To receive reports from the Clinical Commissioning Group (attached) and the London Borough of Enfield (to follow) on their financial and commissioning intentions.
To receive a progress update from Enfield CCG: on the Financial Recovery Plan 2016/17 and beyond.
RECEIVED the report of Graham MacDougall (Director of Commissioning, NHS Enfield CCG) presenting the Enfield CCG commissioning intentions for 2017-19.
Graham MacDougall and Rob Whiteford (Chief Finance Officer Enfield CCG) introduced the report, highlighting the following:
? Savings targets were clarified, and the deficit situation was improving.
? There would need to be efficiencies in the way services were delivered and where money was invested.
? The strategic context was set out.
? The Sustainability and Transformation Plan (STP) over the next five years would have a significant effect on commissioning intentions.
? Funding was coming through to support substantial transformation.
? There were national efficiency programmes to reduce variation across CCGs.
IN RESPONSE to the report, the following comments were received:
1. Councillor Orhan drew attention to the lack of reference to children and young people in the four domains relating to the CCG Improvement and Assessment Framework, and in the commissioning objectives. It was advised that adults and children were included in the sections, but this could be better articulated and made clearer. Graham MacDougall agreed to draw out the areas specific to children.
2. In response to Tony Theodoulou’s query regarding Enfield CCG as an outlier in high levels of musculoskeletal surgical intervention, Graham MacDougall confirmed that bench-marking had shown higher surgery rates relative to Enfield’s peers, and a programme had been set with a new provider to reduce surgical intervention and ensure there was a consistent offer to all patients, and that thresholds for treatment were adhered to.
3. Dr Mo Abedi noted that for each workstream in Right Care, the national transformation programme, had involved GPs in looking at pathways and audits.
4. Deborah Fowler (Healthwatch) stressed the need for as much transparency as possible to provide reassurance to people about what they could reasonably expect, and questioned whether there was definitive guidance publicly available. She also asked where the biggest changes could be expected to be seen. Graham MacDougall highlighted the tie-in with the Sustainability and Transformation Plan (STP) and that providers would be working in different ways. In the second and third year of the STP – 2017/18 and 2018/19 – new contracts with providers would see significant changes.
5. Vivien Giladi (Voluntary Sector) re-iterated the need for the CCG to provide reassurance to the public about changes and thresholds.
6. Ray James commented that while the aims of the changes were recognised, the Enfield Health and Wellbeing Board would be exercised about decisions in respect of Enfield being taken ahead of North Central London and there should not be earlier rationing for the people of Enfield than for people of other boroughs.
7. Ray James apologised to members expecting an update from the Council under this agenda item, as its budget planning would fall naturally in December, and more detail would be provided for the next meeting.
8. Sarah Thompson (CCG) advised that this piece of work was initiated by Enfield, but it actively sought to engage with the four other CCGs across North Central London. Enfield was under special measures and needed to proceed at this time, but would continue to collaborate.
AGREED to note the report and the caveat included in the executive summary.