The financial challenge to
Hertfordshire health services
Alan Pond
Director of Finance NHS Hertfordshire
Interim Chief Executive Herts Valley CCG
Commissioning for Patients –
future funding flows
• Groups of GP practices will commission most
local NHS services
• Two Shadow Clinical Commissioning Groups (CCGs)
in Hertfordshire
• Herts Valleys CCG
• East & North Herts CCG
• The new national NHS Commissioning Board
will commission GP, dentistry, pharmacy and
ophthalmic services, specialised services and
prison health services
Commissioning for Patients
Clinical Commissioning Groups
• Will be statutory bodies with own senior staff
• All practices must be part of a CCG
• NHS Commissioning Board will support by developing
commissioning guidelines, model contracts and tariffs
• CCGs will be able to employ staff directly or buy in
services from external organisations
• CCGs can decide which aspects of commissioning
activity they undertake themselves and which aspects
they share
• Hertfordshire Integrated Commissioning Support
Service being developed to support CCGs
Commissioning for Patients
Finance
• The NHS Commissioning Board will initially calculate
practice-level budgets from the current PCT budgets
and allocate these resources directly to CCGs
• New weighted capitation formula will provide target
allocations for each CCG
• Pace of change policy will drive how quickly funding is moved
to get CCGs to their target
• Commissioning budget will be separate from surgery
income
• CCGs will receive a maximum management allowance
to directly employ staff or buy in services. Indicative
amount is £25 per head
• Details on how any over/underspends will be managed
is yet to be agreed with the DH and the Treasury
Commissioning for Patients
Proposed implementation timetable
In 2012/13
• CCGs formal committees of NHS Hertfordshire
Board
• Formal establishment of CCGs and NHS
Commissioning Board
• Approvals process for CCGs in phased approach
• CCGs receive indicative budgets and must prepare
commissioning plans
In 2013/14
• CCG statutory bodies and where authorised will
receive funding allocation and hold contracts
Transparency in outcomes
• NHS targets focus on measuring outcomes
• New outcomes framework for 2012/13 created
• Framework to be structured around five areas:
1.
2.
3.
4.
5.
Preventing people from dying prematurely
Enhancing the quality of life for people with long-term
conditions
Helping people to recover from episodes of ill health or
following injury
Ensuring people have a positive experience of care
Treating and caring for people in a safe environment and
protecting them from avoidable harm
There are over 500 performance indicators which the PCT is
responsible for reporting on (by provider and by CCG/PCT)
Transparency in outcomes 2
• NHS Operating Framework – Key Priorities
1.
2.
3.
4.
Dementia and care of older people
Carers
Military and Veterans Health
Health visitors and family nurse partnerships
• SHA Ambitions
•
•
•
•
•
Eliminate pressure ulcers
Every patient contact counts
Quality/Safety in Primary Care
Strengthened NHS/Local Government partnerships
Improve patient experience
QIPP – Financial Context
• White Paper
sets out £20bn
efficiencies
over next 4
years
Size of QIPP
Challenge
£276m
• Links to
Operating
Plan,
Framework &
Outcome
Framework
Projected Expenditure
Without QIPP
Projected Funding
Financial Picture – 2012/13
1. Hertfordshire system in balance at 31st March 2012
2. Managed to deliver circa £100m efficiencies in
2011/12 across Hertfordshire
3. Funding used non-recurrently to drive change and
deliver efficiencies
4. PCT funding for 2012/13 £1.76bn
5. Significant challenge across the system in 2012/13 to
2014/15 and beyond…
Financial Picture – 2012/13
Illustration of how the PCT income is spent (2010/11)
Maintaining Performance
Managing Change
• Set out the vision – DQHH puts Hertfordshire
ahead of other areas
• Created early momentum, delivered first year
of QIPP
• Minimise fear to avoid distraction
• Prioritise performance areas to concentrate
on
• Dedicated resource for transition
• Talent management