NHS Hambleton, Richmondshire and Whitby Clinical Commissioning GroupAnnual Operating Plan 2013/1428th March 2013

Debbie Newton

Chief Operating & Finance Officer

Our Strategic Plan

Strategic aims

• We will involve people in their care and we will encourage self-care

• We will buy quality services

• We will change services for the better and in doing so we will provide care as close to home as possible that is easily

accessible

• We will use the money we have in the best possible way

How did we develop our plan?

Our Strategic plan is based on:

•Our current performance•What we know about the range and extent of services in our area •Knowledge of local health and social issues through the Joint Strategic Needs Assessment (JSNA) •Knowledge of patient and stakeholder views through JSNA•Department of Health priorities within “Everyone counts”

How do our initiatives link to the JSNA?

How do our initiatives link to the JSNA?

National Commissioning Requirements

Everyone Counts• Provides planning guidance, incentives and tools which are

intended to improve services from April 2013. • Used by the CCG to ensure delivery of the priorities and

requirements which encompasses four key areas:1. New approaches to planning.

2. Improving outcomes, reducing inequalities.

3. Commissioning support; tools and levers.

4. Planning and assurance.

• Two challenges are highlighted below:1. A guarantee around the reduction of inequality; and ensuring

patients’ interests are placed front and centre in delivery of care.

2. Five offers to NHS commissioners, providing guidance and evidence needed to produce better local health outcomes.

Everyone Counts:The five offers from the NHS Commissioning Board to CCGs 1. NHS services, seven days a week.

2. More transparency, more choice.

3. Listening to patients and increasing their participation.

4. Better data, informed commissioning, driving improved outcomes.

5. Higher standards, safer care.

CQUINS (Commissioning for Quality and Innovation)

• CQUIN for 2013/14 is set at a level of 2.5% value for all healthcare services commissioned through the NHS Standard Contract.

• Trusts are only eligible to obtain CQUIN payments if they satisfy 50% of the pre-qualifying requirements.

• One fifth of the total CQUIN value (0.5% of overall contract value) is to be linked to the national CQUIN goals.

• 0.5% of the value for all healthcare services commissioned through the NHS Standard Contract is to be linked to the national CQUIN goals.

National CQUINFriends and Family Test – “How likely are you to recommend our ward / A&E to friends and family”

Improvement against the NHS Safety Thermometer (excluding VTE), particularly pressure sores

Improving dementia care, including sustained improvement in Finding people with dementia, Assessing and Investigating their symptoms and Referring for support (FAIR)

Venous thromboembolism (VTE) – 95 per cent of patients being risk assessed and achievement of a locally agreed goal for the number of VTE admissions that are reviewed through root cause analysis

Performance

• Contractual levers as set out in the 13/14 standard contract.

• National performance measures are in performance indicators delegated to the CCG.

• Detailed work to review performance and action plans will take place through our monthly Contract Management Board.

• Additional focussed work will continue with providers and patients to ensure the delivery of all ambulance and cancer indicators.

The key risks around non-delivery of the Annual Integrated Plan 2013/14

• Capacity and capability.• Demand management.• Impact of Payment By Results Tariff change, specialist

commissioning and unbundling of diagnostics.• System wide accountability.• Clarity and credibility of strategic plans.• Finance.• Volume of work transferring to primary care.• Continued patient and public involvement and support.

Any significant risk will be added to the CCG Risk Register and therefore result in formal tracking and management.

Delivering our Financial Strategy

Planning Guidance – what we have to do:

Buy safe and sustainable services

End the year with a 1% surplus - £1.6m

Plan for a contingency of 0.5% - £0.8m

Repay share of PCT legacy debt - £1.8m

How much money have we got?

£’000

CCG share of PCT budget 165,573

Uplift for growth 3,808

Amount available to spend 169,381

How do we agree the budgets?

£’000

What we spent in 2013/14 162,563

Efficiencies on provider contracts (-4%) -5,986

Inflation on provider contracts (+2.9%) 4,813

Demographic Growth (+0.72%) 1,105

Other growth and cost pressures 2,581

QIPP -2,048

Payment to providers for Quality (CQUIN +2.5%) 2,977

TOTAL EXPENDITURE 166,005

Where do we spend the money?

What does the bottom line look like?

£’000

How much money have we got 169,381

How much are we spending -166,005

What have we got left 3,376

What will we use this for?

Repay share of PCT legacy debt -1796

0.5% contingency -828

Balance 0.45% surplus 752

Risks to the financial plan

• The split of the PCT budgets to numerous organisations – 6 CCG’s, the NHS Commissioning Board and Local Authorities

• Demographic growth increases more than expected

• Providers cannot meet their efficiency targets

• QIPP programme is not fully delivered

• Unexpected pressures emerge throughout the year

Management Costs£’000

How much can we spend (£25 per head of population) 3,556

Where are we spending it

CCG internal costs 1,582

Services bought from Commissioning Support Unit 1,249

Services bought from other support organisations 725

Delivering our Financial Strategy• With the application of growth the CCG’s overall delegated budget

for commissioning services in 2013/14 is £169m.

• This equates to £1,195 per head of population to spend on commissioning services for its population (Average £1,145).

• The full QIPP programme is £2.0m.

• After repaying its current share of the PCT brought forward deficit, the CCG is planning to deliver a 0.45% surplus (£752k) at the 31st March 2014, which is below the 1% identified in the national planning guidance.

• Gives us a platform to have a balanced financial position next year but this is dependent on mitigating our financial risks.

Questions