1. North West London Month 4 Budget Update SaHF & NWL Strategy and Transformation Programmes August 2014

2. This paper provides the month 4 budget update for NWL-wide financial strategy/ SaHF including Strategy & Transformation programmes. It updates the budgets proposed at the previous Collaboration Board, including reflecting NHSE confirmed contribution. The Collaboration Board are asked to: a)agree the proposed budget changes on slides 5 & 6 for recommendation to CCG Governing Bodies b)note the month 4 budget report and balanced forecast outturn on S&T budgets onslides 7 and 8 2 Purpose / Summary

3. Contents Sources of funding Applications of funding Budget Analysis 1 2 3 Month 4 S&T budget report 4 Forecast outturn S&T spend 5 3

4. Total resource available Sources of funding CCGs contribute to the programme from the 2.5% top slice HENWL contribute for the development of community education networks across NWL NHS E contribute to the Prime Minister’s challenge fund £41.7m 1 £5.0m £1.0m £2.5m Balance of PM match funded locally by CCGs Initial funding A C E 1 includes Richmond CCG contribution of £1m 2 reduced to £15m to reflect NHSE budget and then subsequently to £13.6m as a result of surplus control total target NHS E fund equivalent of the 2.5% contribution from services they commission B £16.3m £59.0m F Additional sources of funding Revised funding 4 £41.7m 1 £1.0m £56.3m £5.0m £2.5m £13.6m 2

5. Applications of funding £31.9m £27.1m £1.95m £3.90m £0.60m £11.60m £4.70m £1.50m £2.85m ---- Total£59.0m -S&T projects (including HENWL contribution) -Provider support -Ealing -Hillingdon -Imperial (A&E) -NWLHT (CMH plus A&E) -West Mids -West Mids Transaction Related Costs -NWLHT Transaction Related Costs -Carried forward to 2015/16 -Over commitment £31.9m 5 £22.75m £1.95m £3.90m £0.60m £11.60m £4.70m - £2.0m (£0.35m) £56.3m Notes Total funding available reduced by £2.7m S&T projects budget unchanged Provider support reduced by £4.35m £2m carried forward to 15/16 (by Brent CCG) as part of agreeing 14/15 revised plans with NHSE Balance of over-commitment of £0.35m Initial fundingRevised funding

6. In Year Budget Pressures 6 The following SaHF implementation in year funding pressures have been reviewed by the COs and proposed to fund:- -Further resilience in respect of A&E closures £0.35m -Maternity transition £0.83m -Imperial emergency surgery £0.25m Agreement of these would increase the total over-commitment to £1.75m It is proposed that the following approach to balancing the budget is adopted. In priority order:- a)Seek re instatement from NHSE of £1.5m reduction related to control totals b)Review S&T budgets to identify in year slippage on plans c)Mid year review of CCG forecast outturns for additional contribution d)CCGs miss control totals agreed with NHSE

7. 7 Breakdown of agreed 2014/15 S&T budget – Unchanged £3.0m 1 Balance of PM match fund of £2.5m funded locally by CCGs (i.e. total match fund £5m). 2 PM match fund of £5m to be funded by NHS England £24.7m Total Slide 7Slide 7 Primary care transformation Enhanced integration 2 1 Hub business case development Informatics strategy Primary Care development + PM match fund £5.0m£3.5m £2.5m£1.25m£0.3m £5.5m £2.1m Other costs (core team, non-pay, events) £2.8m SaHF implementation 5 year strategy £0.2m Programme Office £1.5m Implementation mngt and governance £2.6m Local H & M.H. business case delivery £4.0m 3£13.3m Hospital BC assurance & IMBC £1.0m Imp. of 2014 changes (A&E, Maternity) £1.0m £31.9m Transforming Mental Health services 4 £2.0m £1.0m PC Co- commissioning £1.25m Workforce Whole systems Whole systems implementation £2.0m Communicatio ns £1.0m £3.2m - £1.0m - £7.2m Inc. £1m HENWL S&TCCGs

8. 8 Month 4 S&T budget report Committed Spend YTD BUDGETCOMMITTED SPENDVARIANCE YTD YTDYTDYTDYTD Whole systems£0.7m£0.9m- 1 Enhanced Whole systems implementation integration £0.1m-- TOTALTOTAL£0.8m£0.9m£0.1m PC co-commissioning£0.2m-- Primary care GP Development + PM match fund£0.1m-- 2 trans- Hub business case development £0.2m£0.5m£0.3m formation Primary care IT strategy £0.1m-- TOTALTOTAL£0.6m£0.5m-£0.1m 5 year strategy£0.1m - Programme office£0.4m - Implementation planning and governance£0.6m£0.5m-£0.1m SaHF LH & MH business case delivery£1.2m - 3 Implement- Imp. of 2014 changes (A&E, maternity) £0.1m - ation Hospital BC assurance & IMBC£0.7m£0.8m£0.1m Workforce£0.2m - Communications£0.4m£0.3m-£0.1m TOTALTOTAL£3.7m£3.6m-£0.1m Trans-forming 4 mental health services TOTAL £0.3m - Other costs 5 (core team, non-pay, events) TOTAL£0.8m£0.9m£0.1m Total £6.2m -

9. Forecast outturn S&T spend Enhanced integration 1 Primary care trans- formation 2 SaHF Implement- ation 3 Trans-forming mental health services 4 Other costs (core team, non-pay, events) 5 Whole systems Whole systems implementation TOTAL PC co-commissioning GP Development + PM match fund Hub business case development Primary care IT strategy TOTAL 5 year strategy Programme office Implementation planning and governance LH & MH business case delivery Imp. of 2014 changes (A&E, maternity) Hospital BC assurance & IMBC Workforce Communications TOTAL TOTALTOTAL TOTALTOTAL 1 includes £1m HENWL contribution £5.0m £3.5m £8.5m £1.3m £2.5m 1 £1.3m £0.3m £5.3m £0.2m £1.5m £2.6m £4.0m £1.0m £2.0m £1.0m £13.3m £2.0m £2.8m Total 9 £31.9m ------ ---------- ------------------ - - - BUDGET VARIANCE £5.0m £3.5m £8.5m £1.3m £2.5m £1.3m £0.3m £5.3m £0.2m £1.5m £2.6m £4.0m £1.0m £2.0m £1.0m £13.3m £2.0m £2.8m £31.9m FORECAST OUTTURN