1. Planning Round

2. Planning Requirements 2017-19
1 year winter plan
2 year Operating Plan / Contracts
Operating Plan (financial/activity/narrative) must:
Reflect STP Planning Footprint assumptions / outcomes / initiatives
Deliver 9 ‘must do’s’
Narrative must provide evidence to support activity/finance assumptions – not a traditional operating plan

3. Planning / Contract Timeline
Action
Date
Submission of STPs
21 October 2016
Submission of summary level operational financial plans
1 November 2016
Submission of full draft operational plans
24 November 2016
Signing of contracts
23 December 2016
Submission of final 2017 – 19 operational plans aligned with contracts

4. Winter Plan
Submitted by and on behalf of the Hull and East Riding A&E Delivery Board
Main concerns around service sustainability:
Bedded capacity over winter – hospital and community
Fragility of social care market – care homes sustainability / care packages availability
Funding

5. Main Winter Projects affecting Hull
Description
Planned Beds 2016/17
Bed Target 102
Comment
HEYHT
Surge Ward 27
Seasonal change
*NEW for 2016/17* Additional day surgery trauma capacity 2
Permanent change
*NEW for 2016/17* Impact of reduced length of stay in hospital 6
Total 35
67 ( )
CHCP
Changes to community bed management model and additional capacity commissioned 27
*ICT beds - Highfields 9 beds (permanent) * ICT beds - Rose Villa 4 (seasonal - end March 17) * Step down beds - 4 beds (seasonal) Care Packages bed equivalent (permanent)
Total
13 ( )
10 more beds than 15.16

6. Operational Plan Narrative
The Operational Plan narrative is an opportunity to:
Demonstrate that we have the necessary grip on the main operational and financial issues and challenges facing us
Provide assurance to NHS England that you are addressing the NHS Constitutional Standards
Well placed to make a positive contribution to the STP

7. 9 ‘must do’s’ STP and Operational Plan Links Financial Management
Primary Care – sustainability and transformation
Urgent and Emergency Care transformation
Referral to Treatment Times and Elective Care
Cancer – Cancer Alliances and delivering national cancer plan
Mental Health 5 year forward view
People with Learning Disabilities
Improving Quality in Organisations

8. Collaborative Commissioning
Collaborative Commissioning offers:
Stronger bargaining power
Consistent offer for patients and providers
Sum of the parts is greater than individuals
It’s reassuringly familiar all the CCG’s are focussing on the:
9 must do’s in the Planning Guidance
Priorities laid out in key national documents e.g. 5YFV, 5YFVMH, GPFV, RightCare, etc.
It makes sense to see where we can work together

9. Collaborative Commissioning to address:
Demand Management
RightCare
High Impact Changes
New Models of Care
MCP/ACO
Commissioning at scale
Commissioning and contracting
Expertise
Shared resource
Prevention
Communications
Technology
Shared decision making

10. Collaborative Opportunities (1)
Development of a single set of commissioning intentions across the 6 CCGs
Inclusion of thresholds for smoking and BMI in some elective procedures working towards a consistent approach
Commissioning of weight management services including preventative approaches to support threshold management
Collaborative approaches across certain specialities such as ophthalmology, scoping the potential for a STP wide model or procurement

11. Collaborative Opportunities (2)
Delivery of urgent care standards including access to clinical advisory service via NHS 111
Opportunities to streamline the transactional elements and governance of contracting approaches across organisations including access to business intelligence support
One contract per provider
Community focused models of care for chronic diseases such as diabetes
Different models for outpatient services that move away from traditional face to face follow ups

12. Narrative Plan – Key Messages (1)
Integration and Collaboration around:
Better Care Plan delivery
Sustainability and Transformation Plan development and delivery
Collaborative commissioning – including with Specialised Commissioners
Delivery of the Integrated Care Centre business case
Exploring further opportunities for closer commissioning relationship with the Local Authority

13. Narrative Plan – Key Messages (2)
Commitment to work with member practices to support them to make the shift to a new sustainable at scale model
Delivery of the NHS Constitution Targets
Progression of plans post consultation to develop a 24/7 urgent care centre
Development of alternative pathways to A&E including ‘hear and treat’ and ‘see and treat’ models
Right Care wave 2 participation
Development of a Local Maternity Service (STP footprint)

14. Narrative Plan – Key Messages (3)
Development of the Humber Coast and Vale Cancer Alliance
Development of a mental health ‘crash pad’
Delivery of the Transforming Care Plan for individuals with a learning disability
Promotion of high quality commissioned services via:
Safer staffing levels and staffing skill mix
Supportive service visits to review the level of quality and patient experience / outcome

15. Commissioning Intentions (CI)
Slightly changed methodology this year
For acute sector the plan is to put in a single CI document across all 6 CCGs in STP with local ‘flavour’
Leading to single contract per acute organisation
For other organisations will be individual organisation CIs
This year we are working with a combined narrative statement and an excel ‘project’ statement
All commissioning leads have reviewed their projects

16. Examples of Commissioning Intentions
Change Proposed
Area of Impact
Timescale
Reduce inpatient bed capacity by March 19 to CCG commissioned beds per 1m population
Learning Disability
March 2019
Improve access to healthcare, by 2020, with 75% of individuals on GP register with a learning disability having an annual healthcheck
service is to be reviewed and recommendations to CCG Prioritisation Panel in Jan 2017
March 2020
Community eating disorder teams for children and young people to meet access and waiting time standards
Aim to introduce local target < 18 weeks
Mental Illness
April 2017
COPD (Adults) pathway. Hull and ER CCG wide (potential for STP footprint)
HEYHT / Primary Care / Hull CCG Community / Meds Management /LA PH
To make the best use of health resource by reducing unwarranted variation with a focus on whole population benefit and also the value that the patient derives from their own care and treatment. Review of clinical areas to enable thresholds or changes in pathways to reduce unwarranted activity
All programme areas
2018/19
Online consultation - Implement digital triage solutions (AskMyGP and WebGP) within practices across the city.
Primary Care
March 2017.
Care navigation - Across the groupings within the city, administrative staff will be identified to receive care navigator training. This will support patients in being directed to the right person the first time, releasing capacity for GPs.
Anticipate start date of 1st April 2017

17. 2016/17 Financial Plan

18. Contents CCG Allocations – Programme & Running Costs Business Rules
Budgets
Growth Assumptions
Work to do / Ongoing Developments

19. CCG Allocations
Healthcare Allocations for 17/18 and 18/19 are uplifted by 2% each year (approx. £7.7m)
18/19 Distance From Target of +2.63% (16/17 = %)
Separate Allocation for ‘Running Costs’ - £6.2m for both years

20. Business Rules Deliver Surplus (1% minimum)
Historic Surpluses to be drawn down over next 4 years
Maintain Risk Reserve of 1% - able to plan for 0.5% spent
Hold 0.5% contingency - £1.9m
Deliver underlying recurrent surplus 1%
Parity of Esteem for Mental Health costs

21. CCG Recurrent Programme Budgets
17/18 18/19
Brought Forward Allocation £382.1m £389.8m
Growth £ m £ m
Recurrent Programme Allocation £389.8m £397.5m
Acute Services £202.1m £204.7m
Mental Health £ 42.3m £ 42.4m
Community £ 44.0m £ 44.2m
Continuing Care £ 26.0m £ 26.9m
Primary Care £ 56.0m £ 57.4m
Other / Reserves * £ 14.2m £ 17.4m
Recurrent Programme Expenditure £384.6m £393.0m
Recurrent Programme Surplus £ m £ 4.5m
* Includes contingency

22. 2017/18 CCG Recurrent Programme Budgets
Recurrent Programme Adjustments Incorporated Above
Net Inflation
Investment & Growth
QIPP
TOTAL £m
Acute Services
1.8
3.7
-5.7
-0.2
Mental Health
0.0
1.1
Community
0.3
Continuing Care
0.9
2.7
Primary Care
1.0
2.0
-0.9
2.1
Other / Reserves
3.5
Total
12.4
-6.6
9.5

23. 2018/19 CCG Recurrent Programme Budgets
Recurrent Programme Adjustments Incorporated Above
Net Inflation
Investment & Growth
QIPP
TOTAL £m
Acute Services
2.0
5.8
-5.8
Mental Health
0.0
Community
Continuing Care
0.9
Primary Care
1.0
-0.9
1.1
Other / Reserves
2.2
Total
3.9
9.0
-6.7
6.2

24. CCG Non Recurrent Programme Budgets
17/18 18/19 Non Recurrent Programme Allocation £ 7.6m £ 6.6m (inc historic surplus) Reserves / investments Contingency £ 2.0m £ 2.0m Uncommitted Risk Reserve £ 1.9m £ 2.0m Acute (include IR and HRG4+) (£ 0.2m) (£ 0.2m) Mental Health £ 0.0m £ 0.0m Community * (18/19) £ 1.8m £ 2.9m Primary Care * (17/18) £ 2.5m £ 0.5m Non Recurrent Programme Expenditure £ 6.0m £ 5.2m Non Recurrent Programme Surplus £ 1.6m £ 1.4m *includes 50% of Risk Reserve

25. CCG Recurrent Running Cost Budgets
17/18 18/19 Recurrent Running Cost Allocation £ 6.2m £ 6.2m CCG Staffing Costs/ Commissioning Support £ 5.3m £ 5.3m Estates / Other Non-Pay £ 0.9m £ 0.9m Non Recurrent Programme Expenditure £ 6.2m £ 6.2m Non Recurrent Programme Surplus £ 0.0m £ 0.0m

26. 17/18 CCG Summary of Budgets
Allocation £m
Expenditure
Surplus
Recurrent Programme
389.8
384.6
5.2
Non -Recurrent Programme
(inc Historic Surplus)
7.6
6.0
1.6
Total Programme
397.4
382.0
6.8
Recurrent Running Costs
6.2
0.0
TOTAL CCG
403.6
396.8

27. 18/19 CCG Summary of Budgets
Allocation £m
Expenditure
Surplus
Recurrent Programme
397.5
393.0
4.5
Non -Recurrent Programme
(inc Historic Surplus)
6.6
5.2
1.4
Total Programme
404.1
398.2
5.9
Recurrent Running Costs
6.2
0.0
TOTAL CCG
410.3
404.4

28. Growth Assumptions 2% efficiency requirement in both years
17/18: Uplift of 2.1% (CNST adjustment on specific HRGs of additional 0.8%) – Net 0.1% growth (0.9% for specific HRGs)
18/19: Uplift of 2.1% (CNST adjustment on specific HRGs of additional 0.9%) – Net 0.1% growth (1.0% for specific HRGs)
CQUIN remains at 2.5% in both years
Continuing Care budget incorporates living wage adjustments and national adjustment to Funded Nursing Care packages.
Prescribing budget uplift of 2% per annum to reflect price increases

29. Work to do / ongoing developments
Agree 2 year contracts with providers by 23rd of December
Agree contracting basis / risk sharing arrangements across the STP
Implement QIPP programmes in readiness for 2017/18