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NHS Southwark Clinnical Commissioning Group

Budgetary Framework for 2016-17

1. Introduction

The CCG is entering its fourth year, and faces a tough financial scenario for 2016-17

and future years. The CCG anticipates closing its accounts for 2015-16, having

achieved its 1.9% surplus target, equivalent to c. £7.5M.

The NHS England Board meeting received a paper from Paul Baumann, national

NHSE Chief Fiancial Officer (CFO), setting out the funding for 2016-17 onwards,

under the Five year forward view proposals, as headlined in the autumn statement

recently. Allocations were issued on 8 January 2016.

The NHSE Board took the decision to further significantly change the funding

formula weightings for deprivation and age, giving a great change in CCG positions

compared to their previous target spend levels. For Southwark this has taken the

CCG to a position of some 2.8% above the closing target for 2016-17. This is much

higher than 2 years ago, when under the previous formula the CCG was seen to be

funded below capitation target level.

The publication of the “Five Year Forward View” and associated planning guidance

from the Head of the NHS, has given a set of further priority areas in which to

provide assurance that the CCG is investing for 2015-16.

The first draft operating plan returns were submitted on 8 February, then in full on 2

March, and a final version in early April. Guidance was issued in late December

2015. The guidance sets out nine “must dos” for each health system. These are

attached at Appendix 1.

Funding Available

Funds have been made available, to cover the full five year period, this will include

firm allocations for the first three years, and indicative figures for the last two years.

The five year total funding is announced as being over £8.4bn in real terms, ie.

above inflation in real terms. It should be noted that inflation is estimated at less than

1-2% per annum.

This is weighted more heavily towards year 1 (2016-17), and year 5. This includes

the creation of a transformation fund, which in year 1, 2016-17, is geared towards

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returning all Trusts in England to in year financial balance, giving them more time to

implement long term sustainable recovery plans.

There is an emphasis on system wide leadership, and thus the requirement to

produce a local economy “Sustainability and Transformation Plan” covering the five

years, as well as a one year operating plan. The draft version of this plan is due in

March for some sections, and in June as atotal plan. This will then beput through an

assurance process by NHS England, and to ensure alignment with trust plans.

Applications of Funds for 2016-17 : General Uplift in CCG allocations- The NHSE board approved a quicker movement towards capitation targets, and to having no CCG at less than 5% under target. This means that the distribution of funds is more skewed than in the past where there was a minimum uplift to all CCG’s of nearly 2%.

The average increase for 2016-17 will be 3.4%. In London four CCG’s have received the new national minimum uplift of 1.39% for 2016-17. These are in West and Central North London.

The overall formula has been revised, with a heavier weighting for elderly, and for sparsity of provision, and slightly less for deprivation.

This will benefit some CCGs eg. Bromley, but make little change to Southwark overall. Inner city areas will reduce as a proportion of total national funding as a result.

CCGs are also being encouraged to drawdown their surplus, where it is above the 1% minimum, over the next three years, to give extra non recurrent funding for pump priming of investment, and meeting non recurrent pressures.

Locally this means that Southwark, will apply to draw down c. £3m, at a rate of £1m per annum for each of these three years. This will still leave an accumulated surplus of £4.3m, just over the 1% threshold.

We will see three “place based allocations” for Southwark, a programme budget – for commissioning activity, an indicative budget for specialised commissioning, and a co-commissioning budget for primary care medical services.

This commits £3.8Bn of the overall uplift in the first year 2016-17, this percentage uplift reduces in years 2-4, and then rises again in year 5 , which is 2020-21.

Sustainability and Transformation fund

The Department of Health (DH) is setting up a sustainability fund of c £2.1bn, of which £1.8bn will be targeted at failing trusts who can demonstrate their plans to return to recurrent balance, but who need assistance to get there. Currently nearly all

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local Trusts are in deficit, with King’s being in the most severe position, and approximately half of all trusts in England have a deficit.

This replaces the funding which was previously available via the DH to Trusts. There will be a clear process with NHS Improvement to access these funds.

Winter pressures- The policy adopted in 2015-16 remains, in that circa £2m per CCG is built into recurrent baselines, and any further spend in this is to come from our allocation.

Specialised commissioning- very few additional services are delegated to CCGs,

primarily just bariatric surgery, and some outpatient areas.

Funding for specialised services will grow by 8% in 2016-17, and then by 4-5% in

each subsequent year. This reflects the pressures from new approved drug

treatments.

Primary Care Budgets

NHS England have undertaken work using the Carr Hill national primary care funding

formula, to arrive at the target budgets for each region, and then down to CCG level

for 16-17. This will be needed to support primary care co-commissioning in 16-17

and beyond. The Carr Hill formula usually calculates a target that includes GP,

Dental, Pharmacy and Optical as one single budget.

Additional work has been done to split this between GP services, and the three other

categories, as delegated co-commissioning is only currently for GP services.

Southwark’s baseline budget for GP services is under discussion with NHSE London

colleagues who are analysing current spend by practice. There are significant

pressures on that funding, which we are discussing through our co-commissioning

structures.

This 16-17 primary care medical budget would only be our CCG responsibility if we

agreed to take full level 3 delegated responsibility. At present we plan to continue

with level 2 in 16-17, with level 3 at a later date. We are currently undertaking a PMS

review with NHSE colleagues. This will redefine what is expected from GP

contractors, with a focus on population health improvements, but is not intended to

reduce spend in this key area of service delivery.

This uses GP registered list size, as does the programme budget allocation. Lists

grew by 1.7% in the 6 months to September 2016.

Mental Health- There is an expectation that CCGs will continue to show “parity of

esteem” in that they will grow their investment in mental health, in line with their

overall allocation increases of 2-3% per annum. This includes two new access

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standards for IAPT and Psychosis. Our local work on tendering for IAPT, CAMHS

joint LA/CCG plan investment, and other investments should put Southwark in a

good place to achieve these targets.

Other Areas- There will be a bidding process for the Primary Care Transformation

Fund – capital and revenue funds. This includes digital projects, and also including

funding for GP premises improvement schemes. These are due to be submitted in

late April, and we are working with practices on these bids.

It is still expected that legacy continuing healthcare claims will be met by CCG’s, but

the latest assessment shows that this requirement will reduce from £250m in 2015-

16, to £100m in 2016-17, then zero. This is met from non recurrent reserves at the

start of the year.

We have been asked to set aside a sum of 0.15% for the next year’s programme for

the Healthy London Partnership as part of these national plans. This is also set aside

in our reserves at the start of the year.

2. Opening Southwark CCG Resources 2016-17

Southwark and Lewisham are the only SEL boroughs to be “over target “in SEL,

based on the national formula. Therefore, while Southwark has received 3.05%

growth money, some other CCGs have received more to bring them up towards

target funding level.

Table 1 Opening Resources 2016-17 £’000

2015-16 2016-17

Recurrent Allocation 375,156 393,667

NHSE transformation funds

2,000

Surplus drawdown 1,000

“Programme resources” 382,355 396,667

Running Costs allocation 6,572 6,457

Total Resources 16-17 388,926 403,124

Target surplus for the year

6,477 6,477

This is built up from our recurrent baseline, consolidation of non recurrent items from

15-16 mainly due to the permanent transfer of Public Health funding to the Local

Authority, which has been an in year adjustment until now, plus a 3.05% uplift of

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£11,647k. In addition we are use part of the uplift to increase the Better Care Fund

from NHSE, by circa 1% or just over £200k.

3. Opening Budget Envelopes and Financial Targets for 2015-16

At this stage appropriate budget negotiating envelopes have been drawn up locally,

including input from our CSU acute contracting team, to enable the meetings with

NHS Trusts to go ahead. Despite the changes, the three largest contracts for

Southwark remain Guy’s and St.Thomas’, King’s, and SLAM, which between them

account for over 60% of our resources.We are working with approximate contract

values at this time, and aiming to sign contracts by the national late March deadline.

There have been further changes to the acute Payments by Results tariff, and for

this year the net tariff has increased by 1.1% releasing resource to commissioners,

this is a combination of inflation of 3.1%, including the national increase in National

Insurance, and changes in NHS Pensions, and net of 2.0% efficiency savings.

NHS Improvement has set Foundation Trusts a target of at least 2.0% efficiency

saving, and in reality cost pressures mean that Trusts will require savings beyond

this level. The CCG has a role in assuring the Trusts internal CIP programmes do

not detriment patient quality and safety of care. These are currently being reviewed.

All our trusts in SE London currently are running inyear deficits in 2015-16.

Mental health Payment by Results, based on “cluster” of service tariffs for mental

health will be further shadowed in 2016-17. When implemented this will initially cover

only a quarter of the SLAM contract services. In the coming year we will be

developing these contract currencies with SLAM and monitoring them on a shadow

basis alongside existing contract currencies.

In order to achieve a balanced budget position, including making a continued 1.6%

surplus, the CCG currently needs a net QIPP programme of c. £8m in total. This

figure may still need to increase depending on the outcome of contract negotiations,

and on the final level of reserves we deem necessary, and can afford to manage in

year risk. This is discussed later in this paper.

Table 2 Opening Budget Envelopes 2016-17 £’000

2015-16 2016-17

Acute services 209,724 219,145

Mental Health services 53,663 55,313

Community services, primary care and 34,185 35,786

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transformation

Primary care prescribing 32,485 34,063

Continuing care and Free nursing care 15,650 17,115

Better Care Fund 20,478 20,682

Corporate costs and property costs 5,838 6,193

Total Budget envelopes 372,023 388,297

Reserves and Contingencies 10,331 8,370

Total Programme Budget excluding running costs, net of QIPP savings

382,354 396,667

Negotiations are being held regularly with all major trusts and offers have been

received from the trusts. The CCGs have made a contract offer to mental health

trusts, and are evaluating the offers received from Guy’s and St Thomas’ NHS

Foundation Trust and King’s College Hospital NHS Foundation Trust.

In addition the CCG has an important role in signing off the internal Cost

Improvement Programmes (CIPs), for the trusts, and the commissioner led QIPP

programmes as well, to ensure quality of services is not compromised by the

changes made to stay within available rsources.

As we have a lead commissioner role for King’s, we will undertake this for the whole

of London CCGs, and also be part of a joint four CCG lead commissioner group for

SLAM. Lambeth CCG will lead this work with Guy’s and St.Thomas’. We are working

closely with King’s, NHSE, and the NHS Improvement, to take forward the recovery

plan for King’s.

Nationally we will be reporting on progress to the NHSE regularly, and must reach

agreement on all NHS contracts by late March at the latest. The model contract for

NHS providers has been updated by the DH. In addition there will be local clauses

on quality and performance issues.

A number of services being redesigned will be subject to procurement processes in

year, these will be procured with expert external advisors input, patient

representative input, and technical advice. This includes the IAPT service, which was

tendered this year, and a lead provider arrangement was awarded to SLAM,

effective from April 2016. A number of smaller services are also being considered, as

their current contract and pilot arrangements come to a natural end.

These figures exclude the running costs budget which was £6,572k in 2015-16. It is

understood that this figure will be a flat cash allowance for the full five year period.

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This is also based upon ONS population, which has fallen by 7,000 in the last year in

Southwark to 292,000.

Thus our target spend has been reduced to £6,457k for 2016-17. This represents a

cost pressure of £120k per annum, to stay within target.

4. Investment in 2016-17

The CCG continues implementing its Primary and Community Care strategy this

year, and has undertaken some reprocurement of services. It is also finalising plans

to invest more in mental health services, and the Five Year Forward View requires

CCGs to demonstrate that they are investing an amount equivalent to the growth in

their allocation, 3% for us, to ensure these services are not eroded in real terms.

This can be shown in our work on IAPT and early intervention in psychosis, and in

redesign of Adult Mental Health services, and investment in Children’s cAMHS

services.-these total over £2m, exceeding this requirement.

For the coming year we will continue to invest in improving the quality of community

and primary care services, and achieve safety and quality improvements in all our

contracts. We have had two Urgent Access 8-8 centres in operation for the past

year. These are dealing with patients referred from other practices in their patch, and

ensuring people get seen the same day, rather than using other parts of the health

system. These are an investment of over £2.5M recurrently. We are seeking to take

forward at pace, the development of our local care networks with providers and joint

commissioners of services, to realise the vision we have through the Our Healthier

South East London programme.

These services are managed by our two local GP federations, which all GP practices

are members of. Through this we expect to achieve increased quality and

consistency of care for all Southwark residents. We intend to invest further in their

development in the future. We are also seeking to support practices in their

proposals to look at mergers, and in evaluating their future plans.

The Dulwich development programme has had various NHSE approvals in the past

year, and work is now progressing on the full design of the Health Centre. Also the

remainder of the site has been sold for a new secondary school. The business case

will be completed by early 2017. Other potential developments that support delivery

of the primary care strategy are well progressed, as part of council regeneration

projects, including the Aylesbury estate.

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The CCG’s investment plans are summarised at the end of this paper. These have

been categorised into firm commitments that have started, those committed to- but

not yet underway, and those schemes where investment is still optional..

In total we are aiming to invest to deal with cost pressures- such as outturn on

contracts, and pick up of non recurrent funding. These are appended to this paper.

We are also investing in new and improved services in acute, community and

primary care health services, new schemes in the Better Care Fund, in winter

resilience, and in mental health and disabilities, and safeguarding.

These will be reassessed as the contracts are agreed and the overall position

becomes firm.

5. Better Care Fund 2016-17

Southwark’s Better Care fund plans are currently being updated for 2016-17.

The plans total c. £20,682k revenue monies, and another £1.48M capital, the capital

flows direct to Councils. The fund will be reported through an existing joint

governance structure up to the Health and Wellbeing Board on a quarterly basis.

The creation of the fund, has taken in previous payments by NHSE, and the CCG,

some new funding from NHSE, and has required the CCG to fund a further £6M from

its baseline allocation monies in 2015-16, to reach the required level. This includes

support for the new Social Care Act, to support social work and associated services.

A programme of schemes is in place including support to 7 day working in primary,

community, and social care, mental health investment, and supporting social workers

and elderly care. This is in addition to other jointly managed services, or those which

the CCG commissions on behalf of the Council under a S.75 agreement. This will

also be assured by NHS England.

6. QIPP Programme for 2016-17

The CCG has determined that it will need a net QIPP saving programme of circa

£7M in the year, comprising both new schemes, and the full year effect of some

mental health schemes from 2014-15.

This is after risk rating by the SMT, and after investment to achieve these savings,

and means that the gross programme, is significantly larger.The programme has

been derived through examining areas where we feel confident that the CCG can

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achieve savings, and is linked to our service redesign programme. Table 3 below

summarises the main areas where risk rated QIPP savings are planned. This

programme will need to increase if the outcome of contract negotiations is

unfavourable with some Trusts and other providers.

Table 3 Net QIPP programme 16-17 £’000

2015-16 2016-17

Acute services 5,500 5,100

Community services and primary care 100 210

Mental health /client groups 1,706 1,200

Corporate services 125 0

Continuing Care 0 0

Prescribing 551 424

Total QIPP programme- net 7,982 6,934

Our track record is in delivering the full 2015-16 programme totalling £8m, 2014-15

programme totalling £15.5M, and in delivering programmes between £11m to £20M

in the previous three years. Therefore with tight governance, we believe this

programme is deliverable in 2016-17. The allocation increase in 2017-18 is lower, so

we may well need to plan very early for an increase level of savings in 2017-18m,

potentially exceeding £10m.

7. Reserves and Risk Mitigation

The CCG has had significant cost pressures to deal with in the past few years, most

significantly the growth in acute activity. The current envelopes include an

assumption of funds being set aside for acute growth, for 15-16 outturn, unwinding

non recurrent funding, and demographic growth, and meeting Referral to Treatment

targets (RTT). These areas are much more under control now, although there are

still concerns about maintaining performance and of delivering suatained quality.

Mental Health and client group contracts are overperforming,with an increase

particularly in the use of acute MH beds – particularly external placements, - costing

circa £280k in 2015-16. Significant service change which started in 2015-16, will

continue to be implemented, and to deliver the QIPP savings.

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Prescribing has delivered significant savings to date, and is expected to continue in

2016-17, but at a lower level, as a result of national price changes.

Thus, the CCG needs to maintain a significant level of contingency and earmarked

reserves. At this stage of negotiations, some of these may need to be utilised to

reach better contract agreements that reduce our in year risk exposure. The

outcome of this will not be known until March, when all contracts are agreed, or

whether we will need to find further QIPP to mitigate these calls on reserves.

All CCGs have again been instructed through nationally agreed Business Rules, to

keep aside 1% of budget as an uncommitted reserve to meet non recurrent

pressures in year. In SELwe expect to use part of this to fund the CHC risk pool, and

HLP programme – circa £1m, together. This will be subject to DH approval from now

on. In addition we are require to set aside a ½% contingency fund, and funds to meet

in year activity pressures. All reserves will require IGP committee approval for their

release into contracts, through monthly finance reports.

Boards signed off a new SEL collaborative agreement last year, and the SEL risk

reserve has thus been reduced to ¼% per CCG.

We are also required to create an additional 0.15% Transformation fund for local or

London wide projects, again from the Five year Forward View and local

commitments.

Table 4 Overall planned level of reserves for 2016-17 (as at February 2016)

2015-16 final opening reserves

2016-17 proposed reserves

2016-17 % of

allocation

Set aside for Non recurrent pressures, inc Provisions

3,964 4,050 1.0

Set aside for Healthy London Partnership 595 605 0.15

Other reserves and risk pools

General contingency ½ % 1,981 2,015 0.5

Continuing Care Retrospective Risk Pool 700k reduced to c.300k in 16-17

Inc. in 1% NR above

Inc. in 1% NR above

General risk reserve 8 692

Collaborative SEL risk pool ½% then ¼% 1,982 1,008 0.25

MFF effect of Kings / PRU merging 1,800 0

Total 10,332 8,370

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Risk management arrangements across the CCGs in SEL were agreed formally, as

part of our Authorisation process and have been reviewed again with the NHSE

London Director of Finance recently. These give a framework for robust support

between organisations to ensure that all six can reach their financial targets for the

year. Any funding made available can be repayable or not, depending on the agreed

package to aid recovery.

We have been advised that there will be the last year of a national risk pooling in

operation around continuing care retrospective claims in 2016-17, to fund the cash

flow needed by NHSE to make payments. This risk pool will entail a contribution from

each CCG, with Southwark required to pool c. £0.3M of resources from its non

recurrent reserves. This is a reduction on the £0.7M we contributed last year, as the

formula used reflects usage of the fund.

It should be noted that the 2015-16 reserves started at £10.3M, but we expect to end

the year with c. £0.5M available, after various calls on reserves, and budget

adjustments agreed with NHSE, SEL Risk share, and Trusts. Almost all of this was

committed to offset cost pressures, including contract overperformance, and deliver

the planned surplus.

8. Governance around Budgets and QIPP Programme Delivery

All budget papers are considered by the Integrated Governance and Performance

committee (IGP), and then recommended to the CCG Governing Body (CCG GB).

Service redesign and procurement proposals are put forward to the Commissioning

Strategy Committee(CSC), and in some cases proposals arise through our

Programme Boards, and are then recommended to the CCG GB.

Clinical Board members are involved in all committees, and as Governing Body

voting members. They have protfolios of expertise and lead on particular services

and contracts. They are involved with officers, in negotiating and agreeing key

contract terms and conditions. Key issues are raised and debated at the SMT

meetings as well, which holds managers to account.

The QIPP programme forms an important part of our Integrated Performance report,

challenged by all Board members, and the IGP committee, and its sub groups

examine schemes in detail to ensure they are delivered, or mitigations put in place.

Finally, the NHSCB holds regular assurance reviews with the CCG at which our

contract performance, and management, and the QIPP programme are challenged

and reviewed.

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These measures taken together give a robust process for the management of

budgets and QIPP, and agreement on the utilisation of reserves in year.

There are comprehensive reports from the CSU acute team, and from our client

groups team on contract performance each month. These are supplemented by the

overview in the Integrated performance Report and Finance Report as well.

9. Forward Look to 2017-18 onwards

We need to maintain our record of delivery of improving services, and delivering

QIPP savings, to enable transformation and integration to take place, through

revised models of Neighbourhood working in Local Care Networks.

The Five Year Forward View and planning guidance states the expectation that

CCG’s will maintain at least a 1% annual surplus each year. The current 1.9%

surplus is carried forward from year to year under Treasury rules.This is subject to

the current rules remaining in place. We expect to reduce this to 1% through

drawdown over the next three years , in line with latest NHSE guidance.

We will receive smaller increases to our allocation, from 2017-18 of around 2.5%

p.a., for three years, because we will be above target spend levels, and the

pressures are expected to remain high, with possible increases in inflation, meaning

that as commissioners there will be reduced benefit from tariff changes year to year.

The CCG therefore is predicting a total QIPP of over £35M for the next five years to

2020-21

The SEL strategy work will be taken further in the next year, culminating in business

case from trusts and commissioners, and public consultation, where appropriate, as

part of improving the health outcomes of all people in SE London.

Taken together, these issues represent an increased level of risk to achieve targets

in 16-17, and it is possible that the level of QIPP required, over the five years, will

increase as a consequence. If the outcome of 2016-17 contract negotiations is

favourable, this will not be required in 16-17, subject to the effect of other in year

pressures. We are operating on a tighter level of reserves, as are most CCG’s, and

therefore there is some increase in risk, which will be mitigated by the contract

arrangements we agree shortly.

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10. Recommendations

1. The Council of Members is asked to approve the Budgetary Framework for

2016-17.

2. The CCG are asked to delegate authority for contract negotiations, to the

Chief Officer, Chief Financial Officer, and Chair of the Intergrated Governance

and Perfomance Committee (IG&P), to allow these to be concluded by the

deadline. They will take account of the advice from clinical members of the

committee who are engaged in the negotiations.

3. To note that updates will be made to the IG&P committee, and a final budget

paper will be presented to the CCG Governing Body in May.

4. To note that the Governing Body will be kept appraised of developments in

national policy on use of reserves and allocation isues by the CO and CFO.

Malcolm Hines

Chief Financial Officer, Southwark CCG

2 March 2016

Attachments:

Five Year Forward View – top 9 Must Do priorities for the CCG

List of Cost pressures for 2016-17

List of Proposed Investments for 2016-17

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Appendix 1 - extract from NHS Planning Guidance issued 17 December 2015

National ‘must dos’ for 2016/17

Whilst developing long-term plans for 2020/21, the NHS has a clear set of plans and

priorities for 2016/17 that reflect the Mandate to the NHS and the next steps on

Forward View implementation.

Some of the important jobs for 2016/17 involve partial roll-out rather than full national

coverage. Our ambition is that by March 2017, 25 per cent of the population will have

access to acute hospital services that comply with four priority clinical standards on

every day of the week, and 20 per cent of the population will have enhanced access

to primary care. There are three distinct challenges under the banner of seven day

services:

(i) reducing excess deaths by increasing the level of consultant cover and diagnostic

services available in hospitals at weekends. During 16/17, a quarter of the country

must be offering four of the ten standards, rising to half of the country by 2018 and

complete coverage by 2020;

(ii) improving access to out of hours care by achieving better integration and

redesign of 111, minor injuries units, urgent care centres and GP out of hours

services to enhance the patient offer and flows into hospital; and

(iii) improving access to primary care at weekends and evenings where patients

need it by increasing the capacity and resilience of primary care over the next few

years.

Where relevant, local systems need to reflect this in their 2016/17 Operational

Plans, and all areas will need to set out their ambitions for seven day services as

part of their STPs.

The nine ‘must dos’ for 2016/17 for every local system:

1. Develop a high quality and agreed STP, and subsequently achieve what you

determine are your most locally critical milestones for accelerating progress in

2016/17 towards achieving the triple aim as set out in the Forward View.

2. Return the system to aggregate financial balance. This includes secondary care

providers delivering efficiency savings through actively engaging with the Lord Carter

provider productivity work programme and complying with the maximum total agency

spend and hourly rates set out by NHS Improvement. CCGs will additionally be

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expected to deliver savings by tackling unwarranted variation in demand through

implementing the Right Care programme in every locality.

3. Develop and implement a local plan to address the sustainability and quality of

general practice, including workforce and workload issues. We expect the

development of new care models will feature prominently within STPs.

4. Get back on track with access standards for A&E and ambulance waits, ensuring

more than 95 per cent of patients wait no more than four hours in A&E, and that all

ambulance trusts respond to 75 per cent of Category A calls within eight minutes;

including through making progress in implementing the urgent and emergency care

review and associated ambulance standard pilots.

5. Improvement against and maintenance of the NHS Constitution standards that

more than 92 percent of patients on non-emergency pathways wait no more than 18

weeks from referral to treatment, including offering patient choice.

6. Deliver the NHS Constitution 62 day cancer waiting standard, including by

securing adequate diagnostic capacity; continue to deliver the constitutional two

week and 31 day cancer standards and make progress in improving one-year

survival rates by delivering a year-on-year improvement in the proportion of cancers

diagnosed at stage one and stage two; and reducing the proportion of cancers

diagnosed following an emergency admission.

7. Achieve and maintain the two new mental health access standards: more than 50

per cent of people experiencing a first episode of psychosis will commence treatment

with a NICE approved care package within two weeks of referral; 75 per cent of

people with common mental health conditions referred to the Improved Access to

Psychological Therapies (IAPT) programme will be treated within six weeks of

referral, with 95 per cent treated within 18 weeks. Continue to meet a dementia

diagnosis rate of at least two-thirds of the estimated number of people with

dementia.

8. Deliver actions set out in local plans to transform care for people with learning

disabilities, including implementing enhanced community provision, reducing

inpatient capacity, and rolling out care and treatment reviews in line with published

policy.

9. Develop and implement an affordable plan to make improvements in quality

particularly for organisations in special measures. In addition, providers are required

to participate in the annual publication of avoidable mortality rates by individual

trusts.

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Cost Pressures 2016-17 Budget Area £’000 Total £’000

Acute and Community

15/16 Acute Outturn (net of acute reserves applied) 8,010

LAS SEL 111 site relocation

100

ICES - growth 100

Eating disorders – devolved from NHSE- funded 170

BCF spend up to national minimum rqd. for 16-17 230

Fye of Adult Safeguarding Lead Nurse

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8,636

Mental Health and Client Groups

SLAM outturn 15-16 250

Additional caseload from Council review

1,500

YPD cost pressure / growth

1,050

RHN Price increase 200

GP Support to Nursing Homes

130

Community and residential pressures

294

Children’s caseload growth

260 3,684

Primary Care (pye)

GMS/ PMS equalisation 370 370

Other cost presssures

Local Care Record - GSTT 130

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ongoing costs

130

Total Cost Pressures

12,820

All cost pressures are built into contract negotiation envelopes at present. All contracts for NHS

providers to be agreed by end of March 2016.

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Proposed Investments 2016-17

Budget Area £’000 Total £’000 Category A/B/C ACUTE SERVICES Acute investments including ED redesign and transformation projects 5,276

A

Neuro Rehab level 2B- 20 new beds across SEL 600

C

5,876

COMMUNITY SERVICES

2 Beds at Pulross centre- Int care beds 290

C

Home enteral nutrition growth 70

C

Tier 2-3 weight management 140

C

Complex cancer referral pilot 100

B

Minor eye service 75 C Children’s continence nurse FYE 26

C

Children’s specialist dietician nurse 43

C

744

MENTAL HEALTH

AMH Transformation - Home treatment, Clozapine initiation,MAP Enhanced Treatment with SUN and Optima , Pychosis Community teams (year 2) 1028

A

Transforming care for LD clients- national issue

152 A

SH24 – sexual health prEsCribing on line rollout

35 B

19

Primary care dementia pilot

65 C

Solidarity in crisis service

40 A

Big White Wall service 36 A

IAPT mobilisation of new service -NR

120 A

Early intervention in psychosis

130 A

Additional PICUP activity

65 A

CAMHS plan – nationally funded

689

A

2,360

Primary Care and Local Care Networks

Developing Federations and LCN’s

730

B/C

Population Health fellows expansion 3 to 6

170 900

Corporate and other budgets

CCG structure changes – transformation posts and consultancy

250 B/C

250

Total Investments 10,130

Category A = this investment is already agreed and underway.

Category B= this is committed , but has not yet started.

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Category C= This investment is proposed, but is not yet fully committed or approved.