Agenda item

7.1       The Board considered a report providing an update on the ESBT financial position.

7.2       In response to questions from the Board the following key points were made:

·         The forecast deficit control total for Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG), and Hastings and Rother Clinical Commissioning Group (HR CCG) is a combined £32m for 2018/19; this has been agreed with NHS England.  As part of meeting this, the CCGs have a Quality, Innovation, Productivity and Prevention (QIPP) expenditure reduction target of £18m and this represents approximately 3% of total expenditure. If the CCGs achieve the control total of £32m deficit at the end of the year, this will attract £32m of national Commissioner Sustainability Funding (CSF) to support a break even position. A System Financial Recovery Board of the all the ESBT organisations with an independent chair has been established to monitor the in-year financial position and achieve the expenditure reduction plans. This supports the individual organisations’ governance arrangements. In addition to the Board, financial progress is monitored at weekly ‘confirm and challenge’ sessions chaired by the Chief Finance Officer of the CCGs; bi-monthly meetings between ESBT commissioners and ESHT; and informal fortnightly meetings of the System Financial Recovery Board. This combination of meetings will help to enable regular and timely reporting of financial performance, including from ESHT.

·         Quality impact assessments are carried out on QIPP schemes in order to understand any potential impact on quality or access. Some of the QIPP schemes are aimed at improving quality and reducing costs because they will remove inappropriate referrals and reduce unwarranted clinical variation as well as supporting people in their communities.  The impact will also be monitored on an ongoing basis.

·         There is an expectation from the new Executive Chair of the Sussex and East Surrey Sustainability and Transformation Partnership (STP) that the STP’s acute strategy needs to be reenergised as acute care is a major element of expenditure in the local healthcare system. There is a need for an STP-wide strategy to manage and sustain acute expenditure whilst individual place-based, such as East Sussex Better Together (ESBT), continue to integrate local community care.

·         The STP-wide Clinically Effective Commissioning (CEC) programme is helping to reduce costs by reducing unwanted variation in the CCGs’ policies around when patients are referred from primary care to acute care for medical procedures based on the best available clinical evidence. CEC will improve quality and reduce costs by spending money in the most effective way. Future reports on the progress of CEC will be made back to this Board.

·         The forecast deficit across the whole of the ESBT Alliance for 2018/19 is £79m, including East Sussex Healthcare NHS Trust (ESHT) and ESCC. This means that the ESBT area is under extreme scrutiny from NHS England and will need to demonstrate it can deliver the financial plans for 2018/19 and work towards financial solvency over the next three years. The aim, however, is still for ESBT to continue to deliver integrated services and improve services to people. 

·         2017/18 was the first time in five years that the ESBT CCGs did not deliver a surplus. During the previous four years the CCGs delivered a financial surplus whilst investing in Healthy Hastings and other community programmes.

7.3       The Board RESOLVED to:

1) note the East Sussex Better Together system financial outturn for 2017/18;

2) note the Health and Social Care Commissioning 2018/19 financial position;

3) note the recovery actions being developed and implemented collaboratively through the ESBT structures; and

4) note that it expects to see the ESBT financial picture beginning to improve by the time of its next meeting.