Agenda item

Gail Arnold, Deputy Managing Director for Dartford, Gravesham and Swanley and Swale CCGs and Reg Middleton, Chief Finance Officer, West Kent CCG and in an Interim Capacity for Dartford, Gravesham and Swanley and Swale CCGs.

(1)      The Chair welcomed the guests to the Committee.  Mr Middleton began by explaining that the system had faced considerable challenges over the last number of years and emphasised that they were entering the next financial year in a similar position, with much work to do.  Mr Middleton acknowledged that collaborative and partnership working would help tackle this.  He said that the achievement of financial balance was possible but tight for Swale CCG and that the Dartford CCG position will be an overspend of some magnitude with an outturn of £9/10m deficit rather than the planned break even.  Mr Middleton reported that the two Acute systems were also financially challenged.

(2)      Mr Middleton drew attention to the end of the report and the local systems approach which was showing that the CCGs were working in a different way to tackle the significant challenges.  He said that this included reduction in unwarranted clinical variation, tight contract management and by working with joined up thinking to avoid moving issues around the system.

(3)      Ms Arnold highlighted to the Committee the Quality, Innovation, Productivity and Prevention (QIPP) programme and said that they were now on track for delivery, however reduction in unwarranted clinical variation was varied.  She continued that one of the key issues within the system was a struggling workforce.

(4)      Members commented on medicine management in respiratory conditions, deficit positions, and staff turnover.  Ms Arnold said that there was a relatively high level of admissions to hospital for uncontrolled respiratory problems and a more proactive approach was needed in the form of prevention and improved medicine management.

(5)      Mr Middleton said that the position historically in relation to Swale CCG and Medway NHS Foundation Trust related to the payment by results system and tensions regarding payment.  In this financial year the Lead Commissioner, Medway CCG agreed a block contract which brought stability to the health system.  Mr Middleton emphasised that there was a downside however for the CCG in terms of financial movement when intervention took patients out of the acute setting.

(6)      Mr Middleton said that in relation to staff turnover some changes had been reflective of transitioning across the STP and is in part reflective of changes taking place in the NHS.  He said there is a sense that talent available across the CCGs is used in an effective way and in turn will lead to positivity in the future, but he did admit that morale is difficult, and that staff were being supported through this period.

(7)      Members asked about primary and acute system incentivising of best practice, Multi-Disciplinary Teams (MDT) and estates management.  Ms Arnold said that incentivising of best practice was the process of making sure money in the system was in the place it should be to make improvements. The use of the word incentive in the NHS included the example of funding clinicians time to redesign pathways and time to reinvent.

(8)      Ms Arnold described the MDT approach and the referral process, acknowledging requirements were not always relating to healthcare such as lack of social contact.  Ms Arnold said that there were Health and Social Care Coordinators and third sector signposting ensuring that everyone was proactive to intervene before a medical need. 

(9)      Ms Arnold said that investment had been made in new estate including GP estate, highlighting that recruitment in GPs and staff was easier if the estate is good.   She noted new ways of working such as new opening times and three shift days.

(10)   Mr Inett enquired about patient experience during reduction of deficits and new systems.  Ms Arnold said that pathways were planned based on the needs of the patient.   She noted that over time inefficiencies begin to happen due to system evolution but if the approach is taken to plan the best pathway you mitigate problems further down the system.  She acknowledged that it is difficult to establish processes to move money, particularly when there are limitations on finance but pathways delivering to patient needs deliver better outcomes.  Mr Middleton referred to community services investment and that the CCG had chosen to invest this year in local care services because it was the right thing to do.

(11)   The Chair emphasised that the Committee should be kept informed of any changes within the CCGs.

(12)   RESOLVED that the report be noted, and NHS North Kent CCGs be requested to provide an update at the appropriate time.