East and North Herts CCG Financial Overview Alan Pond Chief Finance Officer East and North Hertfordshire CCG The national picture Liberating the NHS • NHS England and CCGs established • Public Health functions transfer to Local Authorities • (Negligible) Real term increases for NHS funding for each year of Parliament • NHS to release up to £20bn of efficiency savings by 2014/15 • Minimum efficiency savings of 4% per year • Management costs to reduce by one-third by 2014/15 Splitting of PCT functions CCGs NHS England Commission healthcare – hospital and community health services Specialised services GPs, Pharmacists, Opticians Public Health PCT Local Authority Public Health – health prevention NHS Property Services Premises What this meant for the money in Hertfordshire Hertfordshire Allocation £1,708m Hertfordshire County Council £31m Royston £24m CCGs £1,211m E&N Herts £575m Herts Valleys £612m NHS England £466m GP Services £122m Other Services £344m What CCG allocations are spent on National Tariff (Payment by Results) Other Inpatients Outpatients A&E X-ray & pathology tests Critical care High cost drugs Hospital care COMMUNITY CARE District nurses Community chiropody Community physios & OTs Community hospitals Community and mental health care MENTAL HEALTH CARE Mental health inpatients Community health teams Learning disability care Eating disorders Continuing health care Drugs Equipment Ambulances AND Transformation funding Minor injury units Management costs CCG Statutory Financial Duties • To keep spending within resource limit • To keep spending within running cost allowance • Not to spend more cash than allocated • To achieve value for money in use of resources • To produce annual accounts and annual report • To keep appropriate accounting records Funding for 2013/14 • Funding announced December 2012 • No Pace of Change to fair shares – all CCGs received 2.3% growth in allocation • Huge problems with specialist commissioning – funding is NOT currently where costs will fall • All CCGs received a running cost allowance of £25 per head of population (£14m for ENHCCG c2.3% of the overall budget) • Commissioning budget is separate to surgery income Introduction to East and North Herts CCG • 60 constituent GP Practices • 562,000 population UPPER LEA VALLEY WELWYN AND HATFIELD 16 practices 9 practices 124,635 population 111,067 population STEVENAGE NORTH HERTS 9 practices 12 practices 90,281 population 111,384population STORT VALLEY AND VILLAGES LOWER LEA VALLEY 6 practices 8 practices 51,835 population 73,152 population Our mission is: • To reduce health inequality and achieve a stable and sustainable health economy by working together, sharing best practice and improving expertise and clinical outcomes • To work with patients, managers and clinical colleagues from all sectors to commission the best possible healthcare for our patients within available resources How the CCG is organised • Six localities retaining a strong local focus to commission around needs of their local population • Governing Body with GP Chair, elected GP locality representatives, Executive Directors and Lay Members • Integrated strategy developed through locality structures • Improved practice engagement through locality structure and regular communication • Resource allocation and financial reporting at locality level and GP Practice level • Strong patient, carer and public engagement Patient Commissioning Groups • Six Patient Commissioning Groups, (PCGs) aligned geographically to GP Localities • Encouraging the development of patient participation groups (PPGs) in GP surgeries • Any person registered with GPs in east and north Herts can be a member of their Locality Group • GP practice / PPG endorse patients to serve on Locality Patient Commissioning Groups(PCGs) • 6 GP Patient Champions, one in each locality • Invitation to Healthwatch to nominate representatives • Agreed terms of reference following local discussions • Evening meetings every 6/8 weeks • Co- chair arrangement PCGs – what they do • Give feedback on the quality of services that are being commissioned using, for example, patient/carer stories • Capturing information/feedback from patients at surgery level to inform clinical pathway design work • Participate in discussions with clinicians on potential service changes • Being a critical friend to question and influence the CCG’s commissioning priorities and decision-making • Representation on Priorities Forum; Home First Clinical Governance Group; Patient Transport Procurement Process • Looking ahead – Training for patient /carer stories; new QEII development; CCG monitoring visits Health highlights • • • • • • Over half a million people live in ENHCCG. Expected to grow by 26% by 2035. The number aged 65 and over is predicted to increase by 75% Deprivation in Hertfordshire is lower than the national average, although there are pockets of deprivation in ENHCCG. The health of people in ENHCCG is generally similar to or better than the East of England average (which is better than the national average) although this varies at district level. Life expectancy at age 65 has increased over the last seven years although it is slightly lower than the East of England average for both men and women. Early death rates from circulatory diseases, cancer and causes amenable to healthcare have fallen steadily over the last 18 years and are slightly lower than the average for the East of England. Just over 20% of adults smoke, higher than the East of England average; and an estimated 770 deaths per year are due to smoking. Stevenage has significantly higher smoking prevalence and smoking attributable mortality. Emergency hospital admission rates for ambulatory care sensitive conditions (conditions potentially treatable in the community) are lower than the East of England average. However, over 5,200 admissions a year could potentially be avoided. Financial challenge in 2013/14 • 0.1% real terms growth in funding • Increasing and ageing population • Increasing demand and quality pressures • Pay and prices increase = EFFICIENCY SAVINGS NEEDED CCG gap in funding for 2013/14 • 2.3% uplift • Tariff reductions £20m • Population growth • Increased demand • Required 1% underspend £38m • Underspend carried forward Health and Wellbeing Priorities Focus Areas in 2013/14 Pathways: • Urgent care • Stroke care (Acute, rehabilitation) • Out of hospital care - Intermediate Care • Planned care - Long Term Condition Management • Integrated working – collaborative working across different providers to deliver pathways Outcomes: • Avoiding unnecessary hospital admission • Prevention and self-management • Supported discharge • Joined up pathways Key Projects this year 2013/14 savings by category Long term conditions Frail Elderly Planned care End of Life secondary care Mental health Primary care productivity Ambulance services Community services Referral management Prescribing Running costs TOTAL £000 2,969 2,990 4,282 907 1,166 311 253 1,696 1,161 2,661 186 18,583 2% transformation fund One-off grants to support projects to: • improve the cost effectiveness and value for money of services • deliver quantifiable improvements in performance • achieve long-term savings and efficiencies Funds provided to cover: • scheme development and implementation • costs of piloting or double-running • exit costs of other services Planned spending in 2013/14 Fair share funding for Localities in 2013/14 Total allocations £m £ Per weighted head of population 2013/14 financial performance APRIL TO JULY 2013 VARIANCE AGAINST PLAN YTD FORECAST Overall Financial Position YTD underspend of £295k, which is in addition to the required underspend. Forecast position remains achievement of 1% surplus of £6,020k, therefore a zero variance against plan. G 295 G 0 Recurrent Position G 295 G 0 Acute contracts Mainly based on month 4 Trust reports. Most significant area of overspend is Independent Sector R (629) Prescribing Based on month 3 PPA report. G 184 Contingency The ytd position does not include a share of the annual contingency reserve. % Utilised G 0% £ uncommitted G 3,011 The financial challenge continues beyond 2013/14 Planned financial changes 2013/14 to 2015/16 Description Recurrent baseline funding Expected increase Growth in funding Underspend brought forward Total funding Acute hospital care Mental health & LD Community services Ambulance services Continuing health care Prescribing Other non-acute/primary care Running and corporate costs Transformation Fund Contingency reserve Total spending Underspend Planned Savings of: Percentage of Spending 2013/14 £000 602,105 6,000 2014/15 £000 2015/16 £000 608,105 622,091 2,000 610,105 13,986 6,020 628,111 12,442 6,305 640,838 333,480 72,966 36,683 15,614 21,157 72,778 21,842 14,658 11,896 3,011 604,085 339,440 74,353 37,339 15,893 22,741 75,679 23,040 14,658 12,442 6,221 621,806 344,226 75,489 37,865 16,117 24,358 78,411 24,218 14,658 12,691 6,345 634,378 6,020 6,305 6,460 18,583 3.2% 11,357 1.9% 13,842 2.2% 2015/16 Share 54% 12% 6% 3% 4% 12% 4% 2% 2% 1% 100% Change by 2015/16 £000 % 30,733 5.0% 10,746 2523 1182 503 3201 5633 2376 0 795 3334 30,293 3.2% 3.5% 3.2% 3.2% 15.1% 7.7% 10.9% 0.0% 6.7% 110.7% 5.0% 440 7.3% It’s not just about the money NHS Outcomes Quality – Areas to consider Services/ pathways as a whole e.g. maternity, stroke Infection control Mortality rates (SHMI, HSMR) Training levels Staffing numbers and competencies Complaints (and complaint management) Serious Incidents Patient survey results (including Friends and Family test) Mixed Sex Accommodation Breaches Pressure ulcers Falls Discharge arrangements Sources of quality information From Providers Within ENHCCG External sources Board papers Complaints/ PALS/ MP enquiries CQC- visit reports and Quality Risk Profiles Quality Schedules Serious Incidents and incidents Acute Trust Dashboard CQUINs Soft intelligence National Quality Dashboard Complaints/ PALS/MP enquiries GP hotline NHS Choices/ Patient Opinion websites Serious Incidents and incidents Safeguarding activity National Patient Surveys Internal patient surveys Quality Assurance visits Staff Surveys Quality Review Meetings Patient Network Safety Thermometer Quality Accounts Outcomes of national audits/ reviews Information databases e.g. UNIFY How we use the information Bring together data to build a picture and identify hotspots Look at both qualitative and quantitative information Use the information to inform Quality Assurance Visits etc. Identify what learning has taken place as a result of complaints and Serious Incidents etc. Look at the impact on quality of any changes within the providers Identify information that has not been shared Challenge the Trusts in relation to our findings, and test their insight and responsiveness How the information helps to improve quality It provides the CCG with a patient perspective on quality (complaints, patient surveys etc.) The bringing together of information helps identify hotspots at an early stage Looking across providers allows the CCG to identify areas where providers can share learning and best practice The level of information available allows the CCG to be better informed when commissioning services Final messages • Health and healthcare in East and North Hertfordshire is generally good • Quality – safety, effectiveness and patient experience – is at the heart of our decision making • CCG is financially sound, but challenges are growing for us and our partners • We must all maximise our use of every pound spent – further integration between health and social care Any Questions?