This paper provides a briefing to the Committee on the 2018/19 financial position of the Hammersmith and Fulham Clinical Commissioning Group.
The Committee had requested a report from the CCG setting out the current financial position. It provided detailed information about months 6 and 7, 2018/19. The paper had also been presented to the governing body of the CCG. This set out how the CCG would manage its financial recovery, and targets for expenditure reduction. Ms Cree confirmed that they had not had notice of funding for 2019/20, and, any impact from the implementation of NHS long term plans would not be known until after Brexit.
The aim for the 2018/19 plan was to deliver reduction, and targets were factored to allow for any slippage. The H&F CCG allocation had remained either the same or had been cut and historically, had been overallocated. The month 6 position indicated a release of all the reserves available to the CCG and it was likely that by the end of the financial year, there would be a £5 million overspend. Ms Cree confirmed that she had received an assurance that NHS England would help mitigate.
Ms Redfern referred to section 6.3 of the report, page 86. The cuts being proposed were brutal and not clearly discernible from the report. The report did not offer a clear narrative about the local priorities. It was critical that a local commentary should clearly explain the proposals, and that this should be set out strategically. Ms Redfern stated that it was incumbent upon the CCG to clearly set out the detail, which was absent from the scenario outlined in page 86.
Ms Redfern pointed out that that there was a critical piece of information that was missing, and referred to a letter that had been sent to the Council by the CCG, which had advised that £1.25 million was being withheld from the Council. This would impact on services delivered through Adult Social Care. Ms Redfern challenged the legality of this, given that there was no formal notice given of the decision to withhold funds, and that the issue had not been discussed by the Health and Wellbeing Board.
That the meeting be extended by a further thirty minutes.
Councillor Kwon asked what the risk was of driving up demand for services across the Borough; what was the cost of making cuts and whether these were sustainable. Ms Cree referred to section 6.3 of the report, and explained that the proposals will be used as a basis for the review, which would then be followed by an impact equalities assessment. The detail was absent from the report as this had not yet been determined. Ms Cree said that there was a framework that would be followed and it was confirmed that some services might be downgraded and rationalised, and that non-statutory duties would cease.
Mr Grealy expressed disappointment that the CCG was unable to provide a list of services to be discussed and the impact of reducing these. Section 6.3 referred to only statutory provision. It was clear that all planned investment would stop and funding reduced in line with national levels and statutory duty. Mr Grealy was of the view that the local provision would be decimated and that it was critical to understand which services would be cut. Mr Grealy also challenged the CCG to provide details about the cost of maintaining the bureaucracy required to support the North-West London Collaboration of CCGs.
Martin Calleja clarified that the report provided the level of detail requested by the QIPP (quality, innovation, productivity and prevention) plan. The indication was that the plans proposed in section 6.3 had to be immediately implemented. The possible financial and reputational repercussions were a serious concern. Ms Cree responded that the CCG had been asked to set out a financial position, which combined figures for 2018/19 and 2019/20 and a reduction in the operating cost was included. The CCG would also be required to meet national requirements to further reduce costs in the budget by 10%, sought across the whole of the organisation. Ms Cree felt that the CCG had been clear about the process in which they had been engaged, and had considered what information was needed to make those decisions. The CCG intended to fully involve residents and key stakeholders, to ensure transparency.
Councillor Coleman said that the CCG met regularly with Council members and officers, and yet had failed to raise the issue. Without warning or notice, the CCG had determined that it would withhold Better Care Funding of £1.25 million. Ms Cree responded that the issue had been discussed in many conversations, particularly about QIPP plans. Councillor Coleman pointed out that the letter failed to offer reasons, or provide sufficiently transparent explanations as to why the funds would be withheld. Councillor Coleman recognised that there existed severe financial pressures arising from austerity measures. However, the letter from the CCG had been unhelpful, and he challenged the CCG to be more co-operative and transparent in their future communications and interactions with the Council.
Councillor Coleman asked if the CCG planned to consult on cuts to services. Ms Cree responded that there might be a need to consult on some of the service changes, but clarified that this would only be undertaken if there was a statutory requirement to consult.
Councillor Fennimore commented that there was no reference to the potential impact on residents. While Councillor Fennimore concurred with Ms Andreae’s comment that £1 could only be spent once, there was a need to work with others to achieve the best expenditure for the benefit of residents.
Councillor Richardson said that the report raised serious concerns, and lacked detail about the possible implications for residents. There was no sense of Borough-wide priorities, and no clear explanation about the reason for the hole in the budget. A more detailed report that offered a response to the concerns raised by the Committee, was requested.
ACTION: CCG to keep the PAC informed of their plans for financial recovery and how they plan to consult with stakeholders, and provide a further update.
That the report be noted.