Financial Position 2015/16 and 2016/17 Council Meeting 21st April 2016 Newbury and District CCG Financial Position 2015/16 and 2016/17 Council Meeting 21st April 2016

2015/16 CCG will achieve planned surplus position of 1% allocation at £1.277m BUT are achieving this through spending “the family silver”. Spend on hospital services this year at RBFT, HH, GW and Independent Sector Providers is almost £2m (3.2%) over plan.

2015/16Hospital Spend RBFT - Main over-performance:- HH GWH Emergency admissions (5.2% over plan), Day Cases (7.4% over plan) Elective admissions (4.6% over plan) HH 7.6% over plan on emergency admissions GWH 7% over plan on electives (mainly T&O). Independent Sector Circle, BIH and Spire Dunedin all over plan

Independent Sector 2015/16

2015/16 FINANCES Not achieving Planned QIPP Savings Plan £2.2m, forecast achievement £1.7m, of which £620k covered by QIPP reserve How is this position being covered? Use of contingency £740k Use of reserves £2.7m Family silver use – once its gone its gone!!! The 2015/16 end position impacts on 2016/17.

2015/16 CONTEXT Hospitals nationally forecasting £2.4bn deficit at the end of 2015/16 Hospitals locally also forecasting financial deficits for 2015/16 Royal Berks £9.1m Berkshire Healthcare £2.0m SCAS £3.7m Why? Agency Costs Not achieving CIPs (efficiency levels not achievable) Tariff system not working (for anyone) Costs of treating increasingly elderly population DTOCs Fines and penalties associated with not hitting performance targets

2016/17 THE GOOD NEWS: Newbury and District received 3.05% additional funding in 2016/17 (Additional £3.8m) Newbury and District CCG is in the bottom 10 CCGs in the country at £1089 per person (1.87% below target)

2016/17 THE BAD NEWS: Its not really all additional! It needs to cover:-

2016/17 Plans The QIPP Gap is therefore £3.4m of which only £2m (58%) has been identified Most of the QIPP schemes identified adversely affect acute income Dilemma -Why would Trusts/ IS help us to achieve these? Current tariff, payment and contracting arrangements are not working for anyone There has been a conscious shift nationally to move (or at least share) the deficit pain to CCGs

What can you do to help? Consider all referrals:- Urgent Care Centre Hospitals - Can anything else be done first? Alternative treatment, physio, pain service Self management, weight loss, exercise, monitoring etc Comply with restricted procedures guidance Reduce variation Consider referral choice MFF RBFT 1.1498 UCLH 1.297 OUH 1.1003 Consider prescribing Nurofen on prescription - £130 for 20 capsules Identify QIPP savings (please!)

Do you know the price of treatment? 1st Outpatient Attendance Paediatric clinical haematology Paediatric ENT T&O A&E Attendance (no treatment) MRI Scan – 1 area Non-Elective Alzheimer’s Minor pain procedure Day case cataract Tonsillectomy (<18) Tooth extraction (<18) See Treat and Convey and Urgent Ambulances £417 £103 £119 £57 £138 + 22 report £4790 £2120 £980 £1287 £427 £232

Primary Care CCG moved to fully delegated commissioning for GP Primary care services Budget of £14m for Newbury transferring The CCG will not receive any transfer of resource from NHS England to manage this area

In summary 2015/16 2016/17 CCG forecasting to achieve planned surplus CCGs spending too much on hospital services CCGs not achieving transformational QIPP savings National and local provider deficits a real issue Living off the family silver! Impacting on 2016/17 2016/17 Growth monies positive but need to stem the acute demand Rules changed to shift provider deficits to commissioners No family silver left (apart from that c/f from 2015/16) Cannot spend Non recurrent monies of £1.7m QIPP gap of almost £3.4m, £1.4m yet to be identified Need to do something different – ACS!