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Everyone Counts 2014/15 Planning Guidance Nicola Bailey Chief Operating Officer Michael Houghton

Everyone Counts 2014/15 Planning Guidance Nicola Bailey Chief Operating Officer Michael Houghton Director of Commissioning and Development. Planning Framework. Planning Framework. 1 v ision: high quality health care for all, now and for future generations 5 outcome domains

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Everyone Counts 2014/15 Planning Guidance Nicola Bailey Chief Operating Officer Michael Houghton

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  1. Everyone Counts 2014/15 Planning Guidance Nicola Bailey Chief Operating Officer Michael Houghton Director of Commissioning and Development

  2. Planning Framework

  3. Planning Framework • 1vision: 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

  4. 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. 5 Outcome Domains, 7 Measures (ambitions) • Preventing premature death • 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 • Quality of life for LTCs • Quick recovery from ill health • Great experience of care • Safe care

  6. 3 Key Measures 1. Improving health ffffffffff 2. Reducing health inequalities 3. Parity of esteem • Promoting health, preventing ill health in partnership • Better care for the most vulnerable fffff • For mental and physical health

  7. 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 centres of excellence

  8. Unit of Planning – County Durham

  9. Five year strategic plan Clinical Programme Board

  10. 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 driven by the strategic plan

  11. 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

  12. 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

  13. Strategic enablers • NHS standard contract • The quality premium • Commissioning for quality and innovation • Non recurrent funds

  14. Better Care Fund • Links to earlier letters: • Joint LGA/NHS England narrative (Aug 2013) • Joint letter & draft template (Oct 2013) • £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) Pay for performance based on: Plans must deliver on national conditions: • Delayed transfers of care • Emergency admissions • Effectiveness of reablement • Admissions to residential and nursing care • Patient and service-user experience • Local metric • 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

  15. Planning Timetable

  16. 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

  17. Durham, Darlington and Teesplanning guidance andallocation of resources 2014-15 and 2015-16

  18. Total NHS England resources 2014-15 and 2015-16

  19. Total NHS England resources 2014-15 and 2015-16

  20. NHS England Allocations 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

  21. 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).

  22. 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.

  23. CCG Allocations

  24. North Durham CCG • Note – programme budget allocation will change once specialised commissioning and other allocation adjustments confirmed

  25. ‘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:

  26. 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

  27. 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.

  28. Planning Assumptions / ‘Business Rules’

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