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East and North Herts CCG Financial Overview Alan Pond Chief Finance Officer East and North Hertfordshire CCG

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The national picture Liberating the NHS NHS England and CCGs established Public Health functions transfer to Local Authorities (Negligible) Real term increases for NHS funding for each year of Parliament NHS to release up to 20bn of efficiency savings by 2014/15 Minimum efficiency savings of 4% per year Management costs to reduce by one-third by 2014/15

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Splitting of PCT functions CCGs Commission healthcare hospital and community health services NHS England Specialised services GPs, Pharmacists, Opticians Public Health Local Authority Public Health health prevention NHS Property Services Premises PCT

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Hertfordshire Allocation 1,708m Hertfordshire County Council 31m CCGs 1,211m E&N Herts 575m Herts Valleys 612m NHS England 466m GP Services 122m Other Services 344m What this meant for the money in Hertfordshire Royston 24m

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What CCG allocations are spent on Hospital care Community and mental health care DrugsEquipment Ambulances Minor injury unitsManagement costs COMMUNITY CAREMENTAL HEALTH CARE District nursesMental health inpatients Community chiropodyCommunity health teams Community physios & OTs Learning disability care Community hospitals Eating disorders Continuing health care AND Transformation funding

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CCG Statutory Financial Duties To keep spending within resource limit To keep spending within running cost allowance Not to spend more cash than allocated To achieve value for money in use of resources To produce annual accounts and annual report To keep appropriate accounting records

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Funding for 2013/14 Funding announced December 2012 No Pace of Change to fair shares all CCGs received 2.3% growth in allocation Huge problems with specialist commissioning funding is NOT currently where costs will fall All CCGs received a running cost allowance of 25 per head of population (14m for ENHCCG c2.3% of the overall budget) Commissioning budget is separate to surgery income

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Introduction to East and North Herts CCG 60 constituent GP Practices 562,000 population STORT VALLEY AND VILLAGES 6 practices 51,835 population STEVENAGE 9 practices 90,281 population UPPER LEA VALLEY 16 practices 124,635 population WELWYN AND HATFIELD 9 practices 111,067 population NORTH HERTS 12 practices 111,384population LOWER LEA VALLEY 8 practices 73,152 population

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Our mission is: To reduce health inequality and achieve a stable and sustainable health economy by working together, sharing best practice and improving expertise and clinical outcomes To work with patients, managers and clinical colleagues from all sectors to commission the best possible healthcare for our patients within available resources

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How the CCG is organised Six localities retaining a strong local focus to commission around needs of their local population Governing Body with GP Chair, elected GP locality representatives, Executive Directors and Lay Members Integrated strategy developed through locality structures Improved practice engagement through locality structure and regular communication Resource allocation and financial reporting at locality level and GP Practice level Strong patient, carer and public engagement

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Patient Commissioning Groups Six Patient Commissioning Groups, (PCGs) aligned geographically to GP Localities Encouraging the development of patient participation groups (PPGs) in GP surgeries Any person registered with GPs in east and north Herts can be a member of their Locality Group GP practice / PPG endorse patients to serve on Locality Patient Commissioning Groups(PCGs) 6 GP Patient Champions, one in each locality Invitation to Healthwatch to nominate representatives Agreed terms of reference following local discussions Evening meetings every 6/8 weeks Co- chair arrangement

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PCGs what they do Give feedback on the quality of services that are being commissioned using, for example, patient/carer stories Capturing information/feedback from patients at surgery level to inform clinical pathway design work Participate in discussions with clinicians on potential service changes Being a critical friend to question and influence the CCGs commissioning priorities and decision-making Representation on Priorities Forum; Home First Clinical Governance Group; Patient Transport Procurement Process Looking ahead Training for patient /carer stories; new QEII development; CCG monitoring visits

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Health highlights Over half a million people live in ENHCCG. Expected to grow by 26% by 2035. The number aged 65 and over is predicted to increase by 75% Deprivation in Hertfordshire is lower than the national average, although there are pockets of deprivation in ENHCCG. The health of people in ENHCCG is generally similar to or better than the East of England average (which is better than the national average) although this varies at district level. Life expectancy at age 65 has increased over the last seven years although it is slightly lower than the East of England average for both men and women. Early death rates from circulatory diseases, cancer and causes amenable to healthcare have fallen steadily over the last 18 years and are slightly lower than the average for the East of England. Just over 20% of adults smoke, higher than the East of England average; and an estimated 770 deaths per year are due to smoking. Stevenage has significantly higher smoking prevalence and smoking attributable mortality. Emergency hospital admission rates for ambulatory care sensitive conditions (conditions potentially treatable in the community) are lower than the East of England average. However, over 5,200 admissions a year could potentially be avoided.

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Financial challenge in 2013/14 0.1% real terms growth in funding Increasing and ageing population Increasing demand and quality pressures Pay and prices increase = EFFICIENCY SAVINGS NEEDED

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CCG gap in funding for 2013/14 Population growth Increased demand Required 1% underspend 2.3% uplift Tariff reductions Underspend carried forward 38m 20m

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Health and Wellbeing Priorities

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Pathways : Urgent care Stroke care (Acute, rehabilitation) Out of hospital care - Intermediate Care Planned care - Long Term Condition Management Integrated working collaborative working across different providers to deliver pathways Outcomes: Avoiding unnecessary hospital admission Prevention and self-management Supported discharge Joined up pathways Focus Areas in 2013/14

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Key Projects this year

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2013/14 savings by category

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2% transformation fund One-off grants to support projects to: improve the cost effectiveness and value for money of services deliver quantifiable improvements in performance achieve long-term savings and efficiencies Funds provided to cover: scheme development and implementation costs of piloting or double-running exit costs of other services

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Planned spending in 2013/14

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Fair share funding for Localities in 2013/14 Total allocations m Per weighted head of population

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2013/14 financial performance

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The financial challenge continues beyond 2013/14

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Planned financial changes 2013/14 to 2015/16

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Its not just about the money NHS Outcomes

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Quality Areas to consider Services/ pathways as a whole e.g. maternity, stroke Infection control Mortality rates (SHMI, HSMR) Training levels Staffing numbers and competencies Complaints (and complaint management) Serious Incidents Patient survey results (including Friends and Family test) Mixed Sex Accommodation Breaches Pressure ulcers Falls Discharge arrangements

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From ProvidersWithin ENHCCGExternal sources Board papersComplaints/ PALS/ MP enquiries CQC- visit reports and Quality Risk Profiles Quality SchedulesSerious Incidents and incidents Acute Trust Dashboard CQUINsSoft intelligenceNational Quality Dashboard Complaints/ PALS/MP enquiries GP hotlineNHS Choices/ Patient Opinion websites Serious Incidents and incidents Safeguarding activityNational Patient Surveys Internal patient surveysQuality Assurance visitsStaff Surveys Quality Review MeetingsPatient NetworkSafety Thermometer Quality AccountsOutcomes of national audits/ reviews Information databases e.g. UNIFY Sources of quality information

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Bring together data to build a picture and identify hotspots Look at both qualitative and quantitative information Use the information to inform Quality Assurance Visits etc. Identify what learning has taken place as a result of complaints and Serious Incidents etc. Look at the impact on quality of any changes within the providers Identify information that has not been shared Challenge the Trusts in relation to our findings, and test their insight and responsiveness How we use the information

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It provides the CCG with a patient perspective on quality (complaints, patient surveys etc.) The bringing together of information helps identify hotspots at an early stage Looking across providers allows the CCG to identify areas where providers can share learning and best practice The level of information available allows the CCG to be better informed when commissioning services How the information helps to improve quality

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Final messages Health and healthcare in East and North Hertfordshire is generally good Quality safety, effectiveness and patient experience is at the heart of our decision making CCG is financially sound, but challenges are growing for us and our partners We must all maximise our use of every pound spent further integration between health and social care

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Any Questions?