Agenda item

To consider a report detailing the finances of the Pooled Budget and the related performance indicators and measures.

M Chidgey, Interim Chief Finance Officer and Director of Provider Management provided an overview of the integrated performance report. He noted that the intention had been to provide a strategic overview of how the resources available in the totality had been used to improve outcomes and deliver high quality health and care in Stockport. Elements around accident and emergency performance, delayed transfers of care and care home capacity and admission rates were highlighted as particular challenges. He noted the systems thinking approach which had been underway.

M Cullen, Borough Treasurer provided an overview of the pooled budget finances as at Quarter 1 and noting that alignment of the integrated presentation to points of delivery to ensure the impact could be monitored against key outcomes and service performance. He outlined the end of year forecast deficit within the pool as at £1.64m and the options being investigated to bring the pool back into balance by year-end.

A discussion took place regarding the NHS Funded Nursing Care cost increases as communicated by the Department of Health and the risks posed to the pool and the impact on both commissioning organisations. M Cullen noted that work was underway and a more detailed paper on the risk flow through the economy would be presented to the Board at its November meeting. The procurement decisions of the CCG Governing Body were highlighted for the Board’s endorsement.

The Board provided positive feedback on the content and presentation of the report, in particular the focus first on outcomes followed by finances. It was clarified that the re-assignment of monies between the Children’s and Adult’s Directorates of the Council for Out of Hospital care for children was technical adjustment within the Council and not a change in service.

The challenges of Quarter 2 performance were discussed by the Board and it was noted that a Tripartite on urgent care performance had recently taken place. It was noted the emergency department and delayed discharge remained significant challenges within the Stockport economy. The Board noted the additional pressures of the upcoming winter period and the need to ensure continued system wide review and management of strategic and operational performance. G Mullins noted that the Stockport Together Programme had been undertaking significant work which it was anticipated would begin to impact on performance in Quarter 4 of the 2016/17 year and included both supporting people more flexibly and robustly within the community and improving the acute system flow. The Board noted the need to balance short term investment to solve immediate problems with medium / longer term investment in support of transformation. The detail of future changes within the key Stockport Together work streams would be presented via a series of service specific business cases from October 2016 onwards. The importance of linking into Greater Manchester initiatives was noted.

In response to a question regarding the all age all-cause mortality rate for women in deprived areas, R Gill noted that a key focus of the neighbourhood work would be active case management and find and treat initiatives. In addition he explained that lifestyle choices had a significant impact and work needed to be continually undertaken to ensure people made informed choices on order to reduce health inequalities in Stockport.

A discussion took place regarding financial risk within the pooled budget. M Cullen noted that for the 16/17 year it had been agreed that risks would sit as far as they can within individual organisations within the pool. The ambition was to develop the risk share in future years to move to a situation where funds were truly integrated within the pool.

Resolved: That the Board:

1. Approves the reduction to the value of the pool (SMBC contribution of £0.224m)

2. Notes the financial position as at Quarter 1 illustrating a deficit of £1.6m and that the relevant Section 75 Agreement processes have been instigated.

3. Endorses the procurement decisions approved by the Stockport CCG Governing Body.