The Forward View into action:

planning for 2015/16

Summary for NHS Confederation members

Planning guidance at a glance

• Combines points from NHS England Mandate, Five Year Forward View (5YFV), autumn

statement and financial allocations, and confirms the roadmap for year one of 5YFV

• Operational plans to be refreshed for 15/16 only. Few new national requirements (except

mental health)

• “Intense focus” on maintaining performance and NHS Constitution standards.

Commissioner and provider activity and financial assumptions must align better

• Extra £1.83bn allocated through Mandate. £200m investment fund for 15/16 & £250m for

primary care and out of hospital infrastructure. Winter pressures funds upfront, not in-year

• Permissive approach to developing and implementing new models. “Vanguard” areas to

move at pace; new “success regime” for challenged areas; most areas in middle group

• Local areas “strongly encouraged” to use 14/15 units of planning to develop & progress

vision for future. Partnerships and whole system working emphasised

Co-creating new models of care

• Sets out how local and national organisations can work together to accelerate the design and implementation of 5YFV new models of care:

• Multispecialty community providers• Integrated primary and acute care systems• Viable smaller hospitals• Enhanced health in care homes

• Permissive approach to change across the country. CEOs of six national bodies as single leadership group, with coalition of partners

• Areas already making strongest progress (“the vanguard”). Focussed support and investment from transformation fund to prototype 5YFV models, adopt at pace and share learning. Some may be part of local systems facing significant difficulties. Express interest by end of January

• Most challenged areas to have a “new and directive regime” (or “success regime”) overseen by national bodies, to create conditions for success

• Majority of areas in neither vanguard nor challenged group; NHS England to “make it easier” for them to implement change

New models of care (continued)

Primary care • 10 point plan to attract more training doctors into general practice.• CCGs that take on co-commissioning responsibilities will have more freedom to take local

action

Urgent and emergency care models• Commissioners and providers to prioritise implementing urgent and emergency care

review • Urgent and emergency care networks established by April 2015 to oversee planning and

delivery of a regional or sub-regional urgent care system.

Maternity

• A national review of maternity services will be completed by summer 2015 which will look

at giving mothers more choice without comprising safety.

Specialised services

• Continue move towards centres of excellence; NHS England to begin first round of

service reviews, with local partners, by summer 2015

Creating a new relationship with patients and communities

Getting serious about prevention, including: • New national diabetes prevention programme (Local areas can register interest by

end January)• CCGs to work with local government to reduce inequalities in health, healthcare and

outcomes – with joint, quantifiable ambitions• New national Prevention Board, chaired by PHE

Empowering patients• All CCGs to lead major expansion of personal health budgets, including integrated

health and social care budgets for people with learning disabilities by April 2016. JHWSs to include clear goals on expanding PHBs

• Demonstrator sites to take first steps towards integrated personal commissioning• More action to honour patients’ entitlement to choice enshrined in NHS Constitution

– particularly maternity and mental health

Engaging communities• More support for carers• Newly accredited roles for 3 million volunteers

Workforce

• “Provision of healthcare is mainly about people not buildings”

• Emphasises LETBs must work with commissioners and providers to ensure future

workforce meets needs

• New Workforce Advisory Board to help develop the workforce to deliver the new

models

• Employers should take “significant additional actions” on staff health and wellbeing:

• New taskforce on healthy workplaces

• Will develop incentives for employers that implement health and wellbeing

programmes as recommended by NICE

• Implementation of NHS Race Equality Standard from April 2015

• All healthcare employers should review policies to support staff who are carers

Priorities for operational delivery in 2015/16

• “Intense” focus on meeting NHS constitution standards – including waiting times

• Focus on improving quality and outcomes, including• Improvements against Outcomes Framework• Commissioners and providers to use CQC inspection reports to assure themselves of good

quality, and develop joint plans where improvement needed• Revitalised National Quality Board (priorities and programme due in spring)• Commissioners and providers to embed clear clinical accountability and ‘named doctor’

• Major national and local emphasis on patient safety. • Expect commissioners and providers to take an active part in local Patient Safety

Collaborative• New national indicators for sepsis and acute kidney injury• New national quality premium for validating antibiotic prescribing data

• Towards parity of esteem• Introduction of access and waiting time standards in mental health services• Commissioners and providers to ensure adequate liaison psychiatry in acute settings, and

invest in community CAMHS• NHSE to coordinate investment in community based specialist teams for children and

young people with eating disorders

Enabling change

• Towards a ‘paperless NHS’:• NHS number as primary identifier in all settings

• 60% of GP practices to use e-prescriptions by March 2016

• Primary care to expand online services for patients

• Discharge summaries available electronically everywhere by October 2015

• At least 80% elective referrals from GPs to be electronic by March 2016

• By April 2016, commissioners to publish roadmaps for fully interoperable digital

records

• Accelerating useful innovation:• NHSE and NICE to develop deployment model for new technologies in 2015

• Small number of “test bed” sites evaluating impact of combinations of different

technologies / innovations

• Commissioners to take actions to support NHS objective of sequencing

100,000 genomes

Driving efficiency

• NHS cannot rely solely on top-down initiatives to deliver savings

• National bodies to align approach to assuring plans

• Opportunity for 1% net per year savings from closing the gap between the least and most efficient providers. Further opportunities for savings from investment in prevention and technology

• £1.5bn of additional NHS funding includes winter pressures funding provided recurrently (rather than in year). Essential commissioners and providers develop accurate, aligned finance and activity plans; significant differences will be reviewed. NHS organisations should not expect in-year injections of funding

• Commissioners and providers must jointly agree plans for spending 50% balance from marginal tariff, targeted towards reducing non-elective admissions

• All CCGs to increase mental health spend in real terms, by at least as much as their own allocation increases

Driving efficiency (continued)

• CCG commissioning budgets will increase by average of 3.4% and primary care

commissioning budgets by 4.1%.

• NHS England internal budgets will decrease by 13.7% and CCG admin budgets will

decrease by 9.7%

• All commissioners to set aside 1% non recurrent spend, to invest in service

transformation

• BCF plans should be reviewed if risk to delivery changes

• CQUIN 15/16 changes:• 2 indicators with minor updating: dementia and delirium, and physical health care for

people with mental health conditions

• 2 new indicators: acute kidney injury and early identification and treatment of sepsis

• new theme: improving urgent and emergency care

• safety thermometer and friends and family now in Standard Contract rather than CQUIN

TimetableJan 2015 Publication of revised National Tariff, standard contract for 2015/16

Jan – 11 Mar 2015 Contract negotiations – including voluntary mediation

13 Jan 2015 Submission of initial headline plan data (CCGs, NHSE, NHS Trusts)

From 29 Jan 2015 Weekly contract tracker to be submitted each Thursday (CCGs, NHSE, NHS Trusts and

NHS FTs)

13 Feb 2015 Checkpoint for progress with planning measures and trajectories (CCGs, NHSE)

20 Feb 2015 National contract stocktake – to check the status of contracts

27 Feb 2015 Submission of full draft plans (CCGs, NHSE, NHS Trusts, FTs)

27 Feb – 30 Mar 2015 Assurance of draft plans (CCGs, NHSE, NHS Trusts, FTs)

6 Mar 2015 Checkpoint for progress with planning measures and trajectories (CCGs, NHSE)

11 Mar 2015 Contracts signed post-mediation. (CCGs, NHSE, NHS Trusts, FTs)

Joint dispute resolution process applies to contracts unsigned after this date

12 – 23 Mar 2015 Contract arbitration (CCGs, NHS England, NHS Trusts, FTs)

By 25 Mar 2015 Arbitration outcomes notified to commissioners and providers (CCGs, NHSE, NHS

Trusts, FTs)

By 31 Mar 2015 Plans approved by Boards of CCGs, NHS Trusts and Foundation Trusts

10 Apr 2015 Submission of full final plans

From 10 Apr 2015 Assurance and reconciliation of operational plans