St Helens CCG Financial Recovery Consultation

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1 Background Who are we? St Helens CCG Financial Recovery Consultation St Helens Clinical Commissioning Group (CCG) is the local NHS organisation responsible for planning, organising and buying NHS funded healthcare for the 195,797people who are registered with St Helens GP practices. This includes: hospital services, community health services, the delegated commissioning of general practice and mental health services. NHS England has responsibility for buying dentist, pharmacist and optical primary care services and specialist services such as heart transplants and secure mental health services, whilst local authorities commission public health services like health visiting and sexual health. St Helens CCG is a membership organisation that also includes the 35 GP practices across the Borough. Together we work in partnership, with the local authority, including public health, health and voluntary services to transform the health and social care system to meet the challenges of the future. The CCG has a big financial challenge to meet in the short term. It has a savings plan of 12.5million to achieve this year and a further 17.5 million to be saved in 2017/18 in order to balance the budget. In response to this we have developed a two year financial recovery plan that sets out the steps we will take to ensure we comply with our statutory financial duty to achieve financial balance. As part of NHS England business rules, the CCG also has to plan to achieve a 1% surplus, effectively setting aside 1% of its funding not to be spent which gets reinvested back into health services the following year. The NHS receives a fixed budget from Parliament to buy health services for the entire population. St Helens CCG does this with a budget of 312 million. When commissioning (buying) health services the CCG tries to meet the health and wellbeing needs for the local population. It makes decisions about which health services to purchase, based on these identified needs. Like many CCG s across the country, we are in a position of having more demand on services than can be commissioned from the available budget. The challenge faced by all organisations across the NHS, is how to spend the available budget in ways that most benefit the health of the whole population and delivers good value for money. St Helens CCG is a financially challenged organisation. It has a growing population, a limited budget and a growing demand for all types of healthcare services, as well as a financial deficit it needs to clear. St Helens CCG has to evaluate every service that it commissions to see if they offer

2 good quality, good outcomes, and value for money and also whether it is an effective and equitable way of allocating our resources for the benefit of the whole population. The majority of the planned savings set out in our two year financial recovery plan will come from the transformation of services to reduce complexity, waste and duplication across health and social care, but in order to meet our challenging financial targets we have also had to look at restricting access to some services in order for the CCG to get back into a healthy financial state by March Although the CCG has achieved NHS England financial business rules in previous years the St Helens health economy has been financially challenged for a number of years. Although the CCG has achieved a surplus this has required external funding support which cannot continue and in 2015/16 the CCG was unable to achieve the 1% surplus business rule planning requirement. Key financial pressure areas relate to NHS Contracts, continuing healthcare and complex care packages and prescribing. This is significantly affecting the CCG s ability to meet its statutory financial duties in 2016/17 let alone meet the 1% surplus set by NHS England. The CCG is looking to secure more efficient, effective ways of working across all of these areas. What is this consultation about? This consultation document provides an overview in relation to some key aspects of our recovery plan; this includes the issues around the commissioning of Fertility Services, Prescribing for Minor Ailments and Gluten Free Products. In addition it also seeks public views on the potential cessation of non-urgent referrals to hospital for a four month period later this year (October January) to further support the CCG s financial recovery. The CCG will also be holding public events in September to further inform our final approach and decision making in relation to these key aspects of our recovery plan. This is in addition to focus groups being held in the community during August and September. What has St Helens CCG already done? St Helens has already made some significant prioritisation decisions, resulting in many procedures not being provided on the NHS. We introduced a prior approval process for clinical procedures where there is evidence to show they have limited benefit to patients. This is in line with national guidance and in common with other Cheshire and Merseyside CCGs and is also known as procedures of limited clinical value (PLCV). It includes procedures such as: abdominal hernia (surgical management of hernias), adenoidectomy, circumcision, glue ear/grommet insertion, management of

3 haemorrhoids and tonsillectomy. The CCG is also looking further at this policy and will ensure that it is adhered to. The CCG now has some more difficult decisions to make about the prioritisation of funds for 2016 and beyond. Throughout the year the CCG has taken a number of measures to manage the growing pressures on the CCG resources and also in order to improve the quality of local services and care pathways for patients that deliver both improved outcomes and value for money. The full CCG operational plan for 16/17 can be accessed via the CCG website at St Helens CCG is consulting on the following proposed four key service changes to support our financial recovery: Proposed change one To stop providing over the counter / minor aliment medicines for short term, self-limiting conditions. Over the counter medicines refers to the types of medicines that can be bought over the counter because they are deemed safe enough for people to self-manage common and minor ailments. These medicines such as painkillers, cough and cold remedies, antihistamines and some skin products which can be used for conditions described as self-limiting i.e. the condition will improve on its own. They do not include any medicines that are available by prescription only, such as antibiotics, statins etc. The case for self-care and over the counter medication is further strengthened by the excellent service offered by community pharmacists, which include long opening hours and seven day opening, all of which provide great access for patients in their local communities. The information available on NHS choices is also extensive and assists patients to selfcare appropriately. Where a treatment is needed for a long-term chronic condition or there are legal restrictions on the amount of medicine that can be purchased over the counter, then the patient s regular clinician will still be able to prescribe. What is the cost of over the counter medicines in St Helens? St Helens currently spends over 1 million a year paying for widely available, over the counter medicines. When prescribing minor ailments the NHS pays both for the food plus the additional cost of processing the items. Proposed change two - To stop providing gluten-free foods unless there are specific circumstances whereby a dependent patient could be at risk of dietary neglect. A decision was taken over 30 years ago to include gluten-free foods on prescription, when there was limited availability of gluten free foods to buy. Today

4 the availability of gluten-free foods has increased dramatically and they are found in almost all major supermarkets. Health experts say that as a protein, gluten is not essential in people s diets and can be replaced by other foods. There is a lot of information available to patients via the GP, dietitian or available online about how to eat a healthy gluten-free diet. When prescribing gluten-free foods the NHS pays both for the food plus the additional cost of processing the items. Foods currently available through the St Helens CCG gluten-free supply service include bread/rolls, bread mixes, crackers, pasta, pizza bases, breakfast cereals and oats. What is the cost of gluten-free products to St Helens CCG? Last year St Helens CCG spent 103,000 on gluten-free food. If this service stopped then potentially, we could reinvest this money into other health services in St Helens, depending on local needs. Proposed change three - To stop routinely commissioning specialist fertility services. The proposal is to suspend access to IVF by placing restrictions on age referral criteria but to leave in place all investigations required, as these could potentially identify other health issues that otherwise could be missed. The programme will suspend access to the fertility pathway following investigation, for anybody aged 37 and under but leave access open to anybody aged over 37 who meets all the existing criteria of the local policy (this effectively means a two year wait for those under 37). Anybody that has already commenced IVF cycle treatment will be allowed to continue but no new referrals will be accepted after the proposed implementation date of 1 st November The spend in the year 2014/15 on specialist fertility services was approximately 287k and 285K for 15/16. Proposed change four To pause any non-urgent referrals to hospital for a maximum four month period later this year. This does not include any clinically urgent referrals, suspected cancer and referrals for sick children. Any decision not to refer will be made in agreement with the patient and GP and will be a clinical decision based on urgency by your GP with you. Referrals to hospital (also known as secondary care) is one of our biggest area of financial pressure with activity in the hospital generated by referrals exceeds the budget we receive. The CCG works with NHS Services to agree activity management plans, however it is unlikely that this alone will support the financial position. In addition, by pausing non-urgent referrals during winter periods, also support local hospitals with the growing demand at A&E departments during their

5 busiest period and urgent admissions. The CCG hopes to save at least 2.5 million during 16/17 to support its financial recovery though this measure should local referral rates continue to exceed our budget. Should this be achieved earlier than a four month period then the CCG will reinstate all referrals as normal. Important messages for the public The entire NHS is facing financial pressures and St Helens CCG is by no means the only organisation affected Anyone who wishes to have their say on our proposals will be able to We believe we are under-funded as an area compared with other areas in Cheshire and Merseyside We are making as many efficiency savings as we possibly can in addition to looking at ways to reduce inefficiency and waste If you would like to take part in the consultation survey online please click the link below If you wish to complete a paper copy please contact The Engagement and Involvement team 1st Floor The Gamble Building Victoria Square, St Helens WA10 1DY Or -

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