David Evans - Accountable Officer and Andrew Nash - Chief Finance Officer, Shropshire CCG, will attend the meeting to provide an update on the CCG and answer questions from Members.

The Chairman thanked David Evans, Accountable Officer and Andrew Nash, Chief Financial Officer, for attending the meeting .

Mr Evans explained that Shropshire CCG was under legal direction and was being monitored closely by NHS England.  He had only been in post for a matter of weeks and it was an extremely challenging time. The position was still be established but it looked as if there was a deficit of £14.3m to address, rather than £9.6m as previously thought.  

He emphasised that the CCG was required to live within its means and the Medium Term Financial Strategy was being updated to reflect the current position. The Board would need to take decisions on how to deliver efficiencies.  In reply to a question from the Chairman about brokerage, it was confirmed that there was a statutory duty to break even, and any debt would have to be repaid at some point.  Part of recovery would mean achieving a surplus to pay off this debt.  It was not intended to take £14.5m out of the budget over one year, but over three years. It was unlikely that break even would be achieved in 2018/19. 

The Committee asked if it was possible for the CCG to deliver the services required in Shropshire and break even.  Mr Nash explained that there had never been a funding formula that satisfied all CCGs.  He reported that there had been a year on year increase in Shropshire CCG funding and an increase this year.  The CCG had to live within its means and would have to look at where to take funding from over the next three years. 

The Chair asked if there was potential to draw funds into Shropshire by means of the Sustainable Transformation Plan (STP).  Members noted that any funds that came through the STP could not be used for paying off debt but would be used for transforming services, for example, to kick start programmes to deliver services closer to home. 

Members raised issues around delivery of services closer to home, particularly the shortage of domicillary care and whether the STP would help address this.  Mr Evans confirmed that there was an STP workstream looking at workforce.  The proportion of working age to retired population in Shropshire had previously been 5 to 1, dropped to 3.5 to 1 and was now 2 to 1.  In addition to tackling workforce issues there was a need to enable the population to take more care of itself, with more support available to self-manage health issues. 

In response to questions about the CCG budget and what plans there were to make savings, Mr Nash confirmed that the total CCG budget was £415m.  He reiterated the challenging situation but said that solutions would not purely be driven by finance.  All decisions in revising the Medium Term Financial Strategy would be made on the basis of clinical involvement and delivering good quality services.    It was too early to talk about any plans, these would not be available for another few months, but 30 – 40 schemes were being worked up.

The system needed to work across the Health and Social Care economy to prevent admissions in the first place and to discharge from hospital as quickly as possible.  Members noted that 30% of the acute hospital bed base was occupied for over seven days, mostly by people over the age of 70.  Whilst in hospital older people would decompensate and discharge as soon as possible would help prevent this. 

Mr Nash said that the CCG would be looking to share more data with GPs in future. GPs would be a fundamental part of delivery solutions, alongside District Nurses.  Mr Evans added that future services were likely to be delivered on a neighbourhood basis, with district nurses, social care, primary and community health care being delivered by a team.  Pilot schemes were to be launched in Ludlow, Bridgnorth and Church Stretton in the next year.  They acknowledged the significant challenges around delivery in rural and sparse areas, for example south west Shropshire where 9,000 people lived in an area of 300m².  

The Committee commented on the lack of carers in rural areas, partly due to them being expensive areas to live.  There was also a need to make the care industry more appealing.  A Member representing a rural electoral division emphasised the need to involve someone who understood delivery of services in rural areas whilst looking at this, Elected Members and also GPs based in Wales who serviced Shropshire residents. 

Mr Evans acknowledged the challenges of identifying a work force, the sparse population and travel times and distances.  He emphasised the need to work collectively and avoid any duplication of effort, locality based teams would help address this.  It was not possible for GP Practices to work alone anymore and funds were being made available to encourage Practices to collaborate in different ways.  Mr Evans acknowledged the need to involve local elected members and the need to look at the specific needs of a population.

Members asked about underutilised PFI buildings in the county, for example, in Market Drayton and Cleobury Mortimer and whether the CCG was carrying the cost for these.  Mr Evans confirmed this was the case and commented on the need to ensure spare physical capacity was utilised, perhaps for delivery of acute services closer to a community, or as a well being hub.  He referred to work underway on one public estate across the whole of Shropshire’s public sector. 

Members asked about a previous dispute regarding money owed by the CCG to Shropshire Council and Mr Evans said he understood that this had now been dealt with.  He emphasised the need in future to not let any disputes over money get in the way of doing the right thing for Shropshire people.  The Portfolio Holder for Adults said he welcomed the new leadership of the CCG and commented on a more positive working environment with a definitive way forward agreed on funding issues.  He also commented that the CCG’s new approach to the needs of individual communities matched the approach of Shropshire Council.  The Sustainable Transformation Plan would help keep a view across the whole Health and Social Care system and prevent deficits being shunted from organisation to organisation. 

The Chairman expressed the Committee’s appreciation to Mr Evans and Mr Nash for attending the meeting.