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Governing Body Meeting in Public - 16 January 2019
Planning and Commissioning Intentions
2019/20
Andrew Parker, Director of Primary Care Development
Christine Caton, Chief Financial Officer
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Contents
1. NHS Long Term Plan
2. Lambeth Together
3. Planning for 2019/20
Appendix A. NHS Long Term Plan Summary
Appendix B. Longer-term deliverables
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1. NHS Long Term Plan
• The NHS published its Long Term Plan for the NHS on Monday 7 January 2019.
• The plan sets out the ambition, challenges and approach to delivering better outcomes of
care for the NHS over the next decade. We are going through the plan in detail so that we
fully understand the implications for south east London. A comprehensive summary of the
plan is included as Appendix A in this presentation.
• Much of our local plans and ways of working, and the development of our Lambeth
Together approach are very much aligned to the improvements in care and reduction in
health inequalities described in the national plan, and an update on Lambeth Together is
described in section 2.
• Lambeth CCG, together with our partners, will be reflecting on and adapting our local
plans in light of the priorities set out in the Long Term Plan, and are actively developing
our commissioning intentions and Planning for 2019/20, with an update provided in
section 3.
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2. Lambeth Together • Leaders of organisations across Lambeth have come together to work as one to co-ordinate
and deliver health and care services in the whole Borough
• Our vision is to improve health and reduce health inequalities for people in Lambeth
• We have seen the benefit of working across the traditional boundaries between hospital and
community services, health and social care, voluntary sector and state sector, staff and
people using services and representative bodies
• We are working towards a range of Delivery Alliances that will be responsible for delivery
and achievement of these outcomes
• The strategic and policy drivers for system level integration of health and care are strong.
• We have a Strategic Alliance leadership, and will be publishing our Communications,
Engagement and Strategic plans for fully integrated health and Care in Lambeth over the
coming months
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Lambeth Together - Key Next Steps • Neighbourhood Base Care and Wellbeing
Building on the recommendations supported at the last GB Meeting in Public, a further set of recommendations will come to
the Governing Body Meeting in March and Council Cabinet in April regarding next steps – to include:
– Detailed service scope and proposed financial envelope
– Key outcomes
– Programme governance and resourcing
– Procurement approach
– The emerging Neighbourhood Nursing Model and GP ‘clusters’ or Primary Care Networks (PCNs) in Neighbourhoods –
supported by GP federations, as envisaged in the NHS Long Term Plan, are incorporated within this ambition.
• Other Delivery Alliances
Work will continue to implement the Lambeth Living Well Network Alliance, to take the next steps for a Lambeth Together
approach for Children’s and Young People, and to design an Alliance approach to support individuals with high care needs.
• Lambeth Together Governance and Leadership
The transitional Lambeth Together Alliance Leadership arrangements will be superseded with new governance and
leadership arrangements from April/May 2019, with maximum alignment to health and Wellbeing Board arrangements.
Committee/s in common arrangements will be redesigned to enable enhanced joint decision making. This will align with SEL
wide arrangements.
• Developing a Strategy for Lambeth Together
The work underway to develop a strategy for Lambeth Together, building on the existing H&EN Plan and Joint Strategic
Needs Assessment work, will be reviewed and aligned to the process for planning and developing Strategic Plans at both
SEL, borough (place) and neighbourhood level as envisaged in the NHS Long Term Plan. This will entail engagement with
local people and stakeholders through the spring, with an update coming to the GB Meeting in Public in March.
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3. Planning for 2019/20
• Systems and organisations have been asked to develop coordinated plans in line with the national
planning timetable described on the next slide.
• Planning by Lambeth and our partners for 2019/20 is well underway, with commissioning intentions letters
shared with our providers in September and November.
• Our approach builds upon and extends our approach from previous years, using the CCG Programme
Boards, Governing Body engagement, joint working wherever possible with the Local Authority, other
CCGs, south east London and the London region to arrive at a set of plans that supports delivery of our
aims and transformative activities for Lambeth and the wider health and care system.
• The plans will be adapted to incorporate the guidance set out in recent days within the newly published NHS
Operational Planning and Contracting Guidance 2019/20.
• This is being done within an increasingly challenging financial environment.
• Lambeth Together is integral to our thinking, as too is our relationship and inter-dependencies as a part of
the south east London STP system.
• The following three slides summarise the guidance details around Finance, Systems, and the Operating
Plan.
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Financial Settlement - Key messages (i)
• NHS Lambeth CCG has received a core allocation growth for 2019/20 of 5.72% The SEL CCG average allocation
increase is 6.01% ranging from 5.72% to 6.33%. For delegated primary care services, growth is increasing by 6.21% in
2019/20, with the SEL average of 6.59%, ranging from 6.21% to 6.94%
• CCGs are asked to deliver a 20% real terms reduction against their 2017/18 running cost allocation in 2020/21.
Applications
• The proposed uplift in the national tariff for 2019/20 is 3.8% (subject to consultation). This includes the costs of Agenda
for Change pay awards paid directly to relevant providers in 2018/19, but excludes the transfer into national prices of a
proportion of the Provider Sustainability Fund and the transfer into national and local prices of 1.25% from CQUIN and the
pensions impact.
• The tariff efficiency factor for 2019/20 will be 1.1% and for each of the following 4 years. Trusts with a deficit Control Total
will need to secure a further 0.5% efficiency to support financial recovery
• There are changes to the Market Forces Factor (MFF) which is being phased over 5 years. There are some material tariff
changes including new blended payments for emergency activity.
• CCG are required to meet the Mental Health Investment Standard (MHIS) which is set at overall programme allocation
growth plus 1%. Spend on Children’s and Young People’s (CYP) mental health must also increase as a percentage of
each CCG’s overall mental health spend.
• CCGs are required to increase investment in primary medical and community services, sufficient to meet the Long Term
Plan commitments.
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Financial Settlement - Key messages (ii)
• Allocations for 2019/20 have been set to fund a stretching but reasonable level of activity, the impact of the 2018/19 pay
awards and the changes to national tariff, fund the MHIS and the cost of meeting Long Term Plan commitments in
primary medical and community services.
• The allocation while positive leaves little available growth after taking account of tariff, pay awards and ring fenced
budget uplifts, in the context of significant outturn pressures, new 2019/20 cost pressures and demand growth.
• CCG Control Totals – these are due to be published. CCGs collectively will be expected to deliver a breakeven
position after using allocated Commissioner Sustainability Fund (CSF) and control totals will be set on this basis.
Key Challenges
• Timescales to secure signed contracts and final operating plans that meet national guidance are very tight.
• Meeting underlying and outturn and cost pressures alongside national investment requirements across primary and
community, the MHIS and acute activity at 2019/20 tariffs.
• New tariff changes will increase the complexity of planning and contract negotiation.
• We need to set plans that enable us to deliver the transformation needed for long term sustainability and improved
outcomes
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System Planning Key Messages
• All STPs/ICSs will produce a system operating plan for 2019/20 comprising a system overview and system
data aggregation.
• Organisations asked to take collective responsibility, with two elements
– an overview setting out how the system will use its financial resources to meet the needs of its
population and what the system will deliver in 2019/20, which should include specialised and direct
commissioning as well as CCG and provider plans.
– a system data aggregation (activity, workforce, finance, contracting), demonstrating how all individual
organisational plans align to the system plan.
• System control totals which will be the sum of individual organisation control totals. The full financial
framework for ICSs is expected to be published separately.
• All NHS providers and CCGs must be included in a system operating plan and system control total.
• System efficiency: STPs/ICSs to focus on the cost-effectiveness of the whole system, not cost-shifting
between organisations.
• All systems will work with the NHS RightCare programme to implement national priority initiatives for
cardiovascular and respiratory conditions in 2019/20.
• Brexit guidance to be followed as available
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Operating Plan key messages
• Emergency Care: Every acute hospital with a type 1 A&E department will move to a comprehensive model of Same Day
Emergency Care (SDEC). This will increase the proportion of acute admissions discharged on the day of attendance from
a fifth to a third. New clinical standards will be developed by NHSE in-year, and so existing A&E and LAS targets will
remain until any revisions.
• Referral to Treatment Times: the expectations remain the same as in 2018/19, with all providers to reduce their waiting
list during 2019/20, there to be no patient who waits more than 52 weeks for treatment, and no more than 1% of patients
should wait six weeks or more for a diagnostic test.
• Cancer Treatment: the delivery of all of the current eight cancer waiting times standards remains a priority.
• Mental Health: improvements in services are expected across the range of existing mental health access targets.
• Learning Disabilities and Autism: the national deliverables for transforming care for people with learning disabilities
include a focus on reducing inpatient care, and increasing the number of annual health checks.
• Primary Care and Community Health Services: CCGs to commit a recurrent £1.50/head recurrently to developing and
maintaining primary care networks (PCNs) so that the target of 100% coverage is achieved as soon as is possible and by
30 June 2019 at the latest. STPs/ICSs must include a primary care strategy as part of the system strategy that will be
developed in Autumn 2019 response to the Long Term Plan.
• Workforce: provider workforce plans are asked to be updated and modelled to reflect issues such as the supply of staff
from Europe and beyond, pay reforms and expected reductions in agency and locum use, staff wellbeing, retention
• Data and Technology: a range of initiatives are proposed including the launch of an NHS App to provide access to 111
online and GP practice record for citizens.
• Personal Health Budgets: by March 2021, 50,000 to 100,000 people should have a PHB.
A set of Longer Term deliverables set out in the planning guidance are contained in Appendix B
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Planning for 2019/20
Date Activity
14 January 2019/20 Initial plan submission – activity focus
12 February Draft 2019/20 organisational operational plans
19 February 2019/20 STP/ICS led contract / plan alignment submission
05 March 2019/20 STP/ICS led contract / plan alignment submission
21 March Deadline for 2019/20 contract signature
29 March Organisation Board / Governing body approval of 2019/20 budgets
04 April Final 2019/20 organisation operational plan submission
11 April Aggregated 2019/20 system operating plan submissions, system operating plan overview and STP/ICS led contract / plan alignment submission
11 April 2019/20 STP/ICS led contract / plan alignment submission
Spending Review 2019 Capital funding announcements
Autumn 2019
Systems to submit 5-year plans signed off by all organisations
This is an edited list of the key planning milestones based on the NHS Operational Planning and
Contracting Guidance 2019/20 published on 10 January 2019
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The NHS Long Term Plan
Find out more: www.longtermplan.nhs.uk | Join the conversation:
#NHSLongTermPlan
Appendix A. NHS Long Term Plan Summary
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Background
In June 2018, the Prime Minister made a commitment that the Government would
provide more funding for the NHS for each of the next five years, with an average
increase of 3.4% a year.
In return, the NHS was asked to come together to develop a long term plan for the
future of the service, detailing our ambitions for improvement over the next decade,
and our plans to meet them over the five years of the funding settlement.
That plan has now been published.
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How the NHS Long Term Plan was developed
Working groups – made up of local and national NHS and
local government leaders, clinical experts and
representatives from patient groups and charities – were
formed to focus on specific areas where the NHS could
improve over the next ten years.
They then engaged extensively with stakeholders to come
up with and test practical ideas which could be included in
a plan.
Over Autumn, working group members organised or
attended over 200 events to hear a wide range of different
views, and received over 2,500 submissions from
individuals and groups representing the opinions and
interests of 3.5 million people.
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What the NHS Long Term Plan will
deliver for patients
The working groups have developed a range of specific ideas and ambitions for
how the NHS can improve over the next decade, covering all three life stages:
• Making sure everyone gets the best start in life
• Delivering world-class care for major health problems
• Supporting people to age well
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Making sure everyone gets the best start
in life… …including:
• reducing stillbirths and mother and child deaths during birth by 50%
• ensuring most women can benefit from continuity of carer through and beyond
their pregnancy, targeted towards those who will benefit most
• providing extra support for expectant mothers at risk of premature birth
• expanding support for perinatal mental health conditions
• taking further action on childhood obesity
• increasing funding for children and young people’s mental health
• bringing down waiting times for autism assessments
• providing the right care for children with a learning disability
• delivering the best treatments available for children with cancer, including CAR-
T and proton beam therapy.
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Delivering world-class care for major
health problems…
…including:
• preventing 150,000 heart attacks, strokes and dementia cases
• providing education and exercise programmes to tens of thousands more
patients with heart problems, preventing up to 14,000 premature deaths
• saving 55,000 more lives a year by diagnosing more cancers early
• investing in spotting and treating lung conditions early to prevent 80,000 stays in
hospital
• spending at least £2.3bn more a year on mental health care
• helping 380,000 more people get therapy for depression and anxiety by 2023/24
• delivering community-based physical and mental care for 370,000 people with
severe mental illness a year by 2023/24.
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Supporting people to age well…
…including:
• increasing funding for primary and community care by at least £4.5bn
• bringing together different professionals to coordinate care better
• helping more people to live independently at home for longer
• developing more rapid community response teams to prevent unnecessary
hospital spells, and speed up discharges home.
• upgrading NHS staff support to people living in care homes.
• improving the recognition of carers and support they receive
• making further progress on care for people with dementia
• giving more people more say about the care they receive and where they
receive it, particularly towards the end of their lives.
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Delivering the ambitions of the NHS
Long Term Plan
To ensure that the NHS can achieve the ambitious improvements for patients, the
NHS Long Term Plan also sets out actions to overcome the challenges that the
NHS faces, such as staff shortages and growing demand for services, by:
1. Doing things differently
2. Preventing illness and tackling health inequalities
3. Backing our workforce
4. Making better use of data and digital technology
5. Getting the most out of taxpayers’ investment in the NHS
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1. Doing things differently
The NHS will:
• give people more control over their own health and the care they receive,
• encourage more collaboration between GPs and their teams and community
services, as ‘primary care networks’, to increase the services they can provide
jointly;
• place an increasing focus on NHS organisations working with each other and
their local partners, as ‘Integrated Care Systems’, to plan and deliver services
which meet the needs of their communities.
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2. Preventing illness and tackling
health inequalities
The NHS will:
• increase its contribution to tackling some of the most significant causes of ill
health, including new action to help people stop smoking, overcome drinking
problems and avoid Type 2 diabetes, with a particular focus on the communities
and groups of people most affected by these problems.
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3. Backing our workforce
The NHS will:
• continue to increase the NHS workforce, training and recruiting more
professionals – including thousands more clinical placements for undergraduate
nurses, hundreds more medical school places, and more routes into the NHS
such as apprenticeships.
• take steps to make the NHS a better place to work, so fewer staff leave and
more feel able to make better use of their skills and experience for patients.
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4. Making better use of data and digital
technology
The NHS will:
• provide more convenient access to services and health information for patients,
with the new NHS App as a digital ‘front door’;
• provide better access to digital tools and patient records for staff, and;
• improve the planning and delivery of services through the greater use of
analysis of patient and population data.
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5. Getting the most out of taxpayers’
investment in the NHS
The NHS will:
• continue working with doctors and other health professionals to identify ways to
reduce duplication in how clinical services are delivered;
• make better use of the NHS’ combined buying power to get commonly-used
products for cheaper, and;
• reduce spend on administration.
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What happens next
Sustainability and Transformation Partnerships (STPs) and Integrated Care
Systems (ICSs) now need to develop and implement their own strategies for the
next five years.
These strategies will set out how they intend to take the ambitions that the NHS
Long Term Plan details, and work together to turn them into local action to improve
services and the health and wellbeing of the communities they serve – building on
the work they have already been doing.
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What this means for staff, patients and
the public
This means that over the next few months, staff, patients and the public will have
the opportunity to help shape what the NHS Long Term Plan means for their area,
and how the services they use or work in need to change and improve over the
next few years.
Local Healthwatch groups will receive national funding to support NHS teams in
ensuring that the views of patients and the public are heard, and Age UK will be
leading work across a range of other charities to provide specific opportunities to
hear from people with specific health needs.
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Find out more
The NHS Long Term Plan, along with accompanying resources, case studies and
videos, is available online at www.longtermplan.nhs.uk.
And over the coming months, local NHS organisations and their partners will be
sharing details of what the NHS Long Term Plan could mean in their area.
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Appendix B – NHS Operational Planning and Contracting
Guidance 2019/20Longer-term deliverables
System architecture Work towards every area of the country being part of an ICS by April 2021
Health inequalities
All local health systems will be expected to set out during 2019 how they will specifically reduce
health inequalities by 2023/24 and 2028/29, including clearly setting out how those CCGs
benefiting from the health inequalities adjustment are targeting that funding to improve the
equity of access and outcomes
Maternity
Start to implement an enhanced and targeted continuity of carer model to help improve
outcomes for the most vulnerable mothers and babies
Offer all women who smoke during their pregnancy, specialist smoking cessation support to help
them quit
Support work to achieve a 50% reduction in stillbirth, maternal mortality, neonatal mortality and
serious brain injury by 2025
By spring 2019, every trust in England with a maternity and neonatal service will be part of the
National Maternal and Neonatal Health Safety Collaborative, supported by Local Learning Systems
Roll out the Saving Babies Lives Care Bundle during 2019
Maternity digital care records are being offered to 20,000 eligible women in 20 accelerator sites
across England, rising to 100,000 by October 2019
Continue to work with midwives, mothers and their families to implement continuity of carer so
that, by March 2021, most women receive continuity of the person caring for them during
pregnancy, during birth and postnatally
All maternity services that do not deliver an accredited, evidence-based infant feeding
programme, such as the UNICEF Baby Friendly Initiative, will begin the accreditation process in
2019/20
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Appendix B – NHS Operational Planning and Contracting
Guidance 2019/20 Longer-term deliverables
Mental health
By 2020/21, the NHS will ensure that at least 280,000 people living with severe mental health
problems have their physical health needs met
Continue to deliver enhanced access to mental health services for children and young people
Begin roll out of Mental Health Support Teams working in schools and colleges in trailblazer areas
to cover one fifth to a quarter of the country by the end of 2023
Continue to expand access to IAPT services for adults and older adults with common mental
health problems, with a focus on those with long term conditions
Continue to progress delivery of standards for early intervention in psychosis, IAPT and services
for young people with eating disorders by 2021
Delivering against multi-agency suicide prevention plans, working towards a national 10%
reduction in suicides by 2020/21
Learning disability and autism
Expand the STOMP-STAMP programmes to stop the overmedication of people with a learning
disability, autism or both by 2023/24
Continue to reduce the number of people with a learning disability, autism or both in inpatient
care
Cancer
From September 2019, all boys aged 12 and 13 will be offered vaccination against HPV-related
diseases, such as oral, throat and anal cancer
Extend lung health checks (already piloted in Manchester and Liverpool)
From 2019, we will start the rollout of new Rapid Diagnostic Centres (RDCs) across the country
Implement a stratified approach for follow up for breast cancer in 2019 and prostate and
colorectal cancers in 2020 (expanding to all cancers which are clinically appropriate in 2023). From
2019, we will begin to introduce an innovative quality of life metric – the first on this scale in the
world – to track and respond to the long-term impact of cancer
