Agenda item

Report of the Clinical Commissioning Groups.

Marcus Warnes, Accountable Officer, Staffordshire Clinical Commissioning Groups (CCGs) attended the meeting to present the report and answer questions.

NHS England had a statutory duty to conduct an annual performance assessment of every CCG. The assessment, using the Improvement and Assessment Framework (IAF), is a judgement, reached by considering the CCG’s performance in each of the indicator areas over the full year balanced against the financial management and qualitative assessment of the leadership of the CCG.

The CCGs are assessed against 58 indicators in four categories defined as Better Health, Better Care, Sustainability and Leadership across the Integrated Care System.  Each CCG then receives an overall assessment that places their performance in one of four categories: outstanding, good, requires improvement, or inadequate.

Using the IAF, NHS England also assesses how effectively CCGs work with others (including the local Health and Wellbeing Boards) to improve quality and outcomes for patients as well as considering how they have contributed to the performance of their local systems as individual organisations.

In the 2018/2019 annual assessment, five of the six CCGs in Staffordshire and Stoke-on-Trent have been given an overall rating of Inadequate with only East Staffordshire CCG rated as good.

The key area of concern for the CCGs rated as inadequate, related to the continued financial challenges they have faced during 2018/19. Although NHS England noted that Stafford and Surrounds CCG and Cannock Chase CCG met their deficit control total this year, there has been a significant deterioration in the financial position for North Staffordshire CCG and Stoke-on-Trent CCG and the underlying deficit across Staffordshire and Stoke-on-Trent had exceeded £100million.  All CCG’s had struggled to meet the Quality Innovation Productivity and Prevention (QUIPP) savings.

The CCG’s had asked NHS England why Stafford and Surrounds and Cannock Chase CCG’s had been rated inadequate, but a detailed response had not yet been received.

A Member asked if the £300,000 grant for suicide prevention had been received and what it would be used for.  A response would be requested and sent to the member for information.

Following a question on financial waste in the system and what was being done to reduce the figures, it was reported that too many people were being admitted into hospital, with 52% of people dying in hospital even if their wish was to die elsewhere.  North Staffordshire was also spending £26m on Muscular skeletal operations when evidence suggested that half of the procedures were of no benefit to the patient.  Pricing charges and how partners are choosing when to offer procedures to patients and their benefit was being monitored as there was often limited medical value.

There was a discussion around balancing the budgets, particularly regarding urgent care and hospital reconfiguration.  Timescales for hitting budget targets had slipped and was now 2023.  Everything was being reviewed including waste, efficiencies and expectations.

Prevention was the responsibility of Local Authorities and it was acknowledged that over recent years there had been some difficult decisions to make.  The NHS aspect of the prevention agenda was focusing on mental health and early detection of dementia.  Members felt that preventative work was essential, and the possible sharing of resources was needed to move forward. 

A Member asked how progress on the improvement action plans would be monitored.  It was felt that a regular six monthly update report would be useful.

A question was asked on delayed discharges and where the blockages were.  The Committee was informed that there were more delays in the South of the County.  A report on the extent of the problem and what was being done to address the issue was requested.

It was felt that without real advances in clinical leadership it would impossible to save money.

RESOLVED: 

a)    That a six month financial exception report be presented to the Committee.

b)    Information on the £300,000 grant for suicide prevention be sort and sent to the Committee for information.

c)    A report on the extent of the delayed discharge problem, particularly in the South of the County and what was being done to address the issue was requested.