1. Derbyshire’s Challenge
A great deal of work taking place across the system to address the financial gap.

2. Financially – what is the challenge?
The financial gap does not go away and continues to be a challenge:
We have an estimated funding gap of £80m in our health system this year that’s without taking into account in our local authority challenge.
A great deal of work taking place across the system to address the financial gap.
The NHS in Derby and Derbyshire has an estimated financial gap of £80m for 2018/19. This means services we fund will cost £80m more this year than the annual budget we receive.  This is before savings required by local authorities is factored in.  The financial challenge is therefore significant and despite saving millions of pounds over the last three years across health and social care Derbyshire still has this financial gap and it must be addressed.

3. So what’s Derbyshire’s financial plan?£m
Acute Hospital Services
29.4
Mental Health Services
2.2
Community Health Services
4.2
Continuing Health Care
7.4
Primary Care Prescribing
12.6
Primary Care Services
9.3
Other Programme
4.1
Running Costs
3.6
Total Cost Pressures
72.9 £m
2017/18 Recurrent Exit position
1,547.3
2018/19 Cost Pressures;
Mental Health Investment Standard
4.7
GP Five Year Forward View
1.5
Cost pressures
72.9
Nationally Required Contingency
7.0
Net Planned QIPP
-50.8
Total 2018/19 expenditure
1,582.6
2018/19 Allocation
1,538.6
In year deficit
-44.0
Through our governance and contracting processes we have been discussing ways in which the CCGs can address this financial gap and have developed a range of ideas which are beginning to be taken forward through contract discussions with providers and through the CCG’s decision-making process, including the CCG Governing Bodies.

4. So what’s Derbyshire’s financial plan?
Decisions so far include:
Reduction in Minor Injury Unit Opening Hours
Decommissioning the Mental Health Engagement Service
Possible decommissioning of Voluntary Sector discretionary grant funding
Review of Memory Assessment Service
Transacted £ms of ‘behind the scenes’ savings with providers on service prices, double payments etc
Through our governance and contracting processes we have been discussing ways in which the CCGs can address this financial gap and have developed a range of ideas which are beginning to be taken forward through contract discussions with providers and through the CCG’s decision-making process, including the CCG Governing Bodies. Our process for reviewing every line of expenditure, weeding out where we are paying incorrectly through contractual agreements and also looking at where we need to make some radical decisions about the services we commission has led to us being able to assure NHS England that we have some control over the situation.
Our community services contracts have been a major area of focus and it is apparent that historic service specifications and contractual arrangements have not always enabled commissioners to see the full value of investment in community care.  A forensic review of this has seen us identifying savings across a number of areas, as well as identifying where we need to conduct a full review or re-specification of a particular contract line or service.  To date, the CCG Governing Bodies have made decisions on the following areas, and these are transacted through our contracting team.
DCHS Pool Cars – used for supporting community staff to travel.  CCGs have withdrawn funding and DCHS are looking to see whether they can locally fund this.
CRH and RDH Pull Teams – which have supported flow through acute care.  CCGs have withdrawn funding and DCHS are working with the acute trusts to see if this service can continue to be provided through local agreement.
MIU Opening Hours reduction at Ilkeston and Ripley Hospitals to 8am-8pm – bringing opening hours into line with Derby Urgent Care Centre, Whitworth MIU and Buxton MIU and reflecting very low volumes of activity between 8pm and 10pm.  CCGs and DCHS have mutually agreed this reduction in hours.
Care Home Advisory Service – CCGs have withdrawn funding for this and separate communications have been issued to practices and care homes on this service
In addition, the CCG Governing Bodies have:
Asked for a review to be undertaken of specialist community nursing services for diabetes, Parkinson’s and Neurology
Asked for a review of the Memory Assessment Service currently provided by Derbyshire Healthcare NHS Foundation Trust
Agreed to decommission the Mental Health Engagement Service currently delivered by Healthwatch Derbyshire
Written to all voluntary sector organisations currently providing services via a discretionary grant award to say that each element of grant funding is at risk of potential decommissioning subject to further review around the impact of this approach
Work continues to develop schemes which can support the financial recovery of the CCGs and wider health and care system and it is without doubt that decisions in some areas will be very challenging.  We will continue to keep member practices regularly abreast of developments from this point forward, and there will be chance to hear further details at the forthcoming Membership Forums.

5. So what’s Derbyshire’s financial plan?
What next:
Still £13m of unidentified savings, assuming all other options are eventually delivered
Significant work identifying schemes to deliver savings
Similar scale financial challenge in 19/20
Awaiting outcome of NHS funding injection, but not making any financial assumptions
The NHS has to reset the finances and then return to a refreshed STP strategy: things must change in the short term
Through our governance and contracting processes we have been discussing ways in which the CCGs can address this financial gap and have developed a range of ideas which are beginning to be taken forward through contract discussions with providers and through the CCG’s decision-making process, including the CCG Governing Bodies. Our process for reviewing every line of expenditure, weeding out where we are paying incorrectly through contractual agreements and also looking at where we need to make some radical decisions about the services we commission has led to us being able to assure NHS England that we have some control over the situation.
Our community services contracts have been a major area of focus and it is apparent that historic service specifications and contractual arrangements have not always enabled commissioners to see the full value of investment in community care.  A forensic review of this has seen us identifying savings across a number of areas, as well as identifying where we need to conduct a full review or re-specification of a particular contract line or service.  To date, the CCG Governing Bodies have made decisions on the following areas, and these are transacted through our contracting team.
DCHS Pool Cars – used for supporting community staff to travel.  CCGs have withdrawn funding and DCHS are looking to see whether they can locally fund this.
CRH and RDH Pull Teams – which have supported flow through acute care.  CCGs have withdrawn funding and DCHS are working with the acute trusts to see if this service can continue to be provided through local agreement.
MIU Opening Hours reduction at Ilkeston and Ripley Hospitals to 8am-8pm – bringing opening hours into line with Derby Urgent Care Centre, Whitworth MIU and Buxton MIU and reflecting very low volumes of activity between 8pm and 10pm.  CCGs and DCHS have mutually agreed this reduction in hours.
Care Home Advisory Service – CCGs have withdrawn funding for this and separate communications have been issued to practices and care homes on this service
In addition, the CCG Governing Bodies have:
Asked for a review to be undertaken of specialist community nursing services for diabetes, Parkinson’s and Neurology
Asked for a review of the Memory Assessment Service currently provided by Derbyshire Healthcare NHS Foundation Trust
Agreed to decommission the Mental Health Engagement Service currently delivered by Healthwatch Derbyshire
Written to all voluntary sector organisations currently providing services via a discretionary grant award to say that each element of grant funding is at risk of potential decommissioning subject to further review around the impact of this approach
Work continues to develop schemes which can support the financial recovery of the CCGs and wider health and care system and it is without doubt that decisions in some areas will be very challenging.  We will continue to keep member practices regularly abreast of developments from this point forward, and there will be chance to hear further details at the forthcoming Membership Forums.