1 year winter plan 2 year Operating Plan Contracts Operating Plan financialactivitynarrative must Reflect STP Planning Footprint assumptions outcomes initiatives Deliver 9 must dos ID: 556241
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Slide1
Planning Round 2017-19Slide2
1 year winter plan
2 year Operating Plan / Contracts
Operating Plan (financial/activity/narrative) must:
Reflect STP Planning Footprint assumptions / outcomes / initiativesDeliver 9 ‘must do’s’Narrative must provide evidence to support activity/finance assumptions – not a traditional operating plan
Planning Requirements 2017-19Slide3
Planning / Contract Timeline
Action
Date
Submission of STPs21 October 2016Submission of summary level 2017-19 operational financial plans1 November 2016Submission of full draft 2017-19 operational plans24 November 2016Signing of contracts
23 December 2016
Submission of final 2017 – 19 operational plans aligned with contracts
23 December
2016Slide4
Submitted by and on behalf of the Hull and East Riding A&E Delivery Board
Main concerns around service sustainability:
Bedded capacity over winter – hospital and community
Fragility of social care market – care homes sustainability / care packages availabilityFunding
Winter PlanSlide5
Main Winter Projects affecting Hull
Description
Planned Beds 2016/17
Bed Target 102
Comment
HEYHT
Surge Ward
27
Seasonal change
*NEW for 2016/17*
Additional day surgery trauma capacity
2
Permanent change
*NEW for 2016/17*Impact of reduced length of stay in hospital6 Permanent changeTotal3567 (102 - 35)
CHCPChanges to community bed management model and additional capacity commissioned27 *ICT beds - Highfields 9 beds (permanent)* ICT beds - Rose Villa 4 (seasonal - end March 17)* Step down beds - 4 beds (seasonal)Care Packages - 10 bed equivalent (permanent)Total2713 (40 - 27)10 more beds than 15.16Slide6
Operational Plan NarrativeThe Operational Plan narrative is an opportunity to:Demonstrate that
we have the necessary
grip on the main operational and financial issues and challenges facing
usProvide assurance to NHS England that you are addressing the NHS Constitutional Standards Well placed to make a positive contribution to the STPSlide7
9 ‘must do’s’STP and Operational Plan LinksFinancial Management
Primary Care – sustainability and transformation
Urgent and Emergency Care transformation
Referral to Treatment Times and Elective CareCancer – Cancer Alliances and delivering national cancer planMental Health 5 year forward viewPeople with Learning DisabilitiesImproving Quality in OrganisationsSlide8
Collaborative CommissioningCollaborative Commissioning offers:Stronger bargaining power
Consistent offer
for
patients and providersSum of the parts is greater than individualsIt’s reassuringly familiar all the CCG’s are focussing on the:9 must do’s in the Planning GuidancePriorities laid out in key national documents e.g. 5YFV, 5YFVMH, GPFV, RightCare, etc.It makes sense to see where we can work togetherSlide9
Collaborative Commissioning to address:Slide10
Collaborative Opportunities (1)Development of a single set of commissioning intentions across the 6 CCGs
Inclusion
of thresholds for smoking and BMI in some elective procedures
working towards a consistent approachCommissioning of weight management services including preventative approaches to support threshold managementCollaborative approaches across certain specialities such as ophthalmology, scoping the potential for a STP wide model or procurement Slide11
Collaborative Opportunities (2)Delivery of urgent care standards including access to clinical advisory service via NHS 111
Opportunities
to streamline the transactional elements and governance of contracting approaches across organisations including access to business intelligence
supportOne contract per provider Community focused models of care for chronic diseases such as diabetes Different models for outpatient services that move away from traditional face to face follow ups Slide12
Narrative Plan – Key Messages (1)Integration and Collaboration around:Better Care Plan delivery
Sustainability and Transformation Plan development and delivery
Collaborative commissioning – including with Specialised Commissioners
Delivery of the Integrated Care Centre business caseExploring further opportunities for closer commissioning relationship with the Local AuthoritySlide13
Narrative Plan – Key Messages (2)Commitment to work with member practices to support them to make the shift
to
a new sustainable at scale
modelDelivery of the NHS Constitution TargetsProgression of plans post consultation to develop a 24/7 urgent care centreDevelopment of alternative pathways to A&E including ‘hear and treat’ and ‘see and treat’ modelsRight Care wave 2 participationDevelopment of a Local Maternity Service (STP footprint)Slide14
Narrative Plan – Key Messages (3)Development of the Humber Coast and Vale Cancer Alliance
Development of a mental health ‘crash pad’
Delivery of the Transforming Care Plan for individuals with a learning disability
Promotion of high quality commissioned services via:Safer staffing levels and staffing skill mixSupportive service visits to review the level of quality and patient experience / outcomeSlide15
Commissioning Intentions (CI)
Slightly changed methodology this year
For acute sector the plan is to put in a single CI document across all 6 CCGs in STP with local ‘flavour’
Leading to single contract per acute organisation
For other organisations will be individual organisation CIs
This year we are working with a combined narrative statement and an excel ‘project’ statement
All commissioning leads have reviewed their projectsSlide16
Examples of Commissioning Intentions
Change Proposed
Area of Impact
TimescaleReduce inpatient bed capacity by March 19 to 10-15 CCG commissioned beds per 1m populationLearning DisabilityMarch 2019Improve access to healthcare, by 2020, with 75% of individuals on GP register with a learning disability having
an
annual
healthcheck
service is to be reviewed and recommendations to CCG Prioritisation Panel in Jan 2017
Learning Disability
March 2020
Community eating disorder teams for children and young people to meet access and waiting time
standards
Aim to introduce
local target < 18 weeks
Mental Illness
April 2017
COPD (Adults) pathway. Hull and ER CCG wide (potential for STP footprint)HEYHT / Primary Care / Hull CCG Community / Meds Management /LA PH 2017.18To make the best use of health resource by reducing unwarranted variation with a focus on whole population benefit and also the value that the patient derives from their own care and treatment.Review of clinical areas to enable thresholds or changes in pathways to reduce unwarranted activityAll programme areas2018/19Online consultation - Implement digital triage solutions (AskMyGP and WebGP) within practices across the city.
Primary CareMarch 2017. Care navigation - Across the groupings within the city, administrative staff will be identified to receive care navigator training. This will support patients in being directed to the right person the first time, releasing capacity for GPs. Primary CareAnticipate start date of 1st April 2017Slide17
2016/17 Financial Plan Slide18
Contents
CCG
Allocations – Programme & Running Costs
Business RulesBudgetsGrowth AssumptionsWork to do / Ongoing DevelopmentsSlide19
CCG AllocationsHealthcare Allocations for 17/18 and 18/19 are uplifted by 2% each year (approx. £7.7m)
18/19 Distance From Target of +2.63% (16/17 =
+ 1.94
%)Separate Allocation for ‘Running Costs’ - £6.2m for both yearsSlide20
Business RulesDeliver Surplus (1% minimum)
Historic Surpluses to be drawn down over next 4 years
Maintain Risk Reserve
of 1% - able to plan for 0.5% spentHold 0.5% contingency - £1.9mDeliver underlying recurrent surplus 1%Parity of Esteem for Mental Health costsSlide21
CCG Recurrent Programme Budgets
17/18 18/19Brought Forward Allocation £382.1m £389.8mGrowth £ 7.7m £ 7.7mRecurrent Programme Allocation £389.8m £397.5mAcute Services £202.1m £204.7mMental Health
£ 42.3m £ 42.4mCommunity
£ 44.0m £ 44.2m
Continuing Care
£ 26.0m £ 26.9mPrimary Care £ 56.0m £ 57.4mOther / Reserves * £
14.2m
£ 17.4m
Recurrent Programme Expenditure £
384.6m £393.0m
Recurrent Programme Surplus
£
5
.2m £ 4.5m* Includes contingencySlide22
2017/18 CCG Recurrent Programme BudgetsRecurrent Programme Adjustments Incorporated Above
Net Inflation Investment & Growth QIPPTOTAL
£m
£m
£m
£m
Acute Services
1.8
3.7
-5.7
-0.2
Mental Health
0.0
1.1
0.01.1Community0.00.30.00.3Continuing Care
0.91.80.02.7Primary Care1.02.0-0.92.1Other / Reserves0.03.50.0
3.5
Total
3.7
12.4
-6.6
9.5Slide23
2018/19 CCG Recurrent Programme BudgetsRecurrent Programme Adjustments Incorporated Above
Net Inflation Investment & Growth QIPPTOTAL
£m
£m
£m
£m
Acute Services
2.0
5.8
-5.8
2.0
Mental Health
0.0
0.0
0.00.0Community0.00.00.00.0Continuing Care
0.90.00.00.9Primary Care1.01.0-0.91.1Other / Reserves0.02.20.0
2.2
Total
3.9
9.0
-6.7
6.2Slide24
CCG Non Recurrent Programme Budgets 17/18 18/19Non
Recurrent Programme Allocation £
7.6m
£ 6.6m (inc historic surplus)Reserves / investmentsContingency £ 2.0m £ 2.0mUncommitted Risk Reserve £ 1.9m £ 2.0mAcute (include IR and HRG4+) (£ 0.2m) (£ 0.2m)Mental Health £ 0.0m £ 0.0mCommunity * (18/19) £ 1.8m £ 2.9mPrimary Care * (17/18) £ 2
.5m £ 0
.5m
Non Recurrent Programme Expenditure £
6.0m £ 5.2mNon Recurrent Programme Surplus £ 1.6m £ 1.4m*includes 50% of Risk ReserveSlide25
CCG Recurrent Running Cost Budgets 17/18 18/19Recurrent Running Cost Allocation £
6.2m £ 6.2m
CCG
Staffing Costs/ Commissioning Support £ 5.3m £ 5.3mEstates / Other Non-Pay £ 0.9m £ 0.9mNon Recurrent Programme Expenditure £ 6.2m £ 6.2mNon Recurrent Programme Surplus £ 0.0m £ 0.0mSlide26
17/18 CCG Summary of Budgets
Allocation
£m
Expenditure £m
Surplus
£m
Recurrent Programme
389.8
384.6
5.2
Non -Recurrent Programme
(
inc
Historic Surplus)
7.6
6.0
1.6Total Programme397.4382.06.8
Recurrent Running Costs
6.2
6.2
0.0
TOTAL CCG
403.6
396.8
6.8Slide27
18/19 CCG Summary of Budgets
Allocation
£m
Expenditure £m
Surplus
£m
Recurrent Programme
397.5
393.0
4.5
Non -Recurrent Programme
(
inc
Historic Surplus)
6.6
5.2
1.4Total Programme404.1398.25.9
Recurrent Running Costs
6.2
6.2
0.0
TOTAL CCG
410.3
404.4
5.9Slide28
Growth Assumptions2% efficiency
requirement in both years
17/18: Uplift
of 2.1% (CNST adjustment on specific HRGs of additional 0.8%) – Net 0.1% growth (0.9% for specific HRGs)18/19: Uplift of 2.1% (CNST adjustment on specific HRGs of additional 0.9%) – Net 0.1% growth (1.0% for specific HRGs)CQUIN remains at 2.5% in both years
Continuing Care budget incorporates
living wage
adjustments and national adjustment to Funded Nursing Care packages.
Prescribing budget uplift of 2% per annum to reflect price increases
Slide29
Work to do / ongoing developments
Agree 2 year contracts with providers by 23
rd
of DecemberAgree contracting basis / risk sharing arrangements across the STPImplement QIPP programmes in readiness for 2017/18