The minutes of the meeting held on 19 July 2016 were approved and signed as a record of the meeting.

At 6.39pm Councillor Andy Stranack disclosed that he is a member of the Specialist User Group for Outcome Based Commissioning for the Over 65s.

None.

The Committee AGREED to split between Part A and Part B of the agenda.

The Committee discussed with officers the reasons for the submission of confidential reports, as this goes against the spirit and nature of scrutiny.

It was reported that the CCG were embargoed by NHS England in part but took the decision to move some of the business into Part A of the agenda.
Croydon Health Services' presentation had been embargoed by NHS Improvement, however elements of the discussion could take part in Part A of the agenda.
 

Dr Agnelo Fernandes, Deputy Clinical Lead supported by Mike Sexton, Director of Finance and Stephen Warren, Director of Commissioning were in attendance on behalf of the Clinical Commissioning Group.

Mike Bell, Chairman, Croydon Health Services NHS Trust and John Goulston, Chief Executive in attendance at the meeting to response to the Committee's concerns as both organisations have been placed in special financial measures as directed by the governing bodies NHS Improvement and NHS England.
Both organisations made presentations which included the deficit and annual shortfall which the CCG inherited from the PCT. The national programme of sustainability transformation plans.

There will be a period of consultation once the plans have been agreed by each governing body. The Committee voice its dissatisfaction regarding the embargoed information regarding the recovery plan for each organisation. Members are well versed in handling sensitive information. Members would have appreciated the opportunity to comment on the draft recovery plans for the provider and commissioner prior to the sign off.
CCG has been carrying a deficit balance since 2014, however the senior management team have been working to deliver year on year savings as prescribed by NHS England. The CCG have looked at extensive service redesign, however this could only achieve some savings. The main programme which should deliver savings will be the outcome based commissioning (OBC).

CHS are seeking to improve safety and quality in performance and recognise the substantial challenge. Currently the deficit is £39.8m, the Trust have to achieve £14.m in savings. NHS Improvement this that the recovery plan is strong and that if the Trust make savings of and reduce the deficit to £32.8m the Trust will receive a £10m incentive.

It was reported that 5 other authorities CCGs across the country are currently in financial measures.

The Committee asked how the CCG had got into this position. Officers reported that the demographic of Croydon does not fit the national average. The area of Croydon has pressures across mental health, accident and emergency usage, and the home office located in Croydon brings with it other unique health challenges.

The Committee AGREED that the Chair should contact the other 5 authorities health scrutiny Chair's to write a combined letter to NHS Improvement to stress the dissatisfaction about the embargoed financial recovery plan.
 

The Committee NOTED the report.

The JHOSC were due to meet in Kingston on 11 October 2016 to scrutinise the South West London sustainability and transformation plan.

The South East London JHOSC are due to meet again on 6 October 2016 to discuss SLaMs decision to close the multiple places of safety across it's estate and replace it with a single place of safety located on the Maudsley site.

The Sub-Committee agreed that the work programme should include areas of social care scrutiny.

The Chair agreed to review the work programme with the Vice Chairman to address this.
 

John Goulston, CEO, Croydon NHS Trust was in a position to share a presentation with the Committee giving some detail of the financial recovery plan being pulled together and agreed by NHS Improvement.

The CEO discussed some of the key contributing factors which had lead the Trust being placed in financial measures. Currently the workforce pressures continue to exceed the Trust's income. The construction of the new Accident and Emergency Department had also resulted in higher staffing levels. The additional cost pressures which have resulted from a number of large claims against the Trust in the region of £3.4m.

The Trust are looking at ways to reduce agency cost across all medical disciplines. Staffing review meetings keep a constant overview at agency nursing figures to identify spending trends. The senior management team are also reviewing non pay roles to find solutions to high expenditure.

The Trust reported key risks to financial stability and delivering the plan is non elective income shortfall and the forecasting emergencies. The Trust's shortfall remains high at £11.m. Management are looking at budgets line by line, asking directorates what it is that the Trust should be doing more of. One initiative currently being investigated is that 500 Croydon patients will transfer back under Croydon Health Services care. The Trust are getting support from NHS Improvement regarding best practice to deliver emergency care and looking at neighbouring Trusts.

The Trust want to work on reducing the deficit.

CCG Senior Management team reported that PriceWaterhouse Cooper (PWC) were not confident that the financial recovery plan could be achieved. The financial overspend can be attributed to an increase in adult mental health beds, high outpatient numbers and currently accident and emergency is out performing against planned care. The CCG are working to find solutions to and gain an understanding of the reasons behind the continued increase in medical episodes.

Major cost savings for 2017/18 should be realised form the outcome based commissioning initiative, however the timeline has slipped, however the CCG continue to look at redesigning emergency pathways. CHS reported that the risk is shared amongst the alliance.

The CCG and CHS have agreed to report back to the Committee on 18 October 2016.