to achieve the target relating to breast feeding, there has been a significant improvement in the last quarter. Peter explained that there has also been significant improvement in stroke care and MRSA targets 2


Judith Hooper advised the committee that there was a possibility figures relating to smoking at birth in the Wakefield area may not have been recorded accurately. Judith has spoken to DPH at Wakefield who is investigating but is not sure how this will affect the overall performance figures. ACTION: Judith Hooper to report back to next F&P meeting re possible inaccuracies in reported figures. Peter concluded by stating that the PCTs overall performance was likely to be formally reported as fair/good.

FPC/40/10

SLA Update Report Carol McKenna presented the SLA report to the Committee. She explained that there was still a significant overtrade with CHFT (ÂŁ1.3m). The main contract variances are mainly due to an increase in non-mandatory services, eg. ICU and high cost drugs. The contract with CHFT for 2010/11 is still under negotiation but it is expected to reach agreement in the next week. A settlement has been reached with MYHT for their full-year payment, which includes a payment of ÂŁ1.85m overtrade. MYHT contract for 2010/11 has been agreed and signed. There have been overtrades with other Providers, significantly Barnsley Foundation Trust which is mainly spread across their elected and non-elected obstetric activity. This may be due, in part, to the CHFT reconfiguration of maternity services. Contract negotiations with Bradford, Barnsley and Leeds are currently ongoing.

FPC/41/10

Budget Update Report Steve Brennan presented a Budget Update Report to the Committee. He explained that the report contained a breakdown of individual budgets and also gave an update regarding the signing of contracts since the budget was approved at the March Board meeting. Acute contracts with CHFT, LTHT and SCG remain unsigned and there is an anticipated pressure of ÂŁ2.4m if these and other contracts are agreed at the levels currently being discussed. Tony Gerrard queried the report in that it did not appear to reflect the schedule of changes report to the Board following the previous F&P Committee meeting. Steve Brennan assured him that these changes were incorporated in the report Rob Millington asked whether the secondary sector were also 3


working towards efficiency savings. Bryan confirmed that discussions have commenced with the implementation of the Transformation Board. However, is unlikely to generate significant savings this year. HITs Steve Brennan tabled a spreadsheet which showed money earmarked for investments in 2010/11. Some investments have been taken out which has left a total of ÂŁ3.6m in the plan. However, due to the PCTs financial pressure, bidders have been asked to confirm their pre-committed expenditure and this is expected to be in the region of ÂŁ1m. Steve and Sam are shortly to undertake a process to identify such investments. All other potential investments will then be removed and the rest of the monies will be available to offset shortfalls in the budgets. Rob Millington enquired how efficiencies were shown. Steve confirmed that the spreadsheet showed efficiencies against individual budgets. Rob commented that it would be useful to see a paper which demonstrated the efficiencies. Bryan explained that it would be shown through the normal reporting process. Tony Gerrard commented that it would be useful for those containing risk to be highlighted.

FPC/42/10

Management Costs Bryan Machin informed the Committee that he and Mike Potts had met with all the Directors to discuss management costs. There is a planned 10% reduction in management costs for the year 2010/11 with 15 % recurrent costs. It is hoped that the 10% reduction will be made by freezing vacancies and not employing agency staff. Discussions are ongoing re functions and the sharing of functions across the organisation. It has been agreed not to undertake a full restructure but more flexible working needs to happen across the whole PCT. Bryan agreed to produce a paper giving details of management costs for the next meeting. ACTION: Bryan to produce a paper on Management Costs for next F&P meeting.

FPC/43/10

QIPP Bryan Machin advised the Committee that the Strategic Development Committee had agreed to refocus their agenda and look at identifying and the delivery of savings. Pressure is being put on the SHA by DoH regarding QIPP. The Chief Executive of Y&H SHA has requested information on QIPP from each PCT. Sam Williamson advised that a control document was needed to monitor progress and give a consistent approach throughout the PCT. This is currently being progressed. Sam produced a copy of 4


the document currently being worked on and the Committee agreed it appeared to be a useful tool. Bryan confirmed that the PCT needed to focus on a few potentially good schemes.

FPC/44/10

Escalation to Risk Register The Committee agreed that Chlamydia screening, YAS (which should already be on the risk register) and management costs – risk to deliver savings, should be on the Corporate Risk Register. Tony Gerrard commented that it would be useful to know what was already included on the Register. Sam confirmed that she was meeting with Helena and Carol later in the week to discuss risk reporting.

FPC/45/10

Any Other Business None

FPC/46/10

Date & Time of Next Meeting The next meeting will be held on Wednesday 23 June 2010, 2.00pm in the Committee Room, Broad Lea House, Bradley.

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