Norfolk Clinical Commissioning Groups and
Norfolk County Council Adult Social Care
The Commissioning Environment
Clive Rennie,
Head of Integrated Commissioning for Mental Health &
Learning Disabilities
Coverage

National MH Strategy

Current Funding Environment(s)
 CCG’s
 NCC

Organisational Arrangements
Commissioning
Intentions
National Picture – The Messages
Commission high quality, cost effective general and
specialist health services for people with learning
disabilities.
 Jointly commission services for people who
challenge services and those with complex needs.
 Work with local authorities and others to address
the social factors which adversely affect the health
of people with learning disabilities.

National Picture – The Messages
Wider interlink across Government Departments
 Cross Cutting Strategies
 Health Inequalities
 Poor experience of Health provision
 Primary Care Annual Health check
 Reasonable adjustments to enable equitable access
to services

National Picture – The Messages
Increase Employment
 Listen to the Patient experience - Winterbourne
 Carers needs
 Mental Capacity Act training

Current Funding Environment
Clinical Commissioning Groups
– 2.3% extra funding in 2013/14
– CCG’s have a recurrent deficit position based on PCT end
position
– All CCG’s have to save 2% non-recurrent usage
– All CCG’s have to have a 1% surplus
– Activity, demographics and technology advances are
adding cost pressure of 2% and above per annum
– Continuing Health Care Restitution Costs – 15% growth per
annum
Current Funding Environment
Clinical Commissioning Groups
– Increased funding passed across to Social Care from CCG’s
– 3% cost savings need to be made through Quality
Innovation Productivity and Prevention (QIPP) plans
– Equates to:
 £20Billion nationally
 £30M locally across the 4 CCG’s Norwich, West, South,
North
– No indication of the funding settlement for 2014/15 until
December 2014
Current Funding Environment
Clinical Commissioning Groups
- Increase
funding pass through to Social Care
- Increased pressure on Acute i.e. A&E/ Beds/
Dementia
- Community provision focus
-What currency? Block/ Cost and Volume/ PbR Care
Clusters
Current Funding Environment
Norfolk County Council Adult Social Care
Comprehensive Spending Review 2011
 NCC savings 140M
 2011-2014 – 50.62M savings in Adult Social Care
 Comprehensive Spending Review 2014
 2014 – 2017 – 189M savings in NCC
 2014/15 – 73M savings

Current Funding Environment
Norfolk County Council Adult Social Care

2014 – 2017 – Adult Social Care share of the savings 56.6M
(1% of the Adult Social Care budget)

2014/15 – 21M

2015/16 – 26.7M

2016/17 – 8.2M

Consultation - Norfolk Putting People First – starts 19th
September
Integrated Commissioning
Organisational Arrangements

Integrated Commissioning Team for Mental Health and
Learning Disabilities

Legal agreement under Section 75 of the Health and Social
Care Act 2012 between:
 Norfolk
Clinical Commissioning Groups
 Norfolk County Council
 NHS Anglia Commissioning Support Unit
Integrated Commissioning
Organisational Arrangements

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Head of MH and LD Commissioning for 4 Norfolk CCG’s and
NCC
Commissioning Lead for Adult Social Care (Community
Services)
Head of Service, Mental Health
Commissioning Lead - Adults with Learning Disabilities
Commissioning Lead - Dementia
Commissioning Lead – Autism/ Aspergers
Commissioning Lead - IAPT
Commissioning
Organisational Arrangements

Creation of the NHS England and Area Teams

Linkage to the Department of Health

Creation of Commissioning Support Services (Hosted)

Transfer of Public Health
Integrated Commissioning
Organisational Arrangements
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Mental Health and Learning Disability Commissioning Board –
Norfolk CCG’s, Norfolk Adult Social Care, Public Health,
Healthwatch
CCG Board’s
Adult Social Care – Senior Management Team
NCC - Cabinet
NSFT – Contract and Performance Meeting
Contract meetings with other providers
Information and Performance Sub Group
IAPT Contract Sub Group
Clinical Quality and Patient Safety Reference meeting
Access and Assessment Service Reference Group
GP Leads clinical meeting
Organisational Arrangements –
Providers

Learning Disabilities
 Norfolk County Council – Social Care provision
 Hertfordshire Partnership NHS Foundation Trust – Healthcare
provision – Assessment and Treatment
 Joint Funding for individual placements – Cawston Park, St Johns,
Rowan House
 Social Care Individual funding packages
 Supported Housing placements
 Primary Care - Direct Enhanced Services
 NNUH/ QEH/ JPH – Specialist Learning Disability Nurses
Organisational Arrangements
– Budgets/ Expenditure approximations

Health 18M

Social Care 86M

Total 104M
Draft Commissioning Intentions 2014/15

To undertake the financial instruction (deflator)as outlined in
Operating Framework for the NHS for all Mental Health and
Learning Disability contracts with Health funding streams

To review all Health funded third sector contracts in line with the
principles established by Norfolk CCG’s

To undertake the necessary actions to reduce the spending
commitments on services in line with the budget reductions set by
NCC Cabinet
Other Draft Commissioning Intentions 2014/15

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Dementia diagnosis trajectory to meet national calculator uplift
between 2% - 5% per annum – requirement for additional
resource to meet the early/ timely diagnosis of patients.
To ensure the pathway for patients assessed and referred under
the FAIR scheme (Dementia CQUIN into the Acute Trusts
2012/13/14) is opened to direct referrals from Acute Trusts to
Memory Services and to ensure that the current low level
waiting times are not compromised by this change of pathway.
To implement the Dementia Direct Enhanced Service agreement
for GP’s to ensure that accurate recording of all patients with
Dementia is on the Quality and Outcome Framework
Draft Commissioning Intentions 2014/15

The system of activity and currency is changing in 2014/15 for
the main Mental Health FT contracts to shadow Payment By
Results as opposed to the current Block contract
arrangements. This change will need to translate into the
2014/15 main contract

The restructuring of Mental Health services under the Radical
Redesign process and the Payment By Results Care Clusters
requires new clinical specifications to be agreed and costed.

Specific work is being undertaken for the design and
modelling of the Psychiatric Liaison Service at QEH
Draft Commissioning Intentions 2014/15

The Improving Access to Psychological Therapies service
across all the CCG’s in Norfolk will be re-commissioned in
2015. To undertake options appraisal leading to the tendering
and procurement process in 2014/15

Specific work is being undertaken for the design and
modelling of the Psychiatric Liaison Service at QEH

To ensure that the self-assessment of Autism commissioning
and provision is undertaken and to plan the implementation
of the outcomes of any deficits within the Norfolk system that
are identified
Draft Commissioning Intentions 2014/15

To appraise the options as regards the potential
establishment of a new Section 75 arrangement for Social
Care provision in Mental Health

To agree the Section 75 arrangement between NCC and the
Norfolk CCG’s for Learning Disability Services

To have staffed 136 suites in place throughout Norfolk. This is
in line with recent CQC and HMIC report recommendations

To adopt, in Norfolk, the pilot and standards set in the North
Essex agreement for the conveyancing of Mental Health
patients by EEAST.