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?