Agenda item

Mike Gilbert (Assistant Accountable Officer, NHS Swale CCG and NHS Dartford, Gravesend and Swanley CCG) was in attendance for this item.

(1)       The Chair welcomed Mr Gilbert to the Committee. Mr Gilbert began by explaining that NHS Dartford, Gravesend and Swanley CCG had been invited to present to the Committee following it being rated as inadequate and placed in financial special measures by NHS England in their annual assessment of CCGs. Four areas of concern had been identified by NHS England: the first two areas related to the non-delivery of the NHS constitutional standards on A&E 4 hour and 62 day referral to treatment cancer targets which were not unique to the CCG. The second two areas related to the CCG’s deficit of £13.5 million in 2016/17, which was the primary reason for the rating, and the leadership capacity of the CCG which was shared with NHS Swale CCG. Mr Gilbert stated that the CCG accepted the rating and was working with NHS England to make improvements, particularly in relation to its financial performance.  

(2)       Mr Gilbert outlined the actions being taken by the CCG. He reported that the CCG had a financial recovery plan which had been in place since last year; a review at the start of the financial year had identified further efficiencies and the forecasted deficit was £7.3 million in 2017/18. He stated that there had been a number of appointments to the Governing Body including a Chief Operating Officer, Deputy Chief Nurse and additional GP clinical leads. He noted that a number of efficiency schemes had been introduced including a campaign to reduce medicine waste which was anticipated to make £2 million of savings. He highlighted that the CCG was working with GPs on clinical appropriateness of referrals into secondary care; there had been a 9% growth in activity at Darent Valley Hospital. He stated that the CCG was in contractual management discussions with its providers to review, refine and renegotiate contracts to ensure effectiveness and value for money; in some circumstances the CCG may need to decommission services. He stated that the CCG recognised that it was living beyond its means, he highlighted the impact of growth on the area with the creation of the garden city with 60,000 residents moving into the area in the next 10 – 12 years and the importance of funding allocations to reflect this.

(3)       The Chair enquired about the increase in hospital activity and the impact of services being shifted from the acute to community as proposed in the STP. Mr Gilbert explained that there had been a significant increase in activity going to London providers and Darent Valley Hospital; for every patient treated in London, a market forces factor was paid in addition to the national tariff. Whilst the CCG recognised patient choice, it was reviewing with GPs, when offering choice, that routine services provided in London were more expensive. Mr Gilbert reported that the shift of services from the acute to community would require and enable significant investment and integration of community services through local hubs.

(4)       Members asked about the CCG’s relationship with NHS England, joint commissioning with social care and the community services contract with Virgin. Mr Gilbert explained that the CCG had a good working relationship with NHS England locally who recognised the impact of growth in the CCG’s area; both organisations were working together to identify and address issues faced by the CCG. He confirmed that the CCG had had joint commissioning arrangements, for learning difficulties, mental health and some children services, with Kent County Council for the last 18 months; further joint commissioning of adult social care was required. He stated that the CCG had awarded a seven year block contract for community services to Virgin; the contract was performing at the level it was commissioned and did not cost more than the previous contract.

(5)       In response to questions about the joint executive team, over-performance of providers and audit of GP referrals, Mr Gilbert reported that NHS Swale CCG and NHS Dartford, Gravesend and Swanley CCG had a joint executive team which worked for both Governing Bodies; the recently appointed Turnaround Director and Chief Operating Officer worked across both organisations. He explained that providers such as Dartford & Gravesham NHS Trust were paid per patient and the CCG was required to pay for any activity above the planned level which resulted in underfunding. The CCG was working with the Trust to ensure that it met its targets whilst keeping activity within the planned level. He reported that audits were carried out as part of routine contract management checks.

(6)       Members enquired about the commissioning of specialist services, budgeting and funding allocations. Mr Gilbert explained that NHS England commissioned specialist services so were not included in the CCGs’ baselines. He noted that it was more difficult to budget for non-elective activity as there were a number of factors which influenced activity such as winter pressures. He reported that NHS Swale CCG also had a small deficit for the first time in its history. He stated that NHS England set allocations based on a 1% growth in the CCG area; the CCG asked for this to be reviewed as it was based on historic ONS data which did not reflect growth in its area. He stated that whilst the CCG had made representations to NHS England and its local MPs about its funding, the CCG recognised that it had to operate within its current allocation and demonstrate efficiency; as an example the CCG was exploring the use of technology between GPs and consultants to improve the effectiveness of outpatient appointments.

(7)       Members asked about workforce, special measures and the rationalisation of services. Mr Gilbert explained that due to its proximity to London staff were attracted to London’s world renowned specialist centres and pay weighting; staff who worked at Darent Valley Hospital received a fringe waiting. He noted that Dartford & Gravesham NHS Trust and Guy's and St Thomas' NHS Foundation Trust were working together as part of a vanguard to rotate staff between their sites. It was hoped that the health developments as part of the Ebbsfleet garden city would attract staff to work, live and train in North Kent. An area of particular concern was GP workforce which had an increasing workload and the CCG was working with them on their sustainability. He stated that the CCG was determined to turn itself around and get out of special measures this year but recognised that there was a significant amount of work to do.  He reported that the CCG would have to make difficult decisions which could include the rationalisation of services; any decision around this would be done in discussion with local people and may require consultation.  A Member requested that the CCG present to the Committee at the earliest stage about service change proposals.

(8)       RESOLVED that:

(a)       the report be noted and the Kent CCGs be requested to provide an update to the Committee annually;

(b)       NHS Dartford, Gravesham & Swanley CCG be requested to provide an update on its financial recovery plan at the appropriate time.

Mr Pugh, in accordance with his Other Significant Interest as a non-voting member of NHS Swale CCG’s Primary Care Committee, withdrew from the meeting following Mike Gilbert’s presentation and took no part in the discussion or decision.