Financial Overview of the BHR CCGs · Financial Overview of the BHR CCGs Barking and Dagenham...
Transcript of Financial Overview of the BHR CCGs · Financial Overview of the BHR CCGs Barking and Dagenham...
Financial Overview of the BHR
CCGs
Barking and Dagenham Health Scrutiny Committee
22 October 2019
Sharon Morrow, Director of Transformation and Delivery – Unplanned Care
Mark Eaton, System Director of Recovery for Barking and Dagenham,
Havering and Redbridge
Presentation overview
• CCG Spend Breakdown
• Overview of the 19/20 Financial Position
• NHS Financial Position to 23/24
• Financial Benchmarking for the BHR CCGs
• Closing the Excess Spend Gap
• System Efficiencies with >£1m Net Benefit
• Mental Health Parity of Esteem
• Prevention Investments by the NHS
CCG Spend Breakdown
(B&D CCG)
NHS Barking & Dagenham CCG
Annual
Budget
£’000
ACUTE
In Sector Acute Trusts
Barking Havering And Redbridge Hospitals NHS Trust 100,339
Barts Health NHS Trust 25,436
Homerton University Hospital NHS Foundation Trust 2,269
Total In Sector Acute Trusts 128,043
Total Out of Area Acute Trusts 12,537
Total Other Acute 25,488
TOTAL ACUTE 166,069
Total Mental Health 34,124
Total Community Health 34,882
Total Continuing Care 17,187
Total Other Non Acute 16,056
TOTAL NON ACUTE 102,250
TOTAL PRIMARY CARE 30,433
TOTAL PRIMARY CARE CO-COMMISSIONING 32,416
TOTAL RUNNING COSTS 4,605
GRAND TOTAL 335,773
VARIANCE
RESOURCE LIMIT 334,193
HISTORIC SURPLUS/(DEFICIT) (5,480)
PLANNED SURPLUS/(DEFICIT) 3,900
• This table provides a
summary of the budgetary
spend for NHS B&D CCG.
• Approximate % Breakdowns
are:
o 50% on Acute Care
o 10% on Mental Health
o 10% on Community Care
o 5% on Continuing Care
o 19% on Primary Care
o 5% on ‘Other’
o 1% on Running Costs
CCG Spend Breakdown
(BHR CCGs)
NHS BHR CCGs
Annual
Budget
£’000
ACUTE
In Sector Acute Trusts
Barking Havering And Redbridge Hospitals NHS Trust 365,183
Barts Health NHS Trust 114,529
Homerton University Hospital NHS Foundation Trust 9,123
Total In Sector Acute Trusts 488,834
Total Out of Area Acute Trusts 55,393
Total Other Acute 91,731
TOTAL ACUTE 635,958
Total Mental Health 103,649
Total Community Health 96,047
Total Continuing Care 59,756
Total Other Non Acute 51,737
TOTAL NON ACUTE 311,189
TOTAL PRIMARY CARE 119,900
TOTAL PRIMARY CARE CO-COMMISSIONING 108,463
TOTAL RUNNING COSTS 16,962
GRAND TOTAL 1,192,472
VARIANCE
RESOURCE LIMIT 1,182,623
HISTORIC SURPLUS/(DEFICIT) (20,749)
PLANNED SURPLUS/(DEFICIT) 10,900
• This table provides a
summary of the budgetary
spend for the three NHS
BHR CCGs.
• The approximate
breakdowns are as shown on
the previous slide.
• At the end of 19/20 the
CCGs will have a residual
deficit of £9.8m. This is
expected to be cleared by
the end of 21/22.
Overview of the 19/20 Financial Position
• The Control Total set for the BHR CCGs for 19/20 is a surplus of £10.9m broken
down as follows:
o NHS Barking & Dagenham CCG - £3.9m surplus.
o NHS Havering CCG - £3m surplus.
o NHS Redbridge CCG - £4m surplus.
• As at Month 5 the BHR CCGs are forecasting that they will achieve their control
total for 19/20.
• There is residual risk that the CCGs have mitigated to ensure this position is
delivered including:
o The £10.9m surplus was added to the Control Total in April 2019 (after
contracts were signed) and has been mitigated non-recurrently.
o There is ~£6m of risk associated with the delivery of Commissioner QIPPs
(Efficiency Schemes) that have been mitigated.
o There is additional system risk associated with BHRUT that the partners
have agreed will be mitigated by the BHR CCGs for 19/20.
NHS Financial Position to 23/24
• This table shows the
allocation growth for
NHS B&D CCG out
to 23/24 and the
underpinning analysis
provided by NHS
England around
expected population
growth.
• Allocation growth for
NHS B&D CCG is
above the London
Average.
Programme Baseline 2018/19 2019-20 2020-21 2021-22 2022-23 2023-24
Allocation £k 282,610 302,504 317,713 332,696 346,683 359,761
Growth 19,894 15,209 14,983 13,987 13,078
Total Growth % 7.04% 5.03% 4.72% 4.20% 3.77%
Population Growth 3,858 3,640 3,481 3,251 3,048
Population Growth % 1.72% 1.60% 1.50% 1.38% 1.28%
Growth net Population growth % 5.32% 3.43% 3.21% 2.82% 2.49%
Opening DfT 4.19% 5.13% 5.73% 6.49% 6.92%
Closing DfT 5.00% 5.64% 6.07% 6.31% 4.00%
Primary Care Co-Commissioning 2018/19 2019-20 2020-21 2021-22 2022-23 2023-24
Allocation £k 30,564 32,416 34,099 36,207 37,902 39,622
Growth 1,852 1,683 2,108 1,695 1,720
Total Growth % 6.06% 5.19% 6.18% 4.68% 4.54%
Population Growth 3,858 3,640 3,481 3,251 3,048
Population Growth % 1.72% 1.60% 1.50% 1.38% 1.28%
Growth net Population growth % 4.34% 3.59% 4.68% 3.30% 3.26%
Opening DfT 8.07% 6.76% 7.68% 7.65% 7.51%
Closing DfT 6.9% 6.76% 6.70% 6.71% 6.65% 6.51%
Running Costs 2018/19 2019-20 2020-21 2021-22 2022-23 2023-24
Allocation £k 4,602 4,605 4,061
Reduction 3 -544
Total Reduction % 0.07% -11.81%
Total 2018/19 2019-20 2020-21 2021-22 2022-23 2023-24
Allocation £k 317,776 339,525 355,873 368,903 384,585 399,383
Growth 21,749 16,348 17,091 15,682 14,798
Total Growth % 6.84% 4.81% 4.80% 4.25% 3.85%
Population Growth 3,858 3,640 3,481 3,251 3,048
Population Growth % 1.72% 1.60% 1.50% 1.38% 1.28%
Growth net Population growth % 5.12% 3.22% 3.30% 2.87% 2.57%
Population 2018/19 2019-20 2020-21 2021-22 2022-23 2023-24
Estimated registered population 224,032 227,890 231,530 235,011 238,262 241,310
Population Growth 3,858 3,640 3,481 3,251 3,048
Population growth % 1.72% 1.60% 1.50% 1.38% 1.28%
NHS Financial Position to 23/24
• This table shows the
allocation growth for
the BHR CCGs to
23/24.
• Allocation growth for
BHR CCGs is, on
average, above the
London Average.
Programme Baseline 2018/19 2019-20 2020-21 2021-22 2022-23 2023-24
Allocation £k 1,009,916 1,076,870 1,127,530 1,178,1231,226,852 1,273,425
Growth 66,954 50,660 50,593 48,729 46,573
Total Growth % 6.63% 4.70% 4.49% 4.14% 3.80%
Population Growth 11,123 10,719 10,326 9,814 9,278
Population Growth % 1.35% 1.29% 1.22% 1.15% 1.07%
Growth net Population growth % 5.28% 3.42% 3.26% 2.99% 2.72%
Opening DfT
Closing DfT
Primary Care Co-
Commissioning 2018/19 2019-20 2020-21 2021-22 2022-23 2023-24
Allocation £k 103,598 108,463 113,900 120,676 126,161 131,782
Growth 4,865 5,437 6,776 5,485 5,621
Total Growth % 4.70% 5.01% 5.95% 4.55% 4.46%
Population Growth 11,123 10,719 10,326 9,814 9,278
Population Growth % 1.35% 1.29% 1.22% 1.15% 1.07%
Growth net Population growth % 3.34% 3.73% 4.73% 3.40% 3.38%
Opening DfT
Closing DfT
Running Costs 2018/19 2019-20 2020-21 2021-22 2022-23 2023-24
Allocation £k 16,955 16,962 14,960
Growth 7 -2,002
Total 2018/19 2019-20 2020-21 2021-22 2022-23 2023-24
Allocation £k 1,130,469 1,202,295 1,256,390 1,298,7991,353,013 1,405,207
Growth 71,826 54,095 57,369 54,214 52,194
Total Growth % 6.35% 4.50% 4.57% 4.17% 3.86%
Population Growth 11,123 10,719 10,326 9,814 9,278
Population Growth % 1.35% 1.29% 1.22% 1.15% 1.07%
Growth net Population growth % 5.00% 3.21% 3.34% 3.03% 2.78%
Population 2018/19 2019-20 2020-21 2021-22 2022-23 2023-24
Estimated registered population 822,785 833,908 844,627 854,953 864,767 874,045
Population Growth 11,123 10,719 10,326 9,814 9,278
Population growth % 1.35% 1.29% 1.22% 1.15% 1.07%
Financial Benchmarking for the BHR CCGs
• Benchmarking is undertaken both against Demographic Peers
(via the NHS RightCare Programme) and Geographic Peers
(via Local NHS Data). The Geographic Peers consist of the 17
Boroughs of North Central, North East and South East London.
• Against both benchmarking methods the BHR CCGs
overspend in secondary care. Compared to our Geographic
Peers this grew to a maximum of more than £100m/Year in
18/19. Through the work already undertaken this appears to
have dropped in 19/20 to an excess of ~£90m/Year.
• The financial benchmarking on the following slides highlights
why the areas of focus for transformation have been chosen.
Financial Benchmarking for the BHR CCGs
• Approximately £30m/Year of the £90m/Year excess is associated with non-
elective activity associated mostly with Older People and people of all ages with
Long Term Conditions as shown in the table below.
• The Older People Transformation Board is focused on helping keep people
healthier for longer, supporting those people at End of Life and reducing the
onset of Frailty and the risk of Falls.
• The Long Term Conditions (LTCs) Transformation Board is focused on both
working on Primary Prevention with Public Health but also focusing on
Secondary Prevention and reducing the number of unplanned care episodes
arising for people with LTCs.
NHS B&D CCG NHS Havering CCG NHS Redbridge CCG BHR CCGs
Reduction Required Reduction Required Reduction Required Reduction Required
Specialty POD Activity TotalCost Activity TotalCost Activity TotalCost Activity TotalCost
Trauma & Orthopaedics NON-ELECTIVE 8 £73,137 242 £1,682,780 4 £248,046 254 £2,001,780
General Surgery NON-ELECTIVE 541 £1,065,817 891 £2,270,064 211 £679,093 1,643 £4,014,373
Geriatric MedicineNON-ELECTIVE
694 £1,724,863 2,669 £8,240,975 1,198 £3,647,292 4,558 £13,605,344
Gastroenterology NON-ELECTIVE 145 £658,553 276 £1,338,452 187 £832,576 607 £2,828,624
Urology NON-ELECTIVE 265 £255,785 487 £644,293 342 £385,929 1,094 £1,285,926
Respiratory Medicine NON-ELECTIVE 154 £602,308 327 £1,308,274 61 £232,765 543 £2,144,735
Nephrology NON-ELECTIVE 254 £489,849 338 £1,048,620 115 £116,923 706 £1,652,746
Endocrinology NON-ELECTIVE 89 £439,563 83 £436,456 146 £635,689 318 £1,513,492
Stroke Medicine NON-ELECTIVE 6 £329,725 82 £923,801 26 £564,773 114 £1,816,589
Financial Benchmarking for the BHR CCGs
• Approximately £15m/Year of the £90m/Year excess is associated with excess
Outpatient Activity, much of this associated with patients who are discharged at
the first appointment, have not yet been discharged after finishing their episode
of care, were put into the wrong clinic or required diagnostics before a face to
face appointment. This excess of activity is constraining the ability to achieve
access targets.
• The Planned Care Transformation Board is focused on reducing inappropriate
Outpatient Activity by increasing investment in Out of Hospital support and
services and working with Acute Providers to improve (and streamline) their
Outpatient Services. NHS B&D CCG NHS Havering CCG NHS Redbridge CCG BHR CCGs
Reduction Required Reduction Required Reduction Required Reduction Required
Specialty POD Activity TotalCost Activity TotalCost Activity TotalCost Activity TotalCost
Trauma & Orthopaedics
OPFA 1,317 £229,791 3,905 £662,150 3,266 £578,517 8,490 £1,470,877
OPFU 3,011 £219,997 11,302 £820,002 6,553 £505,909 20,871 £1,546,393
OPPROC 1,322 £298,994 2,639 £565,994 1,579 £340,099 5,541 £1,206,223
General Surgery
OPFA 1,851 £391,054 3,086 £610,363 1,909 £402,508 6,845 £1,403,852
OPFU 2,371 £211,980 5,337 £460,208 2,975 £305,175 10,677 £976,986
OPPROC 651 £138,417 1,290 £302,266 832 £176,096 2,773 £617,112
Gynaecology OPFA 4,704 £832,163 4,991 £882,451 3,923 £696,502 13,622 £2,411,669
OphthalmologyOPFA 355 £132,065 111 £93,166 1,050 £282,168 1,521 £508,192
OPFU 1,112 £59,073 6,879 £404,602 3,672 £255,265 11,665 £718,949
CardiologyOPFA 2,883 £174,204 8,578 £735,210 624 £0 12,082 £900,415
OPPROC 723 £120,880 2,961 £517,041 1,695 £266,613 5,382 £904,730
Urology OPPROC 246 £54,285 2,094 £553,004 869 £261,066 3,206 £867,674
Rheumatology OPFU 1,274 £129,893 4,129 £440,982 2,265 £275,336 7,667 £846,423
Financial Benchmarking for the BHR CCGs
• Approximately £27m/Year of the £90m/Year excess is associated with excess
spend on Elective Activity. Much of this is associated with care delivered in high
cost settings because of the excess activity in Outpatients preventing people
having timely access to NHS hospitals whilst some relates to services that
should have been provided either as an Outpatient Procedure or in the
community.
• The Planned Care Transformation Board is focused on reshaping how and
where care is delivered including ensuring that the services are provided Closer
to Home and that access rates are improved.
NHS B&D CCG NHS Havering CCG NHS Redbridge CCG BHR CCGs
Reduction Required Reduction Required Reduction Required Reduction Required
Specialty POD Activity TotalCost Activity TotalCost Activity TotalCost Activity TotalCost
Trauma & OrthopaedicsELECTIVE
549 £932,566 2,057 £6,285,669 1,435 £3,351,748 4,044£10,572,93
3
General Surgery ELECTIVE 377 £641,938 1,093 £1,855,797 464 £689,444 1,933 £3,184,332
Gastroenterology ELECTIVE 678 £307,249 3,355 £1,615,174 1,906 £915,965 5,940 £2,839,902
Ophthalmology ELECTIVE 4 £0 1,051 £914,380 813 £730,364 1,869 £1,640,794
Cardiology ELECTIVE 0 £0 205 £331,676 240 £374,167 388 £538,883
Urology ELECTIVE 97 £7,497 736 £721,674 364 £385,685 1,199 £1,114,701
ENT ELECTIVE 437 £463,582 618 £720,003 450 £562,984 1,507 £1,747,313
Interventional Radiology ELECTIVE 1,250 £942,293 2,080 £1,528,205 1,229 £998,310 4,557 £3,468,524
Neurosurgery ELECTIVE 142 £346,600 194 £615,570 228 £341,053 565 £1,303,771
Pain Management ELECTIVE 326 £229,521 832 £658,738 456 £339,419 1,614 £1,227,914
Closing the Excess Spend Gap
• The table below shows the expected trajectory for the BHR CCGs to close the
£90m/Year excess spend by 22/23 and to achieve a position of being better
than average by 23/24.
• The financial recovery will be driven by the Transformational Programmes
described earlier and is realised through improved outcomes for our population
and changing the settings of care where clinically appropriate.
FRP Acute Spend Reduction Assumptions 19-20 (£m) 20-21 (£m) 21-22 (£m) 22-23 (£m) 23-24 (£m)
FRP Elective Reductions - -20.9 -16.2 -9.4 -10.4
FRP Non-Elective Reductions - -13.0 -11.4 -9.5 -7.6
Total FRP Acute Spend Reductions - -33.9 -27.7 -19.0 -18.0
FRP Reprovision Assumptions (£) by Provider 19-20 (£m) 20-21 (£m) 21-22 (£m) 22-23 (£m) 23-24 (£m)
BHRUT (BHR CCGs Income) - 4.2 3.5 2.4 2.3
Barts - 0.8 0.7 0.5 0.5
NELFT (Community Services) - 3.4 2.8 1.9 1.8
Primary Care - 6.8 5.5 3.8 3.6
Other - 1.7 1.4 0.9 0.9
Total - 16.9 13.8 9.5 9.0
Net Acute Income Changes 19-20 (£m) 20-21 (£m) 21-22 (£m) 22-23 (£m) 23-24 (£m)
BHRUT (BHR CCGs) - -9.4 -11.8 -10.9 -11.0
Barts - -3.2 -3.5 -2.4 -1.7
Other Providers - -16.2 -8.2 -2.9 -2.1
Other Provider Investments - 11.8 9.7 6.6 6.3
System Net Position - -16.9 -13.8 -9.5 -8.5
System Efficiencies with >£1m Net Benefit
• The Shared Efficiency Programmes for 19/20 with a net benefit of >£1m (after
reprovision costs) are shown below.
• These schemes contribute to closing the excess spend gap in secondary care.
SCHEME
19/20 and
20/21 Total
Net Value
NHS Barking and
Dagenham CCG
NHS Havering CCG NHS Redbridge CCG
£k 19/20 (£k) 20/21 (£k) 19/20 (£k) 20/21 (£k) 19/20 (£k) 20/21 (£k)
MSK Out of Hospital Model 3,588 580 360 953 535 555 605
Minor Surgery 2,400 - 605 - 964 - 831
Long Term Conditions MDT 2,228 45 520 82 833 69 679
Outpatient Transformation for
20-212,100 - 530 - 844 - 727
Long Term Conditions (LTC)
(LIS)1,773 154 325 230 487 185 391
Improving Referrals Together
(IRT)1,752 520 - 695 - 537 -
Enhanced Care Home
Support Programme1,200 - 328 - 501 - 370
15,041 1,299 2,669 1,960 4,164 1,346 3,603
Mental Health Parity of Esteem
• The CCGs are required to hit the Mental Health investment standard in 19/20.
• The agreed 19/20 investment for Barking and Dagenham CCG is shown in the
table below.
19/20
Investment
£000's
Impact of planning guidance / tariff uplifts 992.6
IAPT 777.3
Perinatal 149.1
Home Treatment Team 55.0
CYPMH 276.6
MH Placements 0.0
Physical Health checks for SMI 78
Acute and inpatient services 190.3
Health Based Place of Safety 0
Transformation funding into MH 0Long term plan priorities - IAPT, Perinatal, acute and
inpatient services 0
Grand Total 2,519.0
Prevention Investment
• There are three levels of Prevention:
o Primary Prevention – targets individuals who may be at risk of developing a
medical condition to prevent the onset of disease and subsequent ill-health.
o Secondary Prevention – targets individuals who have developed asymptomatic
disease and institutes a treatment regime to prevent the onset of complications.
o Tertiary Prevention – targets individuals with a known disease with the goal of
limiting or preventing further complications. A large % of the spend of the NHS is
focused on Tertiary Prevention and it has proven impossible to disaggregate the
spend specifically focused on tertiary prevention from the treatment of conditions,
exacerbations and other complications associated with disease management.
• Investing in Prevention at all three levels reduces downstream costs for both
Health and Care organisations and is therefore a key focus of the BHR
Transformation Boards and a specific area of focus for the NHS System
Financial Recovery Plan.
• The following two slides describe how the CCGs meet their commitments to
support the Primary and Secondary Prevention Agenda.
Prevention Investment (Primary Prevention)
• Historically Primary Prevention has focused on wide-scale public
health actions such as tackling obesity, preventing cancers, etc.
• The NHS has historically invested in working with people who are
identified at being at risk of developing disease such as people who
are pre-diabetic, pre-hypertensive, etc. and also working with Local
Authorities to enact Health Checks.
• Currently the NHS are seeking to invest in closing the prevalence
gaps around hypertension and promoting effective cancer screening
(including through Faecal Immuno Testing).
• The NHS will continue to expand the scope of its work in Primary
Prevention primarily through the work of the Long Term Conditions
Board at which Public Health is represented.
Prevention Investment (Secondary Prevention)
• The CCGs invest in a range of Secondary Prevention through a range of Local
Improvement Schemes (LISs) (Diabetes, Atrial Fibrillation and Frailty) and also
through medication with the main spend on medication aligned to secondary
prevention detailed below.
Values
Commissioner / Provider BNF Section
Sum of
Items
Sum of Actual
Cost
BARKING & DAGENHAM CCG Anticoagulants And Protamine 45056 £929,153.60
Beta-Adrenoceptor Blocking Drugs 107437 £129,186.94
Bronchodilators 103408 £923,378.91
Corticosteroids (Respiratory) 59725 £1,478,471.48
Drugs Used In Diabetes 262923 £4,380,146.14
Hypertension and Heart Failure 241215 £518,228.55
Lipid-Regulating Drugs 265056 £400,173.62
BARKING & DAGENHAM CCG Total 1084820 £8,758,739.23
HAVERING CCG Anticoagulants And Protamine 62317 £2,446,944.07
Beta-Adrenoceptor Blocking Drugs 157152 £212,172.35
Bronchodilators 127492 £1,304,987.28
Corticosteroids (Respiratory) 76685 £2,080,057.19
Drugs Used In Diabetes 255763 £5,203,481.64
Hypertension and Heart Failure 310628 £761,081.46
Lipid-Regulating Drugs 336339 £616,301.68
HAVERING CCG Total 1326376 £12,625,025.68
REDBRIDGE CCG Anticoagulants And Protamine 41440 £1,730,921.37
Beta-Adrenoceptor Blocking Drugs 133332 £199,423.29
Bronchodilators 95820 £733,915.69
Corticosteroids (Respiratory) 66643 £1,832,061.65
Drugs Used In Diabetes 324220 £6,401,583.19
Hypertension and Heart Failure 286314 £855,159.63
Lipid-Regulating Drugs 308318 £624,096.24
REDBRIDGE CCG Total 1256087 £12,377,161.07
Grand Total 3667283 £33,760,925.98
Any questions?