Everyone Counts 2014/15 Planning Guidance Nicola Bailey Chief Operating Officer Michael Houghton Director of Commissioning and Development Planning Framework Planning Framework 1 vision: high quality health care for all, now and for future generations 5 outcome domains 7 outcome measures 3 key measures 6 characteristics of high quality, sustainable health and care systems 4 essential elements One vision High quality health care for all now and for future generations: driven by quality in all we do equal access for all, especially the vulnerable and the excluded spread existing excellence sustainable, high quality for the long term 5 Outcome Domains, 7 Measures (ambitions) Preventing premature death Quality of life for LTCs
Quick recovery from ill health Great experience of care Safe care Securing additional years of life for people with treatable mental and physical conditions Improving health related quality of life for people with long term conditions Reducing avoidable time in hospital Increasing elderly people living independently at home on discharge Increasing positive experience of hospital care Increasing positive experience of care outside hospital Significant progress on eliminating avoidable deaths 3 Key Measures 1. Improving health ffffffffff 2. Reducing health inequalities Promoting health, preventing ill health in partnership 3. Parity of esteem For mental and physical health Better care for the most
vulnerable fffff 6 System Characteristics The 6 characteristics of high quality, sustainable health and care systems in 5 years time are: Citizen inclusion and empowerment Wider primary care, provided at scale A modern model of integrated care Access to the highest quality urgent and emergency care A step-change in the productivity of elective care Specialised services concentrated in Unit of Planning County Durham ND CC G DDTA T DDE S CCG Unit of Plannin g DC C TEW V CDDF T
Five year strategic plan Clinical Programme Board Unplanned care Planned care Intermediate care Frail elderly 7 day services SeQiHS Planning Fundamentals Strategic and operational plans must explicitly set out the approach to: Improvements in the 5 outcome domains and 7 measures Delivering the 3 key measures Implementing the 6 system characteristics Delivering the 4 essential elements Plans should be: Bold and ambitious Developed in partnership with providers and local authorities Locally led Operational and better care fund plans must be Strategic, Operational and Financial Planning
Strategic plan System vision Sustainability Key values and principles Integration Improvement interventions Quality improvement Governance overview Operational plan Outcomes Activity NHS Constitution Better Care Fund Strategic, Operational and Financial Planning Financial plan
Financial plan summary Financial plan detail 2014/15 2018/19 Investment Capital Revenue resource limit QIPP 2014/15 2018/19 Statement of financial position Contract value 2014/15 2018/19 Planning assumption Risk Cash Strategic enablers NHS standard contract The quality premium Commissioning for quality and innovation Non recurrent funds Better Care Fund 200m for Local Authorities (LAs) in 2014/15 (Section 256 of the NHS Act 2006) 3.8bn pooled budget in 2015/16 (Section 75 of the NHS Act 2006) for health and social care services to work more closely together in local areas, based on a plan agreed between the NHS and LAs 1bn of 3.8bn payment by performance in
2015/16 Signed off by Health and Wellbeing Boards (HWBs) Plans must deliver on national conditions: Protecting social care services; 7-day services to support discharge; Data sharing and the use of the NHS number; Joint assessments and accountable lead professional Links to earlier letters: Joint LGA/NHS England narrative (Aug 2013) Joint letter & draft template (Oc t 2013) Pay for performance based on: Delayed transfers of care Emergency admissions Effectiveness of reablement Admissions to residential and nursing care Patient and service-user experience
Local metric Planning Timetable Plan Assurance Process Address the planning fundamentals Build on the existing CCG and DC assurance frameworks Triangulate between: commissioner and provider plans outcomes, activity and finance plans and planning assumptions plans, local engagement and relationships Operational, BCF and strategic plans Joint process including regional team, area teams, Monitor, NHS Trust Development Authority Durham, Darlington and Tees planning guidance and allocation of resources 2014-15 and 2015-16 Total NHS England resources 2014-15 and 2015-16 2013/14 2014/15 2015/16 bn bn bn 93.62
96.64 98.84 Growth 3.1% 2.3% Estimated GDP deflator 2.1% 1.5% Real term' growth 1.0% 0.8% NHS England recurrent allocation Other non recurrent allocations; Surplus drawdown 0.65 0.40 0.40 Surplus carry forward 0.53 0.47
0.07 Winter pressures 0.25 0.25 AME/Technical 0.66 0.66 0.66 2.09 1.78 1.13 95.71 98.42 99.97 Total allocations Total NHS England resources 2014-15 and 2015-16 2013-14 2014-15 2015-16 bn bn bn Growth Estimated GDP deflator
2.5% 28.1% 0.0% 2.1% 3.3% 5.9% -9.6% 2.1% 11.3% 3.1% 1.8% Specialised Primary Care (AT) Primary Care (GPIT and other) Other direct commissioning Public Health S7a NHS England Programme NHS England Admin Other NHS England 12.96 11.76 13.52 12.02 14.33 12.22
Two year funding allocations 2014/15 and 2015/16 published, NHS England uplift agreed at 3.1% for 2014/15 and 2.3% for 2015/16 The Department of Health Mandate requires NHS England to run a transparent allocation process to ensure locality funding is based on the principle of equal access for equal need, having regard to need to reduce inequalities in access to and outcomes from healthcare Revised fair share formula for CCG and primary care allocations with an agreed pace of change - CCG target allocations published 20 December 2013 CCG sector receive real terms growth plus 250m in 2014/15 and 400m in 2015/16 to support cost pressures and pace of change Average uplift for CCG programme: 2014/15 = 2.54% and in 2015/16 = 2.1% Running costs quantum maintained in 2014/15 and reduced by 10% from 2015/16 Fair Share Allocations Population, age and deprivation are the key factors defining the need for health care. As has previously been reported, in December 2012 NHS England launched a fundamental review of the allocation policy through the Advisory Committee for
Resource Allocation (ACRA). Initial findings were published by NHS England in August 2013, with a proposed new formula which placed a greater emphasis on age. Historically, deprivation factors were addressed through a Disability Free Life Expectancy (DFLE) adjustment representing unmet health need relating to deprivation. This adjustment was removed in the summer exercise due to limited evidence on the cost impact of unmet need (DFLE failed to capture pockets of deprivation in otherwise affluent areas). Fair Share Allocations (continued) NHS England has since however revisited the formula and in December 2013 agreed to a further adjustment for inequalities using the standardised mortality ratio (SMR) < 75 to reflect unmet need. SMR is considered the best available option as it is strongly correlated to deprivation, is available for small areas (7,000 pop) and is updated frequently. Using this measure allows deprived communities within otherwise affluent areas to be recognised. This results in an additional adjustment to the formula to target additional resource to areas with poorer outcomes, enabling additional investment towards closing the gap. This adjustment is set at 10% for CCG allocations 15% for primary care (assuming that unmet need can be more effectively addressed through primary and community care). Although North Durham CCG remains above its target allocation based on this new allocation formula, a pace of change policy has been applied with all CCGs receiving a minimum uplift in 2014/15 of 2.14% and 1.70% in 2015/16. CCG Allocations CCG Allocations
Allocation 13-14 000 Allocation 14-15 000 Growth 14-15 % Allocation 15-16 000 Growth 15-16 % Social Care fund 15-16 000 Total Allocation 15-16 000 NHS Darlington CCG NHS DDES CCG NHS North Durham CCG NHS HAST CCG NHS South Tees CCG Durham, Darlington & Tees 130,681 397,057
5.2% 5.2% 5.3% Lowest Highest 2.14% 4.92% 1.70% 4.49% Better Care Fund BCF % of 15-16 Allocation 000 % North Durham CCG Programme Budgets: 2013/14 2014/15 2015/16 CCG Allocation (000) Growth 306,409 312,966 2.14% 318,286
1.70% 312,966 5,789 324,075 Social Care Fund (from NHS England central funds) Total Allocation 306,409 Total transfer to Better Care Fund 17,226 Running Cost Budgets: Running Cost Allowance (000) Reduction 6,070 6,070 5,463 10% (607k) Note programme budget allocation will change once specialised commissioning and other allocation adjustments confirmed Pace of Change Pace of change agreed by NHS England all CCGs to receive minimum 2.14% uplift in 2014/15 and 1.7% in 2015/16
CCGs have target allocations per head and expectation is for distance from target to reduce over time: Current Position: Programme Budget Baseline Registered Allocation Allocation Population per head 000 306,409 249,084 1,230 Forecast Position: Opening Target allocation per head Distance from target 2014/15 1,192 3.20% 1.51% 1,249 2015/16 1,212 3.04%
1.08% 1,262 CCG Programme Budget allocation Total growth on prior year Closing target allocation per head Distance from target 250,627 312,966 2.14% 1,222 2.16% 252,174 318,286 1.70% 1,237
2.02% Estimated Growth on Allocation registered prior year per head population Better Care Fund (BCF) Previously known as integration transformation fund (ITF) Total 3.8bn pooled budget in 2015/16, includes reablement and carers breaks funding from CCGs along with approx. 3% from CCG baseline resources Requires joint plans to be developed and agreed by Health and Wellbeing Boards Better Care Fund 2015/16 Social Care fund '000 Carers and Reablement '000 CCG Baseline resources '000 Total Better Care Fund
'000 DDES CCG North Durham CCG Total County Durham BCF 7,147 5,789 12,936 2,700 2,084 4,784 12,120 9,353 21,473 21,967 17,226 39,193 Capital (including share of 220m for Disabled Facilities Grant) 4,542 Total resources 43,735 Running Costs 2014/15 - no additional funding for inflation i.e. quantum remains the same but growing population means /head will reduce 2015/16 - 10% reduction
2013/14 = 25 per head 2014/15 = 24.78 per head (population growth) 2015/16 = 22.11 per head Thereafter same methodology applied. 400m pensions pressure anticipated in 2015/16 plus changes to NI rates Concern over consistency with legal framework and ability to deliver transformational strategy From 2014/15 no external funding for transition costs i.e. all restructuring costs must be funded from within running costs. Planning Assumptions / Business Rules CCG Planning Assumptions Business rules 2014/15 2015/16 Minimum 0.5% contingency 1% surplus 2.5% non-recurrent spend (including 1% for transformation)
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