1. 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

2. 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.

3. 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

4. Independent Sector 2015/16

5. 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.

6. 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

7. 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)

8. 2016/17
THE BAD NEWS:
Its not really all additional! It needs to cover:-

9. 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

10. 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
UCLH 1.297
OUH
Consider prescribing
Nurofen on prescription - £130 for 20 capsules
Identify QIPP savings (please!)

11. 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
£ report
£4790
£2120
£980
£1287
£427
£232

12. 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

13. 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!