NHS England Presentation Template

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Planning &
Commissioning
in Surrey and
Sussex
Workforce challenges
Adam Wickings
9th July 2014
www.england.nhs.uk
From A to B
• Hello: My roles
•
•
•
•
•
Overview: Commissioning and Planning in Surrey & Sussex
Call to Action - the national challenge
Two “Units of Planning” and what they’ve planned
Primary Care & “Out of Hospital” Strategy
“Enablers”: Ring-fenced pots of money
• Better Care Funds
• Urgent Care and RTT “resilience” funds
• Change in the Air - co-commissioning, specialised commissioning
• Big themes with workforce implications
www.england.nhs.uk
2
Surrey & Sussex
www.england.nhs.uk
3
Commissioning & Planning responsibilities in
Surrey & Sussex
Commissioning organisations in Surrey and Sussex
are :
• 12 CCGs (5 in Surrey, 7 in Sussex)
• NHSE Area Team commissions:
• Primary Care
• Specialised services
• Prison services
• Armed Forces
• 4 Local Authorities (East Sussex, West Sussex,
Surrey and Brighton)
Provider landscape is as follows:• 6 Acute Trusts
• 2 Healthcare (Acute & Community)
• 3 Community Trusts
www.england.nhs.uk
•
•
354 GP Practices
2 Mental health Trusts
4
Commissioning & Planning responsibilities in
Surrey & Sussex
Commissioning organisations in Surrey and Sussex
are :
• 12 CCGs (5 in Surrey, 7 in Sussex)
• NHSE Area Team commissions:
• Primary Care
• Specialised services
• Prison services
• Armed Forces
• 4 Local Authorities (East Sussex, West Sussex,
Surrey and Brighton)
Provider landscape is as follows:• 6 Acute Trusts
• 2 Healthcare (Acute & Community)
• 3 Community Trusts
www.england.nhs.uk
•
•
 2 Year “Operational Plans”
 2 x 5 yr Strategies
354 GP Practices
2 Mental health Trusts
5
Surrey & Sussex UoPs
2 “Units of Planning”
2 NHS 5 Year
Strategies
www.england.nhs.uk
6
Commissioning & Planning responsibilities in
Surrey & Sussex
Commissioning organisations in Surrey and Sussex
are :
• 12 CCGs (5 in Surrey, 7 in Sussex)
• NHSE Area Team commissions:
• Primary Care
• Specialised services
• Prison services
• Armed Forces
• 4 Local Authorities (East Sussex, West Sussex,
Surrey and Brighton)
Provider landscape is as follows:• 6 Acute Trusts
• 2 Healthcare (Acute & Community)
• 3 Community Trusts
www.england.nhs.uk
•
•
 4 x Health &
Wellbeing Strategies
354 GP Practices
2 Mental health Trusts
7
Surrey & Sussex HWBs
4 Health & Wellbeing
Boards
4 Health & Wellbeing
Strategies
Better Care Funds
www.england.nhs.uk
8
The Need
for Change
www.england.nhs.uk
National Context - A ‘Call to Action’
The NHS faces a range of whopping challenges
•
•
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We have limited financial resources, no longer growing
An ageing population and growing LTC, and so
A greater and growing demand on services
Workforce that in key areas is not growing at even a similar rate
A ‘Call to Action’ tells us that if we are to preserve key values of the NHS, it must
change to survive. More of the same won’t do it. It means transforming services, to put
patients at the centre and to better meet the health needs of the future.
•
•
•
Improving efficiency (£20bn)
Lowering financial costs
Providing more care outside of hospitals: INTEGRATION, FEDERATION,… polysystem?
 TRANSFORMATION
 SELF MANAGEMENT
www.england.nhs.uk
10
The Money - A ‘Call to Action’
How does providing care “out of hospital” not save money?
•
•
•
•
Staff in the community are not cheaper than hospital staff (and they have to travel)
Buildings in the community are not cheaper than hospitals (they’re more expensive)
Episodes of care, e.g. appointments, are not cheaper than hospital OP appts moving appointments from hospitals to clinics, health-centres or surgeries is not
cheaper
The point of a hospital is to lump staff and services together to make them efficient
and cheap
How can providing care “out of hospital” save money?
•
•
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Fewer, more-expensive episodes are much cheaper overall
People pay for their own homes
30% of a GP Practice list use 80% of the appointments
They’re the same patients having hospital appointments and admissions etc.
Money is saved when we reduce the fixed assets: hospital buildings
www.england.nhs.uk
11
Why Do we Need to Change here?
Surrey and Sussex need to provide a better landscape of health and social
care services for our communities and must be committed to:•
•
•
•
•
•
Increasing the Potential years of life lost from causes considered amenable
to Healthcare
Improve the quality of life for people with Long term conditions
Increase the proportion of older people living at home
Decrease the number of people having a negative experience of care
outside Hospital, in primary care and in the community
Decrease the number of people having a negative experience of hospital
care
Making a significant progress towards eliminating avoidable deaths in our
hospitals
www.england.nhs.uk
12
How Do we
Do This?
www.england.nhs.uk
Main Workstreams in Surrey & Sussex
Surrey Strategic Plan
Sussex Strategic Plan
•
•
•
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•
•
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Out of hospital (primary care, Better
Care Fund, urgent care
Acute Hospital Urgent and
Emergency Care
Stroke
Complex Invasive Cardiology
Elective productivity
Mental Health
Cancer
Burns
Plastic
•
•
•
•
•
•
•
•
•
Out of hospital (primary care, Better
Care Fund, urgent care
Maternity and paediatrics
Acute Hospital Urgent and
Emergency Care
Stroke
Complex Invasive Cardiology
Elective productivity
Renal
Cancer
Burns/Plastic
Provider Landscape
Enabling Workstreams



www.england.nhs.uk
Workforce
Commissioning developments and levers
Others, e.g. BI, IT, premises
14
Main Workstreams in Surrey & Sussex
Surrey Strategic Plan
Sussex Strategic Plan
•
•
•
•
•
•
•
•
•
•
Out of hospital (primary care, Better
Care Fund, urgent care
Acute Hospital Urgent and
Emergency Care
Stroke
Complex Invasive Cardiology
Elective productivity
Mental Health
Cancer
Burns
Plastic
•
•
•
•
•
•
•
•
•
Out of hospital (primary care, Better
Care Fund, urgent care
Maternity and paediatrics
Acute Hospital Urgent and
Emergency Care
Stroke
Complex Invasive Cardiology
Elective productivity
Renal
Cancer
Burns/Plastic
Provider Landscape
Enabling Workstreams



www.england.nhs.uk
Workforce
Commissioning developments and levers
Others, e.g. BI, IT, premises
15
What’s a Primary Care Strategy?
Wider area transformation
strategy - Call to Action
CCG Commissioning
/ transformation
strategy
Out of Hospital
Strategy
Primary &
Community
Strategy
Primary Care
Strategy
www.england.nhs.uk
16
How can commissioners deliver this
change?
Provider changes – integration?,
federation?, reorganisation?, workforce?
Incentives, contracts, new
commissioning
PLAN
Strategy, aims, values, commissioning
intentions, messages
www.england.nhs.uk
17
Elements of CCG PC Strategies
www.england.nhs.uk
18
“New commissioning”
• Prime Provider models
• “Outcome based commissioning”
• Commissioning from “federations”
• New procurement approaches
• Less commissioner specification
• More co-design
www.england.nhs.uk
19
Main Workstreams in Surrey & Sussex
Surrey Strategic Plan
Sussex Strategic Plan
•
•
•
•
•
•
•
•
•
•
Out of hospital (primary care, Better
Care Fund, urgent care
Acute Hospital Urgent and
Emergency Care
Stroke
Complex Invasive Cardiology
Elective productivity
Mental Health
Cancer
Burns
Plastic
•
•
•
•
•
•
•
•
•
Out of hospital (primary care, Better
Care Fund, urgent care
Maternity and paediatrics
Acute Hospital Urgent and
Emergency Care
Stroke
Complex Invasive Cardiology
Elective productivity
Renal
Cancer
Burns/Plastic
Provider Landscape
Enabling Workstreams



www.england.nhs.uk
Workforce
Commissioning developments and levers
Others, e.g. BI, IT, premises
20
Main Workstreams in Surrey & Sussex
Surrey Strategic Plan
Sussex Strategic Plan
•
•
•
•
•
•
•
•
•
•
Out of hospital (primary care, Better
Care Fund, urgent care
Acute Hospital Urgent and
Emergency Care
Stroke
Complex Invasive Cardiology
Elective productivity
Mental Health
Cancer
Burns
Plastic
•
•
•
•
•
•
•
•
•
Out of hospital (primary care, Better
Care Fund, urgent care
Maternity and paediatrics
Acute Hospital Urgent and
Emergency Care
Stroke
Complex Invasive Cardiology
Elective productivity
Renal
Cancer
Burns/Plastic
Provider Landscape
Enabling Workstreams



www.england.nhs.uk
Workforce
Commissioning developments and levers
Others, e.g. BI, IT, premises
21
“Enablers” –
ring-fenced &
discretionary
funds
www.england.nhs.uk
Better Care Funds (& others)
•
•
£18 M
£65 M
•
Not new money: CCG allocations ring-fenced for use as agreed with HWBs,
technically non-recurrent
Not a “bung” for Local Authorities: NHS money for use on integration,
transformation, out-of-hospital
14-15 plans a plethora of “schemes” and “initiatives”
•
•
Surrey 14-15 BCF
Surrey 15-16 BCF
£47 M Sussex 14-15 BCFs
£120 M Surrey 15-16 BCFs
Other Funds in CCGs Control
• Local Contracts (Local Enhanced Services)
• DES contracts
www.england.nhs.uk
Resilience Non-Recurrent Funds
£17 Million
£xyz Million
resilience funds (winter)
RTT funding
• “New” money: non-recurrent allocations (via CCGs,
not straight to Trusts) for delivery of constitution
standards (4 hrs in A&E, 18 wks RTT)
• Non-recurrent and short timescales, short notice so
very difficult to use well
• 14-15 plans a plethora of “schemes” and “initiatives”
www.england.nhs.uk
Changes in
the air?
Co-commissioning
& beyond
www.england.nhs.uk
25
Primary Care “co-commissioning”
• Moving control from NHSE (back) to CCGs
• Expressions of Interest so far
• Can be about budgets or just co-design
• A journey: back to unified budgets?
• A unified budget allows investment (investment in
primary & community care)
www.england.nhs.uk
26
Specialised Commissioning
• Moving control from NHSE (back) to CCGs
• Re-designation - what is designated as specialised
• Population commissioning - away from contracts
• A journey: back to unified budgets?
• A unified budget allows investment (investment in primary
& community care) or disinvestment…
www.england.nhs.uk
27
Key Themes for workforce planners?
• Redesign, initiatives, federations…
• Get involved with planners
• Integration and federation have to be instead of increases in
workforce
• We can move nurses and doctors from place to place but we
can’t often get more
• Reduce episodes and reduce hand-overs
• Lots of new schemes and initiatives can’t be delivered if they
all mean more nurses or doctors
• What workforce can we recruit successfully?
• Pharmacy?
• Physician assistants?
• Who should do innovation and workforce planning?
• Commissioners?
• Providers?
www.england.nhs.uk
28
“Every child deserves to be given the very best start in life, and healthcare
staff working with children and young people must have the right knowledge
and skills to meet their specific needs and ensure that children receive joined
up health and care across both hospitals and the community” . (CMO 2013)
Sort- Coding and Counting
of Staff on ESR is required
to have robust
Health and Social Care
Information Centre Data
Make a planTraining & governance
wider children’s workforce
e.g. PA’s and school staffpersonal health budgets
and the DfE statutory
guidance which takes effect
from 1st Sept 14
HEE Mandate P11-13
Other issues
Health Visiting – Role of minor
Illness
How do
we work
with
Social
Care
Education
to join up
our
workforce
strategies
School Nursing role in Long term
Conditions
HEE Mandate
https://www.gov.uk/government/uploads/system/uploads
/attachment_data/file/306967/HEE_mandate_201415.pdf?utm_medium=email&utm_source=The+King%27s+
Fund+newsletters&utm_campaign=4043517_HMP+201405-02&dm_i=21A8,2ENZX,FLWRM1,8RQGI,1
SCN WORKS JOINTLY WITH HEE CYP
PROGRAMME BOARD
Nursing
Medical
Significant national
shortage of
registered
children’s nurses
Shortage of
paediatricians to
cover RCPCH
standards in acute
care
Need for a review
of Need for more
community and
advanced roles in
the community
Role of Community
Paediatrican and
recruitment issues
Primary Care
workforce role &
Skills for CYP with
Acute and LTC
Need for more
Practice Educators
How do we get the right balance?
Health
DEPARTMENT OF HEALTH COMMUNITY NURSING STRATEGY
The SCN are engaged in scoping of CYP community nursing
Any
Questions?
9th July 2014
www.england.nhs.uk
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