1. 28th March 2013 Debbie Newton Chief Operating & Finance Officer
NHS Hambleton, Richmondshire and Whitby Clinical Commissioning Group Annual Operating Plan 2013/14
28th March 2013
Debbie Newton
Chief Operating & Finance Officer

2. Our Strategic Plan Strategic aims
We will involve people in their care and we will encourage self-care
We will buy quality services
We will change services for the better and in doing so we will provide care as close to home as possible that is easily accessible
We will use the money we have in the best possible way

3. How did we develop our plan?
Our Strategic plan is based on:
Our current performance
What we know about the range and extent of services in our area
Knowledge of local health and social issues through the Joint Strategic Needs Assessment (JSNA)
Knowledge of patient and stakeholder views through JSNA
Department of Health priorities within “Everyone counts”

4. How do our initiatives link to the JSNA?

5. How do our initiatives link to the JSNA?

6. National Commissioning Requirements

7. Everyone Counts
Provides planning guidance, incentives and tools which are intended to improve services from April 2013.
Used by the CCG to ensure delivery of the priorities and requirements which encompasses four key areas:
New approaches to planning.
Improving outcomes, reducing inequalities.
Commissioning support; tools and levers.
Planning and assurance.
Two challenges are highlighted below:
A guarantee around the reduction of inequality; and ensuring patients’ interests are placed front and centre in delivery of care.
Five offers to NHS commissioners, providing guidance and evidence needed to produce better local health outcomes.

8. Everyone Counts: The five offers from the NHS Commissioning Board to CCGs
NHS services, seven days a week.
More transparency, more choice.
Listening to patients and increasing their participation.
Better data, informed commissioning, driving improved outcomes.
Higher standards, safer care.

9. CQUINS (Commissioning for Quality and Innovation)
CQUIN for 2013/14 is set at a level of 2.5% value for all healthcare services commissioned through the NHS Standard Contract.
Trusts are only eligible to obtain CQUIN payments if they satisfy 50% of the pre-qualifying requirements.
One fifth of the total CQUIN value (0.5% of overall contract value) is to be linked to the national CQUIN goals.
0.5% of the value for all healthcare services commissioned through the NHS Standard Contract is to be linked to the national CQUIN goals.
National CQUIN
Friends and Family Test – “How likely are you to recommend our ward / A&E to friends and family”
Improvement against the NHS Safety Thermometer (excluding VTE), particularly pressure sores
Improving dementia care, including sustained improvement in Finding people with dementia, Assessing and Investigating their symptoms and Referring for support (FAIR)
Venous thromboembolism (VTE) – 95 per cent of patients being risk assessed and achievement of a locally agreed goal for the number of VTE admissions that are reviewed through root cause analysis

10. Performance
Contractual levers as set out in the 13/14 standard contract.
National performance measures are in performance indicators delegated to the CCG.
Detailed work to review performance and action plans will take place through our monthly Contract Management Board.
Additional focussed work will continue with providers and patients to ensure the delivery of all ambulance and cancer indicators.

11. The key risks around non-delivery of the Annual Integrated Plan 2013/14
Capacity and capability.
Demand management.
Impact of Payment By Results Tariff change, specialist commissioning and unbundling of diagnostics.
System wide accountability.
Clarity and credibility of strategic plans.
Finance.
Volume of work transferring to primary care.
Continued patient and public involvement and support.
Any significant risk will be added to the CCG Risk Register and therefore result in formal tracking and management.

12. Delivering our Financial Strategy
Planning Guidance – what we have to do:
Buy safe and sustainable services
End the year with a 1% surplus - £1.6m
Plan for a contingency of 0.5% - £0.8m
Repay share of PCT legacy debt - £1.8m

13. How much money have we got?
£’000 CCG share of PCT budget 165,573 Uplift for growth 3,808 Amount available to spend 169,381

14. How do we agree the budgets?
£’000
What we spent in 2013/14
162,563
Efficiencies on provider contracts (-4%)
-5,986
Inflation on provider contracts (+2.9%)
4,813
Demographic Growth (+0.72%)
1,105
Other growth and cost pressures
2,581
QIPP
-2,048
Payment to providers for Quality (CQUIN +2.5%)
2,977
TOTAL EXPENDITURE
166,005

15. Where do we spend the money?

16. What does the bottom line look like?
£’000
How much money have we got
169,381
How much are we spending
-166,005
What have we got left
3,376
What will we use this for?
Repay share of PCT legacy debt
-1796
0.5% contingency
-828
Balance 0.45% surplus
752

17. Risks to the financial plan
The split of the PCT budgets to numerous organisations – 6 CCG’s, the NHS Commissioning Board and Local Authorities
Demographic growth increases more than expected
Providers cannot meet their efficiency targets
QIPP programme is not fully delivered
Unexpected pressures emerge throughout the year

18. Management Costs
£’000
How much can we spend (£25 per head of population)
3,556
Where are we spending it
CCG internal costs
1,582
Services bought from Commissioning Support Unit
1,249
Services bought from other support organisations
725

19. Delivering our Financial Strategy
With the application of growth the CCG’s overall delegated budget for commissioning services in 2013/14 is £169m.
This equates to £1,195 per head of population to spend on commissioning services for its population (Average £1,145).
The full QIPP programme is £2.0m.
After repaying its current share of the PCT brought forward deficit, the CCG is planning to deliver a 0.45% surplus (£752k) at the 31st March 2014, which is below the 1% identified in the national planning guidance.
Gives us a platform to have a balanced financial position next year but this is dependent on mitigating our financial risks.

20. Questions