Planning & Commissioning in Surrey and Sussex Workforce challenges Adam Wickings 9 th July 2014

Hello: My roles Overview: Commissioning and Planning in Surrey & Sussex Call to Action - the national challenge Two “Units of Planning” and what they’ve planned Primary Care & “Out of Hospital” Strategy “Enablers”: Ring-fenced pots of money Better Care Funds Urgent Care and RTT “resilience” funds Change in the Air - co-commissioning, specialised commissioning Big themes with workforce implications From A to B 2

Surrey & Sussex 3

Commissioning & Planning responsibilities in Surrey & Sussex Commissioning organisations in Surrey and Sussex are : 12 CCGs (5 in Surrey, 7 in Sussex) NHSE Area Team commissions: Primary Care Specialised services Prison services Armed Forces 4 Local Authorities (East Sussex, West Sussex, Surrey and Brighton) Provider landscape is as follows:- 6 Acute Trusts 2 Healthcare (Acute & Community) 3 Community Trusts GP Practices 2 Mental health Trusts

Commissioning & Planning responsibilities in Surrey & Sussex Commissioning organisations in Surrey and Sussex are : 12 CCGs (5 in Surrey, 7 in Sussex) NHSE Area Team commissions: Primary Care Specialised services Prison services Armed Forces 4 Local Authorities (East Sussex, West Sussex, Surrey and Brighton) Provider landscape is as follows:- 6 Acute Trusts 2 Healthcare (Acute & Community) 3 Community Trusts GP Practices 2 Mental health Trusts  2 Year “Operational Plans”  2 x 5 yr Strategies

Surrey & Sussex UoPs 6 2 “Units of Planning” 2 NHS 5 Year Strategies

Commissioning & Planning responsibilities in Surrey & Sussex Commissioning organisations in Surrey and Sussex are : 12 CCGs (5 in Surrey, 7 in Sussex) NHSE Area Team commissions: Primary Care Specialised services Prison services Armed Forces 4 Local Authorities (East Sussex, West Sussex, Surrey and Brighton) Provider landscape is as follows:- 6 Acute Trusts 2 Healthcare (Acute & Community) 3 Community Trusts GP Practices 2 Mental health Trusts  4 x Health & Wellbeing Strategies

Surrey & Sussex HWBs 8 4 Health & Wellbeing Boards 4 Health & Wellbeing Strategies Better Care Funds

The Need for Change

The NHS faces a range of whopping challenges We have limited financial resources, no longer growing An ageing population and growing LTC, and so A greater and growing demand on services Workforce that in key areas is not growing at even a similar rate A ‘Call to Action’ tells us that if we are to preserve key values of the NHS, it must change to survive. More of the same won’t do it. It means transforming services, to put patients at the centre and to better meet the health needs of the future. Improving efficiency (£20bn) Lowering financial costs Providing more care outside of hospitals:-  INTEGRATION, FEDERATION,… polysystem?  TRANSFORMATION  SELF MANAGEMENT National Context - A ‘Call to Action’ 10

How does providing care “out of hospital” not save money? Staff in the community are not cheaper than hospital staff (and they have to travel) Buildings in the community are not cheaper than hospitals (they’re more expensive) Episodes of care, e.g. appointments, are not cheaper than hospital OP appts - moving appointments from hospitals to clinics, health-centres or surgeries is not cheaper The point of a hospital is to lump staff and services together to make them efficient and cheap How can providing care “out of hospital” save money? Fewer, more-expensive episodes are much cheaper overall People pay for their own homes 30% of a GP Practice list use 80% of the appointments They’re the same patients having hospital appointments and admissions etc. Money is saved when we reduce the fixed assets: hospital buildings The Money - A ‘Call to Action’ 11

Surrey and Sussex need to provide a better landscape of health and social care services for our communities and must be committed to:- Increasing the Potential years of life lost from causes considered amenable to Healthcare Improve the quality of life for people with Long term conditions Increase the proportion of older people living at home Decrease the number of people having a negative experience of care outside Hospital, in primary care and in the community Decrease the number of people having a negative experience of hospital care Making a significant progress towards eliminating avoidable deaths in our hospitals Why Do we Need to Change here? 12

How Do we Do This?

Surrey Strategic Plan Out of hospital (primary care, Better Care Fund, urgent care Acute Hospital Urgent and Emergency Care Stroke Complex Invasive Cardiology Elective productivity Mental Health Cancer Burns Plastic 14 Main Workstreams in Surrey & Sussex Sussex Strategic Plan Out of hospital (primary care, Better Care Fund, urgent care Maternity and paediatrics Acute Hospital Urgent and Emergency Care Stroke Complex Invasive Cardiology Elective productivity Renal Cancer Burns/Plastic Provider Landscape Enabling Workstreams  Workforce  Commissioning developments and levers  Others, e.g. BI, IT, premises

Surrey Strategic Plan Out of hospital (primary care, Better Care Fund, urgent care Acute Hospital Urgent and Emergency Care Stroke Complex Invasive Cardiology Elective productivity Mental Health Cancer Burns Plastic 15 Main Workstreams in Surrey & Sussex Sussex Strategic Plan Out of hospital (primary care, Better Care Fund, urgent care Maternity and paediatrics Acute Hospital Urgent and Emergency Care Stroke Complex Invasive Cardiology Elective productivity Renal Cancer Burns/Plastic Provider Landscape Enabling Workstreams  Workforce  Commissioning developments and levers  Others, e.g. BI, IT, premises

Wider area transformation strategy - Call to Action CCG Commissioning / transformation strategy Out of Hospital Strategy Primary & Community Strategy Primary Care Strategy What’s a Primary Care Strategy? 16

17 How can commissioners deliver this change? PLAN Provider changes – integration?, federation?, reorganisation?, workforce? Incentives, contracts, new commissioning Strategy, aims, values, commissioning intentions, messages

Elements of CCG PC Strategies

Prime Provider models “Outcome based commissioning” Commissioning from “federations” New procurement approaches Less commissioner specification More co-design 19 “New commissioning”

Surrey Strategic Plan Out of hospital (primary care, Better Care Fund, urgent care Acute Hospital Urgent and Emergency Care Stroke Complex Invasive Cardiology Elective productivity Mental Health Cancer Burns Plastic 20 Main Workstreams in Surrey & Sussex Sussex Strategic Plan Out of hospital (primary care, Better Care Fund, urgent care Maternity and paediatrics Acute Hospital Urgent and Emergency Care Stroke Complex Invasive Cardiology Elective productivity Renal Cancer Burns/Plastic Provider Landscape Enabling Workstreams  Workforce  Commissioning developments and levers  Others, e.g. BI, IT, premises

Surrey Strategic Plan Out of hospital (primary care, Better Care Fund, urgent care Acute Hospital Urgent and Emergency Care Stroke Complex Invasive Cardiology Elective productivity Mental Health Cancer Burns Plastic 21 Main Workstreams in Surrey & Sussex Sussex Strategic Plan Out of hospital (primary care, Better Care Fund, urgent care Maternity and paediatrics Acute Hospital Urgent and Emergency Care Stroke Complex Invasive Cardiology Elective productivity Renal Cancer Burns/Plastic Provider Landscape Enabling Workstreams  Workforce  Commissioning developments and levers  Others, e.g. BI, IT, premises

“Enablers” – ring-fenced & discretionary funds

£18 MSurrey BCF£47 MSussex BCFs £65 MSurrey BCF£120 MSurrey BCFs Not new money: CCG allocations ring-fenced for use as agreed with HWBs, technically non-recurrent Not a “bung” for Local Authorities: NHS money for use on integration, transformation, out-of-hospital plans a plethora of “schemes” and “initiatives” Other Funds in CCGs Control Local Contracts ( Local Enhanced Services) DES contracts Better Care Funds (& others)

£17 Millionresilience funds (winter) £xyz MillionRTT funding “New” money: non-recurrent allocations (via CCGs, not straight to Trusts) for delivery of constitution standards (4 hrs in A&E, 18 wks RTT) Non-recurrent and short timescales, short notice so very difficult to use well plans a plethora of “schemes” and “initiatives” Resilience Non-Recurrent Funds

Changes in the air? Co-commissioning & beyond 25

Moving control from NHSE (back) to CCGs Expressions of Interest so far Can be about budgets or just co-design A journey: back to unified budgets? A unified budget allows investment (investment in primary & community care) 26 Primary Care “co-commissioning”

Moving control from NHSE (back) to CCGs Re-designation - what is designated as specialised Population commissioning - away from contracts A journey: back to unified budgets? A unified budget allows investment (investment in primary & community care) or disinvestment… 27 Specialised Commissioning

Key Themes for workforce planners? 28 Redesign, initiatives, federations… Get involved with planners Integration and federation have to be instead of increases in workforce We can move nurses and doctors from place to place but we can’t often get more Reduce episodes and reduce hand-overs Lots of new schemes and initiatives can’t be delivered if they all mean more nurses or doctors What workforce can we recruit successfully? Pharmacy? Physician assistants? Who should do innovation and workforce planning? Commissioners? Providers?

“Every child deserves to be given the very best start in life, and healthcare staff working with children and young people must have the right knowledge and skills to meet their specific needs and ensure that children receive joined up health and care across both hospitals and the community”. (CMO 2013) Nursing Medical Primary Care workforce role & Skills for CYP with Acute and LTC Role of Community Paediatrican and recruitment issues Shortage of paediatricians to cover RCPCH standards in acute care Need for more Practice Educators Need for a review of Need for more community and advanced roles in the community Significant national shortage of registered children’s nurses How do we get the right balance? Make a plan- Training & governance wider children’s workforce e.g. PA’s and school staff- personal health budgets and the DfE statutory guidance which takes effect from 1st Sept 14 Sort- Coding and Counting of Staff on ESR is required to have robust Health and Social Care Information Centre Data HEE Mandate P11-13 Other issues Health Visiting – Role of minor Illness School Nursing role in Long term Conditions Health SCN WORKS JOINTLY WITH HEE CYP PROGRAMME BOARD DEPARTMENT OF HEALTH COMMUNITY NURSING STRATEGY The SCN are engaged in scoping of CYP community nursing HEE Mandate /attachment_data/file/306967/HEE_mandate_ pdf?utm_medium= &utm_source=The+King%27s+ Fund+newsletters&utm_campaign= _HMP &dm_i=21A8,2ENZX,FLWRM1,8RQGI,1 /attachment_data/file/306967/HEE_mandate_ pdf?utm_medium= &utm_source=The+King%27s+ Fund+newsletters&utm_campaign= _HMP &dm_i=21A8,2ENZX,FLWRM1,8RQGI,1 How do we work with Social Care Education to join up our workforce strategies

Any Questions? 9 th July 2014