The financial challenge to

Hertfordshire health servicesAlan Pond

Director of Finance NHS Hertfordshire

Interim Chief Executive Herts Valley CCG

• Groups of GP practices will commission most local NHS services

• Two Shadow Clinical Commissioning Groups (CCGs) in Hertfordshire

• Herts Valleys CCG• East & North Herts CCG

• The new national NHS Commissioning Board will commission GP, dentistry, pharmacy and ophthalmic services, specialised services and prison health services

Commissioning for Patients – future funding flows

Clinical Commissioning Groups

•Will be statutory bodies with own senior staff •All practices must be part of a CCG•NHS Commissioning Board will support by developing commissioning guidelines, model contracts and tariffs•CCGs will be able to employ staff directly or buy in services from external organisations•CCGs can decide which aspects of commissioning activity they undertake themselves and which aspects they share•Hertfordshire Integrated Commissioning Support Service being developed to support CCGs

Commissioning for Patients

Finance•The NHS Commissioning Board will initially calculate practice-level budgets from the current PCT budgets and allocate these resources directly to CCGs•New weighted capitation formula will provide target allocations for each CCG

• Pace of change policy will drive how quickly funding is moved to get CCGs to their target

•Commissioning budget will be separate from surgery income•CCGs will receive a maximum management allowance to directly employ staff or buy in services. Indicative amount is £25 per head•Details on how any over/underspends will be managed is yet to be agreed with the DH and the Treasury

Commissioning for Patients

Proposed implementation timetable

In 2012/13 •CCGs formal committees of NHS Hertfordshire Board •Formal establishment of CCGs and NHS Commissioning Board •Approvals process for CCGs in phased approach•CCGs receive indicative budgets and must prepare commissioning plans

In 2013/14 •CCG statutory bodies and where authorised will receive funding allocation and hold contracts

Commissioning for Patients

• NHS targets focus on measuring outcomes• New outcomes framework for 2012/13 created• Framework to be structured around five areas:

1. Preventing people from dying prematurely 2. Enhancing the quality of life for people with long-term

conditions 3. Helping people to recover from episodes of ill health or

following injury 4. Ensuring people have a positive experience of care 5. Treating and caring for people in a safe environment

and protecting them from avoidable harm

Transparency in outcomes

There are over 500 performance indicators which the PCT is responsible for reporting on (by provider and by CCG/PCT)

• NHS Operating Framework – Key Priorities 1. Dementia and care of older people2. Carers3. Military and Veterans Health4. Health visitors and family nurse partnerships

• SHA Ambitions• Eliminate pressure ulcers• Every patient contact counts• Quality/Safety in Primary Care• Strengthened NHS/Local Government

partnerships• Improve patient experience

Transparency in outcomes 2

QIPP – Financial Context

• White Paper sets out £20bn efficiencies over next 4 years

• Links to Operating Plan, Framework & Outcome Framework

Projected ExpenditureWithout QIPP

Projected Funding

Size of QIPP

Challenge

£276m

1. Hertfordshire system in balance at 31st March 2012

2. Managed to deliver circa £100m efficiencies in

2011/12 across Hertfordshire

3. Funding used non-recurrently to drive change and

deliver efficiencies

4. PCT funding for 2012/13 £1.76bn

5. Significant challenge across the system in 2012/13

to 2014/15 and beyond…

Financial Picture – 2012/13

Financial Picture – 2012/13

Illustration of how the PCT income is spent (2010/11)

Managing Change• Set out the vision – DQHH puts

Hertfordshire ahead of other areas• Created early momentum, delivered first

year of QIPP• Minimise fear to avoid distraction• Prioritise performance areas to

concentrate on• Dedicated resource for transition• Talent management

Maintaining Performance