The Committee considered a report on the Somerset Clinical Commissioning Group’s financial performance for 2018/19 as at 31 January 2019. Funding from NHS England amounted to £800m with a planned in-year deficit of £9m This is underpinned by a requirement to deliver Quality, Innovation, Productivity and Prevention (QIPP). The Clinical Commissioning Group has demonstrated achievement of the Commissioner Sustainability Funding (CFC) which will secure an additional £9million funding enabling the Somerset Commissioning Group to deliver a balanced budget position for 2018/19.
The Committee were informed that the challenge is to set a budget plan at the beginning of the year when there are unexpected changes in demand. This year that has been the increase in Emergency Admission to both main hospitals. Somerset is much higher than other comparable CCG areas with similar demographics.
The report contained detailed information on the areas of expenditure with an indication of the reported variances and whether they were red, amber or green indicating whether they were Improving or Static with a favourable variance (green) Static with an adverse variance (amber) or Deteriorating (red).
The Committee discussed the report in detail and during this the following points were raised:
· Staff Pay Awards and how these were funded. It was confirmed that these are planned for but must be found from efficiency savings as the Department of Health funding does not include an increase to take account of pay awards.
· The Committee were interested in plans to address the areas of the budget that were being reported as deteriorating. There is a national programme of NHS Improvements and this contains a wealth of information on how to make efficiencies and this has informed many of the decisions locally. Some efficiencies deliver results quicker than others but all drive change to improve patient outcomes.
· The long term goal of moving resources from secondary care to primary care recognising that the desired balance has not yet been achieved but progress is being made. Work with Somerset County Council has assisted that movement of resources and the investment in Mental Health Services has developed better networks to support people in their local area. Taking the pressure off centralised provision.
· Following on from this there was some discussion around the need to make sure the provision of suitable and adapted housing was included in the strategic vision as this would assist in speeding up the movement from hospital to home. The multi-agency approach is essential to delivering this goal.
· The length of time between the referral by a GP to getting an appointment with a Consultant was too long. It was recognised that for some appointments this was outside the target wait times. MRI scans at Musgrove Park Hospital had slipped and to resolve this a mobile unit has been installed.
· Somerset has the highest level of recorded admissions of young people for unintentional and deliberate injuries. As this was not covered by the Financial Report further information would be shared with the Committee.
· The Committee were interested in prevention work and how this fitted with the Fit for My Future initiative. Prevention is the driving force behind this and it is the best way to meet the challenge and make resources stretch. The baby boomers from the 1940’s will be approaching 80 over the next few years. Plans need to take account of the potential increase in demand.
· The Committee were keen to acknowledge that Somerset bucked the trend in terms of GP recruitment; nevertheless they recognised that there was still an over reliance on agency staff and a strong desire to reverse this and to encourage recruitment of permanent staff.
The Scrutiny for Policies Adults and Health Committee:
Noted the contents of the report and the challenges in delivering the financial position in 2018/19 and actions needed to address the planned in-year deficit.