The Strategic Health Authority for London London Councils – Leaders Committee 6 February 2007 Ruth Carnall and George Greener

Agenda 1.Strategy 2.Service Reconfigurations 3.Financial Pressures 4.Relationships with Local Government

1 Healthcare for London A Framework for Action

2 Healthcare for London: A Framework for Action The project aims to: Advise on the values that should underpin healthcare provision in London Develop a set of design principles that will guide service development and change in London Define the core characteristics of a world class health service to meet the health needs of London Develop a series of illustrative models of care and care-pathways that reflect the principles and characteristics defined above NHS London expects to receive the report in early April 2007

3 How it fits Healthcare for London Mayors strategy on health inequalities PCT commissioning strategies Local Area Agreements London Boroughs Service reconfiguratio n work in sectors

The case for change London's health services have not kept pace with changes in medicine As a result health and healthcare are not as good as they could be London's world-class reputation in health science research is in jeopardy without change Healthcare for London represents an opportunity for: better health improved care and better outcomes stronger and more competitive health science research 4

Key Elements Case for ChangeModels of CareHealth delivery modelsEnablers 1.London as a capital city 2.Public and patient dissatisfaction 3.Sub-optimal health and healthcare services 4.Medical research 5.Workforce 6.Estates 7.Barriers to change 1.Birth 2.Staying Healthy 3.Long term conditions 4.Acute episode 5.Planned care 6.End of life 1. Demand 2. Models for delivery A. Major acute and complex providers B. Community/ primary care (local hospitals/ polyclinics) C. Public health delivery 3. Feasibility - Financial - Skills - Estate 1.Commissioning 2.Information 3.Incentives 4.Estates/Capital 5.Organisational models 5

The programme of engagement Two meetings with London Councils Invitation to submit evidence by the end of February MORI poll of 7000 Londoners for NHS London Two deliberative events for 100 members of the public Voluntary sector event MPs briefings Clinicians conference Range of stakeholder meetings Interactive website: Media opportunities 6

Service Reconfigurations 8

11 Financial Pressures

2006/07 Month 9 Financial Position PlanForecast Variance NHS Trusts PCTs SHA incl. risk reserve Total £m (108) (74) 92 (90) (123) (164) 162 (125) (15) (90) 70 (35) 12

Organisations with a forecast outturn > £10m for 2006/7 PCTsTrusts Plan VariationForecast 1.Hillingdon 2.Kingston 3.Brent 4.Sutton & Merton 5.Hounslow 6.Bexley (54)(5)(59) (17)(5)(22) 0(18)(18) (7)(6)(13) 0(10)(10) 1.QEH Woolwich 2.Whipps Cross 3.North West London 4.BHR Hospitals 5.Bromley Hospitals 6.Lewisham Hospital (36) 0 (36) (30) 0 (30) (32) 6 (26) (9) (7) (16) (13) 0 (13) (15) 3 (12) 13

2007/08 Financial Planning NHS London to achieve overall financial balance or better All organisations to plan for in-year balance at worst Significant repayment of accumulated debt by organisations in turnaround PCTs planning for a 3.6% top slice to cover the remaining accumulated debt May be able to reduce top slice depending on 06/07 outturn Even after 3.6% top slice, no PCT will receive less than 6.8% growth, with an average of 7.8% 14