ARGYLL & BUTE CHP COMMITTEE / Argyll & Bute Community Health Partnership
Aros
Lochgilphead
ARGYLL
PA31 8LB
/
Council Chambers, Kilmory, Lochgilphead / 27 March 2008 – 13.00
Present / Bill Brackenridge, Chairman, Argyll & Bute CHP
Derek Leslie, Argyll & Bute CHP General Manager
Dr Michael Hall, Clinical Director, Argyll & Bute CHP
Evelyn Hide, Vice Chairman, Public Partnership Forum
Elaine Garman, Public Health Rep.
Neil Robinson, Area Pharmaceutical Committee Rep.
Tricia Morrison, CVO Rep.
Pat Tyrrell, Lead Nurse, A&B CHP
Dr Gordon Stewart, GP Sub Committee Rep.
Robin Creelman, Public Partnership Forum Chairman
Douglas Hendry Argyll & Bute Council
John Herrick, Area Dental Committee
Anne Clark, Non Executive Director, NHS Highland,
Elaine Robertson, Non Executive Director, NHS Highland
Donald Barr, Area Optical Committee Rep
In Attendance / Stephen Whiston, Head of Planning, Contracting & Performance A&B CHP
George Morrison, Head of Finance, A & B CHP
David Ritchie, Communications Manager, A&B CHP
Jim Robb, Argyll & Bute Council
Margaret Johnston, Admin Assistant , A & B CHP - Minute Secretary
1CHAIRMAN’S WELCOME
The Chairman opened the meeting by welcoming everyone to the Council Chambers, Kilmory, Lochgilphead and welcoming Derek Leslie, General Manager, Argyll & Bute CHP to his first CHP Committee.
2APOLOGIES
Apologies for absence were received from:
Donald McIntosh, Argyll & Bute Council
Dr Alan Davidson, Consultant Rep
David Logue, Head of HR, A&B CHP
Kate MacAulay, Staffside Rep.
George Freeman, Argyll & Bute Council. The Chairman informed the Committee that Councillor Freeman had been in hospital and would be recuperating at home for a time and wished him a speedy recovery.
3MINUTE OF MEETING HELD ON 31 JANUARY 2008
The minutes of the meeting on 31 January 2008 were accepted as an accurate and complete record of the meeting.
The Committee noted the contents of the Minute.
4MATTERS ARISING
All items covered by agenda.
5NHS HIGHLAND HEALTH BOARD
5.1Minutes of Meeting on 31 January 2008
The Chairman spoke to the previously circulated minutes of the meeting on 31 January 2008 offering to answer any questions. Elaine Robinson referred to page 126 of the minutes and asked if there had been any progression regarding Vale of Leven Hospital. Derek Leslie advised that we are still awaiting confirmation regarding consultation proposals. The Minutes were noted. The Chairman confirmed that he has spoken to the Chairman of NHS Highland regarding this and organised to have up to date Draft Board Minutes rather than rather historic Agreed minutes.
The Committee noted the Minutes.
6FINANCE
6.1Finance Report
George Morrison spoke to a previously circulated paper asking the Committee to note the Financial Report.
Revenue Position as at 31 January 2008:
Mr Morrison confirmed that Argyll & Bute CHP revenue position at 31st January 2008recorded an underspend of £1,342,000. This continues the trend of a developing underspend which has been experienced over the course of this financial year however if bridging funding of £2.5million had not been in place there would have been an overspend of £1million.
Mr Morrison drew attention to two areas of risk:
- Agenda for Change– This remains the biggest financial uncertainty facing the CHP as it is now 3½ years beyond the implementation date with a considerable number of staff awaiting assimilations and appeals to be considered. Mr Morrison confirmed that there is funding in place to support the expected outcome of implementing Agenda for Change however there is obviously a significant financial risk attached to this exercise.
- Recurring Deficit – The recurring deficit has been driven down from £5m at the inception of the Argyll & Bute CHP to £2.6m at the end of this financial year. At present this funding is covered by the bridging funding received however this funding will reduce to £1.5m next year and then down to zero the year after that.
Forecast Outturn for 2007/08
Mr Morrison confirmed that he is continuing to forecast an underspend of £1.5m at the year-end, however there are a number of indicators which suggest that the underspend may be even higher than this.
Financial System
NHS Highland is in the process of implementing a single financial system for the Board area which should be operational from 1st April 2008. Mr Morrison has been assured that the changeover from current arrangements should be relatively seamless with little or no disruption being experienced outwith the finance and procurement departments.
The Committee noted the Finance Report.
6.2Summary Review of Financial Position
George Morrison spoke to a previously circulated paper asking the Committee to note that the Financial Report will be going to the Management Team meeting on 1 April 2008 for approval of the revenue budget for 2008/2009.
Review of Argyll & Bute CHP’s Financial Position
Mr Morrison informed the Committee that since inception, Argyll & Bute CHP has had to contend with a revenue budget deficit of uncertain value which has been due mainly to a lack of clarity regarding the true cost of services provided to the CHP by NHS Greater Glasgow & Clyde. Now that this issue has been resolved, it has been possible to re-assess the CHPs recurring deficit from its date of establishment showing the re-calculated figures taking into account the full cost of services provided by NHS GG&C. The recurring deficit at 1 April 2006 was £4.889m which decreased to £4.222m at 1 April 2007 and going into 2008/09, the CHP’s opening recurring deficit is £2.627m.
Substantial progress has been made over two years to reduce the recurring budget gap and this through a combination of factors; accurate financial planning, effective budget management by Locality Managers and also achievement of savings targets.
Budget Proposal for 2008/09
A budget proposal for 2008/09 has been prepared using the tried and tested straightforward methodology of consistent incremental budget setting however a number of issues were highlighted in relation to the budget
Funding from SGHD
The funding uplift from SGHD is 3.15%, which is a relatively low settlement and is not expected to cover in-year cost growth estimated at 3.6%.
In addition, bridging funding of £1.5m will be available to support the position inherited from Argyll & Clyde Health Board however it is expected that this will be the last year in which bridging funding will be available.
During the course of the year, it is anticipated that a number of specific allocations will be received from SGHD. The base budget proposal contained in this paper does not include anticipated allocations.
Funding carry-forwards from 2007/08
A number of carry-forward requests have been made to the Board in respect of unspent specific allocations from SGHD. Advice has yet to be received from the Board regarding these carry-forwards and as such, they are not included in the CHP budget proposal at this stage.
Prescribing Budgets
The overall CHP prescribing budget has been set on an incremental basis, in line with other budgets. In 2007/08, GP prescribing budgets were set on the basis of historic cost however this provoked some criticism in that it was seen to penalise efficient practices and reward those practices which were high cost. To remedy this, GP prescribing budgets in 2008/09 are being set on the basis of a formula agreed by the CHPs Medicines Management Group.
Income from Prescription sales
The government is phasing out prescription charges over a 3 year period. In 2008/09, this is expected to result in a loss of income of £300,000 to the CHP. It is anticipated that this loss of income will be remedied by an additional allocation of funds from SGHD during the course of the year.
Agenda for Change
The budget contains a provision of £400,000 for further costs relating to the implementation of Agenda for Change. This provision allows for incremental drift and the introduction of the unsocial hours payments agreement. The provision adds to an existing budget reserve being held for Agenda for Change implementation.
General Medical Services (GMS)
No adjustment to GMS budgets is contained within the budget proposal. It is anticipated that notification will be received in due course from SGHD of any additional funding being allocated for GMS. CHP budgets will be updated in line with advice received from SGHD.
Capital Charges
There is a provision of £550,000 contained in the budget for increased capital charges. This relates to the significant investment in capital infrastructure within the CHP, specifically in buildings and medical equipment.
Service Developments
Due to the low level of SGHD funding uplift and the CHP’s overall financial position, there is little scope to provide additional funding for service developments.
Savings Targets
The total savings target for the CHP is £2m, of which £1m is recurring and £1m is non-recurring. The recurring target in particular will present a significant challenge to Managers in the CHP.
Some discussion took place with Elaine Robertson enquiring as to whether the provision made for Agenda for Change is sufficient and was advised by Mr Morrison that the provision should be sufficient. Mr Creelman raised the question of incremental budget methodology and Mr Morrison gave an explanation of this methodology to the Committee.
The Committee noted the summary review and the budget proposals being put before the Management Team for approval.
7PERFORMANCE
7.1Balanced Scorecard
Stephen Whiston spoke to a previously circulated paper which detailed the performance of the CHP against a range of key targets and indicators. This report draws attention to the areas on the score card where performance trends are downwards or causing concern.
Mr Whiston drew the attention of the CHP Committee to the red indicators:
- Sickness & absence
The target for sickness and absence was 4% by March 2008. As at October 2007 the CHP position had improved slightly to 5.53%, however this has increased by 1.0% to 6.34% in January 2008. This is the same trend as NHS Highland however the level of absence in the CHP is recognised as a serious issue both in terms of finance and performance.
- Prescribing of anti-depressants
The second quarterly report of this indicator is red as performance reported is 1.43% almost double the LDP trajectory of 0.81%, although there has been an improvement in the position from the previous period.
Same Day Surgery
Mr Whiston highlighted one other area from the report and reported that Same Day Surgery day cases and outpatients/total elective for set procedures defined by the British Association of Day Surgery – figure of 35.3% April is the first fully completed formal report. There remain gaps in data collection, however it should be noted the day case rate is static around 40%. The national target is 82.5% by December 2010.
Delayed Discharge
Stephen Whiston advised that the situation as at March 2008 in Argyll & Bute as follows.
1 Delayed Discharges over 6 weeks (target 0)
2 Delayed Discharges in Short Stay (target 0)
Mr Whiston advised that we are very close to achieving this target. Jim Robb advised that he is working closely with Josephine Bown, Head of Service Integration in this regard and can see no reason why we should not achieve the 00 target.
Viv Shelley enquired as to what happened in 2005/06 with prescribing of anti-depressants as there was a big dip in prescribing. Stephen Whiston advised that this has been caused by a drug scare at that time.
The Committee noted the Balance Scorecard report.
7.2National Waiting Times Targets
Mr Whiston spoke to a previously circulated paper and reported the following to the Committee.
General Waiting Times Target
Mr Whiston advised that the target for December 2007 was ‘no patient would wait more than 18 weeks for a first consultant outpatient appointment and admission to acute specialities’ and confirmed that the CHP continues to achieve this target.
Diagnostics
Mr Whiston advised that the target for December 2007 was ‘no patient will wait more than 9 weeks for eight diagnostic tests’ and confirm that the CHP had achieved the target. Mr Whiston asked the Committee to note that despite the CT Scanner at LIDGH being out of commission for a time that targets had still been met.
18 Week Patient Referral to Treatment Target
Mr Whiston referred to the announcement of the above and advised that the intention of which is to see by 2011 the following:
- The end of queuing as a rationing mechanism after 63 years
- The end of the anxiety and worry which goes with waiting
- The end of the annual round of waiting list initiatives
- The end of stage of treatment guarantees
Mr Whiston highlighted that the Milestone targets for March 2009 of 15-15-6 (Inpatient, outpatient and diagnostic). However, a meeting with the SGHD and the NHS Board has directed NHS Highland to achieve a 12 -12 -4 target, with the caveat that funding will only be released if the Board sign up to this.
NHS Highland is currently considering and modelling the demand/activity to achieve this target, but the new target raises a number of key issues:
- At the same time, start to focus on pathways for treatment in achieving the patient journey – implementing similar tracking processes as cancer referral and treatment waits
- Significant challenges over the information dimensions – referral, outpatient and diagnostic appointing and treatment computer systems do not “speak to each other”
- Outreach service delivered from Glasgow & Clyde – new targets may drive further centralisation
- Viability of very infrequent clinics – 6 monthly andquarterly
- Identifying initiatives in primary and community care to manage demand re: initial work up to consultant referral for diagnostics e.g. direct referral for CT, MRI etc, preadmission screening, and all follow up appointments seen in primary care.
- Identifying and enabling capacity and skills in CHP and GG&C to support service
- AHP targets e.g. audiology and physiotherapy due to come on line 2009/10
The CHP has already commenced work via the waiting times group to assess and review the picture and resources it has available to undertake this work and it will continue to update the CHP management team accordingly.
Discussion followed Mr Whiston’s report with Viv Shelley drawing attention to the statistics on Table 1 of the report – Ms Shelley asked if these patients are waiting for appointments with Argyll & Bute CHP and Mr Whiston confirmed that this was correct. Mr Creelman enquired if there was any reason why a patient who lives in Dunoon and is receiving treatment from a Consultant at Inverclyde Hospital and requires follow-up blood tests cannot have these tests carried out at their own GP practice rather than having to travel to Inverclyde. Dr Hall advised that he could see no reason why this cannot be done at the patients GP practice.
The Committee noted National Waiting Times Targets – Performance Report.
7.3Delayed Discharge
Stephen Whiston advised the Committee that he had nothing to add to what had already been discussed at Item 7.1 regarding Delayed Discharge.
7.4 Local Delivery Plan
Stephen Whiston spoke very briefly to the previously circulated comprehensive paper which gave the latest progress update on delivery for health looking at trajectories, the progress made on the HEAT target which had been changed, the change in the time lines and looking at the key priorities which form the baselines. Mr Whiston also confirmed that the Local Delivery Plan will be considered by the Board in April 08.
Discussion followed with Derek Leslie emphasising that the Local Delivery Plan shapes our ‘must do’ targetsand priorities for the CHP in 08/09. Mr Leslie also spoke about the Scottish Government’s approach which he feels is now joining together common focus and targets with work being taken forward by the CHP and Argyll & Bute Council on Single Outcome Agreements also in one focused approach. It is important that we meet HEAT targets and monitor success. Mr Leslie also drew attention to the trajectory papers at the end of the report and confirmed that these give a sense of movement and comparison in relation to other Health Boards. Elaine Robertson referred to the paper and asked what was the cause of the increase in the sickness absence rates. Derek Leslie advised that this is one of the key priorities within the Argyll & Bute Partnership Forum and that an action plan exists looking at key interventions of sickness and absence and stressed that this is not an exclusive HR responsibility but one that lies with Managers to examine why there are high levels of sickness absence. It is up to the Managers to manage. Bill Brackenridge also advised that at the Performance Review Group Sickness and Absence is marked red month after month. Viv Shelley moved on to Smoking Cessation and referred to the number of advisers being 9.8 full time equivalents and asked if that included other agencies apart from NHS and also enquired if will we be looking at a coordinated service. Elaine Garman advised that we are only looking at NHS efficiency and are trying to make sure that we are more effective. Ms Garman also confirmed that it is hard to get data as GP’s and voluntary groups are used.