SWINDON CLINICAL COMMISSIONING GROUP Performance Report Month 11 – February 2016

1. SWINDON CLINICAL COMMISSIONING GROUPPerformance Report Month 11 – February 2016 Appendix 3

2. EXECUTIVE SUMMARY Running Costs – Forecast £4k underspend

3. EXECUTIVE SUMMARY Running Costs – Forecast £4k underspend

4. Section 1: CCG Assurance Framework NHS Constitution and Outcome Indicators

5. CCG outcome indicators Outcomes for 34 indicators have been published in December 15. Of these 21 showed a deterioration and 11 showed an improvement. Note though the data is from 2014/15. There are two indicators that have shown significant deterioration moving from green to red rating and are detailed below. Areas of focus: 2.11c‘the percentage of referrals to Improving Access to Psychological Therapies (IAPT) services which indicated a reliable deterioration following completion of treatment’.  This indicator has dropped from 6% in 13/14 to 8.5% in 14/15 putting it high in the upper quartile and the worst performing of its peer group. Action being taken: The reporting period for this indicator is 2014. In April 2015 the IAPT service moved provider and operational standards detailed in the delivery dashboard show that performance is above expected thresholds. The CCG expects the outcome indicator to improvement when the 2015 data is released. The CCG has self-assessed itself against its outcome indicators for the second quarter of 15/16 based on 14/15 data.

6. CCG outcome indicators (Cont’d) Areas of focus: 3.7 ‘People with stroke who are discharged from hospital with a joint health and social care plan’.  This indicator has dropped from 98% in 2013/14 to 59% in 2014/15; a huge drop of 40 percentage points. This puts Swindon CCG in the lower quartile and the worst performing of its peer group for this indicator. Action being taken: A review of the SNNAP audit data reveals there are significant issues with the timeliness and quality of the data being submitted by GWH. This is currently being addressed and an update on QTR3 position is expected imminently.

7. Delivery Dashboard (Mth10) SCCG and its main provider GWH failed to meet all 3 RTT standards in Month 10 which is in line with agreed remedial action plans with GWH. Performance is expected to be back on track by Q1 1617. There were 3 x 52 week waiters in January for SCCG. 1 x Gen Surgery patient at GWH (patient choice); 1 x T&O patient at OUH & 1 x neurosurgery patients at NBT. The NBT neurology patients are due to known neurology waiting times issues at NBT which is currently being addressed with NHSE. SCCG did not meet the following Cancer Targets: 31 day wait for subsequent treatment (radiotherapy) and 62 day from GP referral to 1st definitive treatment in January 16. SCCG main providers GWH & OUH met all of the cancer standards. 31 Day subsequent (radiotherapy) :2 breaches at OUH. Breast: due to patient holiday. Gynae: Pre treatment PET scan showed more extensive disease so treatment had to be adjusted accordingly 62 Day:5 Breaches for SCCG . OUH (1): Gynae - Late referral day 49 (for MDT on day 59). GWH (3): Lower GI - Wait of 27 days for surgery; Skin - Wait of 57 days for minor op; Gynae - Complex pathway as patient also found to have lung cancer during investigations. NBT (1): Urology - Referred on day 35 of the pathway from swindon for MDT discussion 31 day delay for Swindon ONC OPA following MDT discussion. GWH had 4 Cancelled operations not dated within 28 days for QTR3. Reasons: Insufficient anaesthetic staff, Ran out of theatre time, No bed & Poor communication.

8. Delivery Dashboard (Mth10) ED performance has deteriorated and a Remedial Action Plan (RAP) has been developed following a contract performance notice being issued jointly by SCCG & WCCG. Sustainable performance is expected to be achieved by the end July 2016. In terms of sustained performance during winter 2016/17 there are number of caveats and milestones that need to be realised in order to provide complete assurance. A number of these are reliant on partner organisations working together. KPIs are being developed as part of the remedial action plan and will be linked to the Urgent Care Strategy (Front Door and DTOC PIDs). There has been a deterioration in ambulance response times with Red 2 & Red 19 under-performing for both SCCG and SWAS. First-time Red 19 has been missed in 15/16. SWAS Ambulance Handovers >60 minutes for GWH although is under-performing is showing signs of improvement when compared to 14/15. SCCG has had 0 MRSA cases in January (6 YTD), 6 cases of C’diff (55TD) and 19 mixed sex breaches. GWH reported16 cases of C'diff and 0 MRSA and 30 mixed sex breaches in October 15. Mixed Sex breaches are mainly due to the bed capacity pressures at GWH. There were no actual bed bays with mixed sex patients. The breaches were due to patients having to pass each other to gain access to bathroom facilities.

9. RTT Activity & Performance Performance standards: SCCG and its main provider GWH did not meet all 3 RTT standards. This is in line with the agreed remedial action plan. Performance is expected to be back on track and achieved by the Q1 1617 18+ weeks waiters (latest position at 28/02/16): Non-admitted Pathway: 1,466 patients were waiting over 18 weeks for treatment on the non-admitted pathway at GWH at the latest snapshot date. This is against an overall sustainable aim of 500. Admitted Pathway: 1,079 patients were waiting over 18 weeks for treatment on the admitted pathway at GWH at the latest snapshot date. This is against an overall sustainable aim of 200. Incomplete Pathway: The latest data shows 2,545 patients are waiting over 18 weeks for treatment on the incomplete pathway at GWH.

10. Accident & EmergencyPerformance • Total weekly acute A&E attendances (type 1, MIUs and Carfax) increased by only 0.9% (26) on the previous week and is 6.6% (189) higher than the same week in 14/15. • MIU activity decreased by 24 to 732 from the previous week’s figure of 756 and is 1.9% (14) lower than the same period last year. • The 4-hour A&E performance has deteriorated further this week; GWH achieved 77.2%for A&E all types against the national target of 95%.

11. Delayed Transfer of Care • The number of DTOC patients at the latest reported snapshot for GWH trust wide was 30 representing 5.9% of occupied beds. For SCCG the number of DTOC patients was 10; a decrease of 2 on the previous week. • 66.7% (20/30) of the GWH DTOC patients in the reported snapshot were due to healthcare delays with the remainder due to social care delays. • Of the 10 SCCG DTOC patients, 7 were due to healthcare delays and 3 were due to social care delays. The graph opposite shows a breakdown of the reasons for the healthcare delays. The main reason in this reporting week was due to “Awaiting Completion of Assessment” (3/7 patients).

12. Quality Premium projection • Reducing Potential Years of Life Lost data is only published annually, but as recent years have shown a deteriorating position, non-achievement is also forecasted for 15/16. • DToCcurrently forecasting marginally over target, but measures in place to recover position by year-end. • ED Coding achieved, but Mental Health 4 hour performance not– achievement in both is required.

13. Section 2: Financial Performance

14. PERFORMANCE TARGETS CAPITAL RESOURCE LIMIT (£’000) CASH LIMITS (NET of PPA) (£’000) INVOICES PAID WITHIN 30 DAYS At M11 cash book balance was overdrawn by £1.8m. Physical account balance was in credit by £0.2m. The variance reflects processing of BACs run. Final capital resource received during M11 REVENUE RESOURCE LIMIT (£’000) YTD targets have been met. The CCG has 10% of annual invoices received awaiting processing. The lion share of the increase reflects early end of year billing by providers. Currently as planned.

15. FINANCIAL HIGHLIGHTS • Actual: • Acute – YTD spend is £0.1m over Plan after adjusting for activity reserve. Within Acute, acute commissioning has overspent by £2.7m vs plan. • CHC £2.0m over YTD. • Running costs are £0.7m under year to date, mainly due to pay and recruitment and the fact that quality premium is treated as a running cost allocation. • Prescribing is the main driver of primary care overspends, consistent with previous months at £2m over YTD. Overspends have been managed by realigning budgets and investments as a result of the receipt of capital funding and PMCF funding. • Outturn: • FY surplus forecast in line with plan. • Risks around expenditure forecasts remain – in particular regarding prescribing and provider activity. The CCG has already committed all reserves and so any deterioration would impact on our ability to deliver the target surplus.

16. RUNNING COSTS • Actual: • YTD reporting underspend of £0.7m vs plan. The plan has been uplifted by £375k for the Quality Premium as this is required to be reflected as a running cost budget. The additional allocation is being used to offset programme spend. • Favourable payroll variance largely due to AO/COO post and the treatment of Quality Premium. • Agency and contract staff YTD overspend relates to CHC project staff brought into support the clearance of retrospective cases and 1 interim post. • Education and Training favourable variance YTD. This is largely due to less spend on training consultants and fewer SRD workshops than plan. • Marketing and media variance is due to adverts to recruit permanent Accountable Officer post. • Budgeted reserves are being released evenly. • Variances in other goods and services mainly reflects phasing of network costs YTD as they were prepaid in 14/15. • Staffing changes: 1 vacant post filled in month. • Outturn: • FY forecast is £800k under plan. This is due to the budgeting for an AO and COO post for the FY and some staff costs being allocated to PMCF. £375k of this variance relates to the treatment of Quality Premium which we are required to treat as a running cost allocation.

17. PROGRAMME EXPENDITURE • Actual: • YTD – GWH +£1m, NBT +£0.2m, OUH +£0.4m, BMI +£0.4m, GHT (£0.3m), IHG +£0.1m. • Overspends YTD have been managed through release of activity reserve and anticipated allocations. • Continuing Care overspends relate to costs from processing retrospective cases and backlog of new cases. • Outturn: • Drugs and dressings costs forecast has been reduced to £1.5m for FY, the movement reflects adjustments for recharges of public health drug costs to NHS England and Swindon Borough Council. • CHC is expected to be up to £2.2m over plan due to the processing of the backlog of claims. • Acute contracts based on M10 data. (see slide 34)

18. Section 3: QIPP and non-recurrent projects

19. QIPP Scorecard (Mth10) As at Month 10, the delivery of our QIPP programme for 2015/16 is maintaining a positive projected delivery of 90%i.e. £4.33m against a target of £4.8m. This positive improvement in achievement is down to the over performance of savings generated by the introduction of the Dementia Specialist Team. With most schemes now embedded in delivery, the likelihood of extreme volatility in performance is now reduced. 28

20. QIPP - PROJECTED IMPACT ON PRESCRIBING • Comments: • Cost growth is continuing to increase and is now above national growth of 4.82% at 6.19%. Financial plans were set with growth at 4%. Growth has significantly increased vs the 5.86% in November. • This is creating a financial pressure for the CCG despite the fact that QIPP schemes are currently delivering. Despite the projected savings prescribing overall is forecast to overspend by £1.5m at M11. • Savings targeted at £800k for the year; actual data for M9 indicates savings of £867k have been achieved. This is £267k ahead of plan and £171k up on the same period last year. • Dressings scheme is currently proving to be £124k more expensive to M9 vs 14/15. If this continues this would mean a FY cost increase of £165k. • Income from recharges to public health are not expected to be significantly different to plan overall, although higher flu-jab recharges are expected to offset against lower recharge income from public health from the local authority.

21. Metrics for 2015/16 Prime Ministers Challenge Fund Project February 2016

22. PMCF project – M11Overview • Attendances have continued to grow now that all practices can book appointments electronically, the minimum attendance figures for March at the urgent care clinics is already exceeding the maximum recorded daily attendance prior to electronic booking. There continues to be variation between the maximum and minimum attending but it has remained stable. • Use of the Children & Young Person’s clinic has remained more variable as a result of the service being self referral. • Delivery is still largely Face to Face (F2F) but a large number of patients are dealt with by phone based triage in the Children’s clinic often resulting in completion of contact with no further need for F2F to address any outstanding clinical need. • Work is carrying on regarding the development of a weekend service and to provide capacity over the Easter bank holiday weekend. The plans for the pilot of a weekend service have been approved by the PMCF national team. Staffing is in place for the bank holiday and we are working with our local provider to staff weekend slots to commence the service. The service is expected to operate for up to 16 weeks initially. • SUCCESS appears to be having a positive impact on reducing Minor A&E attendances and Paediatric attendances at GWH. However, the scheme does not seem to have had a similar reduction on adult emergency admissions as these have continued to increase; it is possible that the scheme has stemmed any additional increase. • The usage of existing services outside the SUCCESS umbrella of services in Swindon (the Clover Centre and Carfax Walk-In Centre) has continued and activity remains at levels expected (not elevated) within the overall urgent care system. The usage of the Carfax Walk-in centre has indeed reduced. Some of this activity may have shifted to the SUCCESS clinics and Clover Centre, but at the moment we are not able to isolate the activity by appointment time. This is something that is in development as part of a wider project to improve the granularity of community services data. Data regarding the wider impact on primary care is unavailable (i.e. impact on appointment waiting times etc).

23. National metrics

24. Service utilisation within Primary CareThe change in hours offered for patient contact The model has made the following additional appointments available outside existing GP practice hours on a daily basis (Mon-Fri). Following approval of the CCG’s revised proposal regarding weekend services by NHS England the CCG is working on mobilisation. The weekend service is expected to operate initially over the Easter bank holidays and will be trialled for up to 16 weeks. Currently Hermitage is open until 18:30 but increased utilisation may increase this shortly to 20:00, whereas Moredon operates both Nurses and GP appointments until 20:00. The target weekend service will lead to the Children and Young Person’s Clinic being open within in an urgent care centre setting at two neighbourhood hubs with supplementary adult appointments. This will depend

25. Service utilisation within Primary CareThe change in modes of contact (YTD to M11) Model has provided expanded urgent primary care appointment capacity that patients can access in locations in addition to their own GP practice. Please note the additional two neighbourhood hubs at the Carfax and Hermitage sites became operational from June. Face to Face appointments are generally provided in all three services, telephone triage consultations are offered by the Children and Young Person’s Clinic. Activity data for the enhanced Single Point of Access is awaited from the provider.

26. Service utilisation within Primary Care • For this reporting week there were 1,144 attendances at SUCCESS clinics (including urgent home visits). 58.2% (666) of these were at GP/nurse clinics, 37.0% (423) were at children’s clinics and the remaining 4.8% (55) were urgent home visits. • The variance between the min and max daily attendances at SUCCESS GP/Nurse clinics is 54. This is 1 less than last week’s variance. • The variance between the min and max daily attendances at children’s clinics is 35; lower than the previous week’s variance of 39. • The variance between the min and max for home visits is 6, which is the same as last week’s variance. 7

27. Service utilisation within Primary CareThe impact on the “out of hours” service The “out of hours” service starts from 6:30pm and overlaps with PMCF services by 1.5 hours Contacts with the OOH service continue to operate above levels during 14/15. They are reported as 10% up year to date. This is after rebasing 14/15 for 3% population growth and the data includes weekend activity. Time stamped, weekday data has been requested from service provider to better assess service impacts.

28. Service utilisation outside primary careImpact on the wider system attendances Adjusting for growth, utilisation is reported as having grown 16% YTD to M10 by SEQOL. The information includes weekends and reflects the opening hours of the site and so is not co-terminus with the operating of the SUCCSS clinics. A separate project is running to improve the granularity of data received from our community provider but this is not yet operational. Attendances (adjusted for population changes) are 6% below those for 14/15. This data includes weekends and so is not only for the period that the SUCCESS clinics have been operating

29. Service utilisation outside primary careImpact on emergency admissions Adjusting for population growth there has been a 272 increase in adult emergency admissions between April and January. Ignoring population changes emergency admissions year to date are 625 higher or 5.3%. * November – March 2014 activity has been adjusted by 4.5%, and April – March 2015 activity has been adjusted by 3% to reflect changes in population growth.

30. Local metrics

31. Reduction in minor A&E attendancesImpact on minor attendances at GWH Emergency Department Reported Minor A&E attendances have fallen between April and January 2016 by 859 which is a reduction of 6%.* * November – March 2014 activity has been adjusted by 4.5%, and April – March 2015 activity has been adjusted by 3% to reflect changes in population growth.

32. Reduction in paediatric attendancesImpact on paediatric attendances at GWH 435 fewer attendances during April to January 2016 vs previous year, which equates to a 6.9% reduction. * If population movements are ignored attendances are 214 lower than previous year or 2.9% * November – March 2014 activity has been adjusted by 4.5%, and April – March 2015 activity has been adjusted by 3% to reflect changes in population growth.

33. Section 4: Provider Performance

34. ALL ACUTE CONTRACTS SUMMARY YTD The extrapolated M11 position is showing a YTD variance of £2.76m across acute providers. The M10 contractual position reported through SLAM and reflected on the Individual Provider Reports is £2.36m. The M10 reported position of £2.17m was £186k better than the contractual position. As provider information is published in arrears the M11 finance position is extrapolated from M10 SLAM. FO The CCG is forecasting a financial pressure through over performance of £3.45mat year end. When this is adjusted for the potential impact of contract challenges it reduces to £3.14m. Our Mission: To Optimise the Health of the People of Swindon and Shrivenham

35. ALL ACUTE CONTRACTS SUMMARY YTD The extrapolated M11 position is showing a YTD variance of 257k across acute providers. The M10 contractual position reported through SLAM and reflected on the Individual Provider Reports is 54k. The M10 reported position is 253k was 199k worse than the contractual position. As provider information is published in arrears the M11 finance position is extrapolated from M10 SLAM. FO The CCG is forecasting an adverse variance across all types of activity through over performance of 9.05% at year end. Our Mission: To Optimise the Health of the People of Swindon and Shrivenham

36. High Level Summary – By Provider Cost YTD Actual against YTD Plan is £2,257k overspent The CCG is reporting a 2% over-performance YTD and forecasting 2% gross variance at year end across all the acute providers The largest variance to plan by provider at month 10 is IHG (52%). The lowest variance to plan is GHFT who are under-performing (-19%) Activity YTD Actual against YTD Plan is over-performing by 71K The CCG is reporting a 5% over-performance YTD and forecasting a 5% variance at year end across all the acute providers The largest activity variance to plan by provider at month 10 is IHG (42%). The lowest activity variance is GHFT (-14%) Challenges YTD - £ 1,104,814

37. High Level Summary – By POD Cost The largest variance to plan by POD at month 10 is Drugs (12%) due to the implementation of NICE guidelines, followed by Elective (8%), due to providers undertaking additional activity to address RTT backlog. Planning adjustments in the SLAM data have resulted in negative variances on Other. CQUIN FOT is slightly higher than plan due to over activity Activity The largest variance to plan by POD at month 10 is Non Elective (2%) followed by Elective (2%) Note: Activity has not been adjusted for challenges

38. CQUIN 2015-16

39. Acute Providers

40. GWH – M10 • Cost • YTD Actual against YTD Plan is £1.46m overspent • FOT against Plan is £1.1m overspent (after adjustments for challenges and penalties) • Activity • YTD Actual against YTD Plan if over-performing by 68K • FOT against Plan is over-performing by 82K • Reasons • Secondary drugs continue to be an in-year pressure • Elective – General Surgery, Gastroenterology, ENT and Clinical Haematology are over-performing, which is due to increased demand and RTT • Activity over-performance for Drugs and Devices has little or no plan information • Activity over-performance for Non Elective is driven by General Medicine and Gastroenterology • Actions Being Taken • Expensive drugs group has been set up across SCCG, WCCG and GWH. • GWH to initiate a switch process from Jan 16 onwards from Remecade (expensive brand) to Biosimilar Infliximab • Continue to raise challenges regarding Data and Specialist Commissioning • Monitor the impact of the closure of the ISTC • Challenges YTD - £ 1,022,000

41. OUH – M10 • Cost • YTD Actual against YTD Plan is £336K overspent • FOT against Plan is £383K overspent(after challenges) • Activity • Overall activity is 8% higher than YTD Plan (923) • Elective 30% higher than YTD Plan (127) • Outpatients 9% higher than YTD Plan (722) • Day cases 8% higher than YTD Plan (67) • A&E 4% higher than YTD Plan (9) • Drugs 25% lower than YTD Plan (52) • Reasons • Elective – Plastic Surgery, Complex Free Flap Breast Recon £47K overspent • Elective - Critical Care £45K overspent (64 bed days) • Elective – Hepatobiliary Procedure All Bands £53K overspent. • Outpatients – Nephrology £33K overspent (activity 245 above plan in M10) • Outpatients – Cardiology £13K overspend (activity 79 above plan in M10) • Outpatients – Upper Gastro Surgery 10K overspent (activity 89 above plan in M10) • Daycases – Nephrology, Other Red Blood Cell Disorders £20K overspent • Daycases – Oncology, Red Blood Cell Disorders £26K overspent • £49K transfer from Specialist Commissioning in year • Actions Being Taken • Continue to monitor the position • Regularly attend the OUH Contract Review meeting • Continue to raise challenges regarding Data and Specialist Commissioning • Challenges YTD - £ 71,411

42. GHFT – M10 • Cost • YTD Actual against YTD Plan is £290K underspent • FOT against Plan is £359K underspent • Activity • All PODs, with the exception of A&E, are underspending YTD against Plan by 10% (397) • Reasons • Non Elective – YTD Actual against YTD Plan is underspent by £85K • Elective – YTD Actual against YTD Plan is underspent by £90K • Day case – YTD Actual against YTD Plan is underspent by £55K • Vascular/ophthalmology included in plan, which has been integrated into Great Western Hospital • Actions • Contract monitoring information is poor, discuss with GHFT to provide more detail to enable breakdown of PODs to services • Meet to discuss if the underspend will continue to year end • Challenges YTD - £0

43. RUH – M10 • Cost • YTD Actual against YTD Plan is £5K overspent • FOT against Plan is £2K overspent • Activity • Overall activity is 21% higher than YTD Plan (256) • Non Elective 67% higher than YTD Plan (22) • Outpatients 33% higher than YTD Plan (306) • A&E 11% lower than YTD Plan (9) • Day cases 39% lower than YTD Plan (37) • Elective 21% lower than YTD Plan (4) • Reasons • Non Elective – Stroke Medicine, Non Transient Stroke/Cerebrovascular Accident £9K overspent (2 cases) • Non Elective – General Medicine, Excess Bed Days for Syncope/Collapse with Critical Care £4K overspent (17 days) • Non Elective – Rheumatology, Inflammatory Spine, Joint Disorder £8K overspent • Outpatient – Rheumatology, Non Face to Face First and Follow Up £27K overspent • Actions Being Taken • Continue to monitor SLAM for Specialist Commissioning and Critical Care • Challenges YTD - £0

44. UHB – M10 • Cost • YTD Actual against YTD Plan is £12K underspent • FOT against Plan is £14K underspent • Activity • Overall activity is 8% lower than YTD Plan (130) • Non Elective 32% lower than YTD Plan (43) • Day cases 16% lower than YTD Plan (18) • Outpatients 9% lower than YTD Plan (85) • A&E 5% lower than YTD Plan (8) • Elective 9% lower than YTD Plan (7) • Reasons • Non Elective – Ophthalmology, Major Vitreous Retinal Procedure overspent by £14K, Major General Abdominal Procedure overspent by £5K • Outpatients are underspending YTD in Ophthalmology and some Children Services • Electives are underspending YTD in some Children Services • Actions Being Taken • Continue to monitor the position • Check for Specialist Commissioning activity • Penalties have been issued and backdated M1-6 • Challenges YTD - £0

45. NBT – M10 • Cost • YTD Actual against YTD Plan is £297K overspent • FOT against Plan is £358K overspent • Activity • Overall activity is 31% higher than YTD Plan (373) • Day cases 105% higher than YTD Plan (66) • Elective 42% higher than YTD Plan (98) • Outpatients 35% higher than YTD Plan (229) • Non Elective 28% lower than YTD Plan (26) • A&E 4% higher than YTD Plan (4) • Reasons • Day cases – Gastroenterology, Wireless Capsule Endoscopy overspent against YTD Plan by £4K • Day cases – Plastic Surgery, Intermediate Hand Non Trauma Cat 1 overspent against YTD Plan £4K, Intermediate Elbow/Lower Arm Trauma overspent against YTD plan by £7K • Elective – Urology overspent against YTD Plan by £91K, Major Robotic Prostate Procedure £31K, Complex Open/Laparoscopic Kidney/Ureter £23K, Cystectomy with Urinary Diversion £37K • Outpatients – Non Face to Face Follow Ups overspent against YTD Plan by £22K • Actions Being Taken • Check price of Elective procedures with provider, actual higher than plan • Check for Specialist Commissioning activity • Check SLAM, recently installed a new system, experiencing some problems with data extraction • Challenges YTD - £0

46. BMI – M10 • Cost • YTD Actual against YTD Plan is £297K overspent • FOT against Plan is £357K overspent (after adjustments and challenges) • Activity • Overall activity is 11% higher than YTD Plan (888) • Day cases 7% higher than YTD Plan (102) • Outpatients 13% higher than YTD Plan (775) • Elective 7% lower than YTD Plan (18) • Reasons • Elective - Overnight activity down by 18, however costly 20 reconstruction procedures result £162,525 overspend YTD • Day Cases - Cataract extractions activity up by 105 and Diagnostic Colonoscopy activity up by 43 resulting in £90,288 overspend YTD • Outpatients activity up by 775 due to Follow ups and Telephone assessments resulting in £33,073 over-spent YTD • Diagnostics - activity up by 29 resulting in £4,345 overspend YTD • Actions Being Taken • Savings as result of early Easter holiday - £60k potential • Review of waiting times. • Review of Reconstruction procedures categorisation - £54k potential • Monitor the impact of the closure of the ISTC

47. IHG – M9 (awaiting M10 data) • Cost • YTD Actual against YTD Plan is £154K overspent • FOT against Plan is £208K overspent • Activity • Overall activity is 42% higher than YTD Plan • Electives 60% higher than YTD Plan • Outpatients 38% higher than YTD Plan • Reasons • Elective – Inguinal, Umbilical/Femoral Hernia 19 yrs+ without CC overspent against YTD Plan by £38K (activity 29 above plan in M9) • Elective- Vasectomy overspent against YTD Plan by £23K (activity 34 above plan in M9) • Elective – Intermediate Foot Non Trauma All Cats 19 yrs+ overspent against YTD plan by £55K (activity 45 above plan in M9) • Outpatients – Follow Ups overspent against YTD Plan by £11K (activity 113 above plan in M9) • Outpatients – Carpel Tunnel Nerve Study overspent against YTD Plan by £7K (activity 47 above plan in M9) • Outpatients – First Appointments overspent against YTD Plan by £24K (activity 158 above plan in M9) • Actions Being Taken • Manage position through waiting times and referrals • Regularly meet to discuss position • Reduction in the price charged for Vasectomies effective from 1 Dec 2015 • Challenges YTD - £0

48. ISTC – CARE UK The CCG contract with Care UK for the provision of treatment centres came to an end in October. The contract was a legacy arrangement entered into originally by Swindon PCT. The contract paid Care UK a guaranteed block value but offered an incentive to CCGs if utilisation was above these levels. Over the 7 months of the contract the CCG paid £1.8m for activity using the contract price. Had the CCG been paying current tariff then the same activity would only have cost £1.3m. There was a deterioration in the use of the block in the last three months of the contract. Since the end of the contract we have had invoices for November (£85k), December (£82k) and January (£83k). The CCG are currently having issues with validating these invoices and have requested further details from Care UK. The final referrals report produced indicated that there was still £325k of activity in the pipeline at the end of October. Assuming treatment within 13 week targets. Although the rate of referrals slowed there were still 5 referrals into the ISTC in the last week of the contract.

49. Non-acute Providers

50. SEQOL At M10 SEQOL are reporting that total contacts across their services are up by 25% YTD. Please note that this is patient contacts* and does not indicate how may patients are actually using the services. For example the 41,853 contacts reported as Telehealth contacts YTD (18% of SEQOL’s reported contacts YTD) relate to just 160 telehealth units and thus a cohort of 160 patients at any one time. *A contact can range from a letter, 5 minute telephone conversation to a full clinical face-to-face appointment lasting several hours dependent on the service.