The financial challenge to Hertfordshire health services Alan Pond Director of Finance NHS Hertfordshire Interim Chief Executive Herts Valley CCG

Groups of GP practices will commission most local NHS services Two Shadow Clinical Commissioning Groups (CCGs) in Hertfordshire Herts Valleys CCG East & North Herts CCG The new national NHS Commissioning Board will commission GP, dentistry, pharmacy and ophthalmic services, specialised services and prison health services Commissioning for Patients – future funding flows

Clinical Commissioning Groups Will be statutory bodies with own senior staff All practices must be part of a CCG NHS Commissioning Board will support by developing commissioning guidelines, model contracts and tariffs CCGs will be able to employ staff directly or buy in services from external organisations CCGs can decide which aspects of commissioning activity they undertake themselves and which aspects they share Hertfordshire Integrated Commissioning Support Service being developed to support CCGs Commissioning for Patients

Finance The NHS Commissioning Board will initially calculate practice-level budgets from the current PCT budgets and allocate these resources directly to CCGs New weighted capitation formula will provide target allocations for each CCG Pace of change policy will drive how quickly funding is moved to get CCGs to their target Commissioning budget will be separate from surgery income CCGs will receive a maximum management allowance to directly employ staff or buy in services. Indicative amount is £25 per head Details on how any over/underspends will be managed is yet to be agreed with the DH and the Treasury Commissioning for Patients

Proposed implementation timetable In 2012/13 CCGs formal committees of NHS Hertfordshire Board Formal establishment of CCGs and NHS Commissioning Board Approvals process for CCGs in phased approach CCGs receive indicative budgets and must prepare commissioning plans In 2013/14 CCG statutory bodies and where authorised will receive funding allocation and hold contracts Commissioning for Patients

NHS targets focus on measuring outcomes New outcomes framework for 2012/13 created Framework to be structured around five areas: 1.Preventing people from dying prematurely 2.Enhancing the quality of life for people with long-term conditions 3.Helping people to recover from episodes of ill health or following injury 4.Ensuring people have a positive experience of care 5.Treating and caring for people in a safe environment and protecting them from avoidable harm Transparency in outcomes There are over 500 performance indicators which the PCT is responsible for reporting on (by provider and by CCG/PCT)

NHS Operating Framework – Key Priorities 1.Dementia and care of older people 2.Carers 3.Military and Veterans Health 4.Health visitors and family nurse partnerships SHA Ambitions Eliminate pressure ulcers Every patient contact counts Quality/Safety in Primary Care Strengthened NHS/Local Government partnerships Improve patient experience Transparency in outcomes 2

QIPP – Financial Context White Paper sets out £20bn efficiencies over next 4 years Links to Operating Plan, Framework & Outcome Framework Projected Expenditure Without QIPP Projected Funding Size of QIPP Challenge £276m

1.Hertfordshire system in balance at 31 st March Managed to deliver circa £100m efficiencies in 2011/12 across Hertfordshire 3.Funding used non-recurrently to drive change and deliver efficiencies 4.PCT funding for 2012/13 £1.76bn 5.Significant challenge across the system in 2012/13 to 2014/15 and beyond… Financial Picture – 2012/13

Illustration of how the PCT income is spent (2010/11)

Managing Change Set out the vision – DQHH puts Hertfordshire ahead of other areas Created early momentum, delivered first year of QIPP Minimise fear to avoid distraction Prioritise performance areas to concentrate on Dedicated resource for transition Talent management Maintaining Performance