East and North Herts CCG Financial Overview Alan Pond Chief Finance Officer East and North Hertfordshire CCG
Transcript
Slide 1
East and North Herts CCG Financial Overview Alan Pond Chief
Finance Officer East and North Hertfordshire CCG
Slide 2
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
Slide 3
Splitting of PCT functions CCGs Commission healthcare hospital
and community health services NHS England Specialised services GPs,
Pharmacists, Opticians Public Health Local Authority Public Health
health prevention NHS Property Services Premises PCT
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Hertfordshire Allocation 1,708m Hertfordshire County Council
31m CCGs 1,211m E&N Herts 575m Herts Valleys 612m NHS England
466m GP Services 122m Other Services 344m What this meant for the
money in Hertfordshire Royston 24m
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What CCG allocations are spent on Hospital care Community and
mental health care DrugsEquipment Ambulances Minor injury
unitsManagement costs COMMUNITY CAREMENTAL HEALTH CARE District
nursesMental health inpatients Community chiropodyCommunity health
teams Community physios & OTs Learning disability care
Community hospitals Eating disorders Continuing health care AND
Transformation funding
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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
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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
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Introduction to East and North Herts CCG 60 constituent GP
Practices 562,000 population STORT VALLEY AND VILLAGES 6 practices
51,835 population STEVENAGE 9 practices 90,281 population UPPER LEA
VALLEY 16 practices 124,635 population WELWYN AND HATFIELD 9
practices 111,067 population NORTH HERTS 12 practices
111,384population LOWER LEA VALLEY 8 practices 73,152
population
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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
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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
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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
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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 CCGs 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
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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.
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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
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CCG gap in funding for 2013/14 Population growth Increased
demand Required 1% underspend 2.3% uplift Tariff reductions
Underspend carried forward 38m 20m
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Health and Wellbeing Priorities
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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 Focus Areas in 2013/14
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Key Projects this year
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2013/14 savings by category
Slide 20
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
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Planned spending in 2013/14
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Fair share funding for Localities in 2013/14 Total allocations
m Per weighted head of population
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2013/14 financial performance
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The financial challenge continues beyond 2013/14
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Planned financial changes 2013/14 to 2015/16
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Its not just about the money NHS Outcomes
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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
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From ProvidersWithin ENHCCGExternal sources Board
papersComplaints/ PALS/ MP enquiries CQC- visit reports and Quality
Risk Profiles Quality SchedulesSerious Incidents and incidents
Acute Trust Dashboard CQUINsSoft intelligenceNational Quality
Dashboard Complaints/ PALS/MP enquiries GP hotlineNHS Choices/
Patient Opinion websites Serious Incidents and incidents
Safeguarding activityNational Patient Surveys Internal patient
surveysQuality Assurance visitsStaff Surveys Quality Review
MeetingsPatient NetworkSafety Thermometer Quality AccountsOutcomes
of national audits/ reviews Information databases e.g. UNIFY
Sources of quality information
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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 we use the information
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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 How the information helps to improve quality
Slide 31
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