The Local Health Economy : Understanding Finance in the NHS

Transcription

1 The Local Health Economy : Understanding Finance in the NHS Connaught Hall, Attleborough 20 May 2015 Ann Donkin, Accountable Officer

2 Introduction to NHS Finance Complex to describe, both internally and externally! Huge public and political interest and importance Financial responsibility is important, but the focus is always on the quality of care The NHS market and the commissioner / provider relationship Efficiency, innovation and future funding challenges nationally est. 30 billion

3 Setting the Scene Access to NHS services is based on clinical need, not an individual s ability to pay Patients have the right to receive NHS services free of charge However, Social Care is means tested March 2013

4 Setting the Scene

5 Setting the Scene The Health and Social Care Act 2012 Abolishes Primary Care Trusts, establishes Clinical Commissioning Groups (CCGs) Local GPs strategically directing how money in spent in their area on services available to their patients NHS England becomes the lead organisation to provide assurance on CCGs, manage Primary Care Contracts, and commission nationwide specialised services CCGs responsible for commissioning local services Public Health becomes part of the Local Authority Health & Wellbeing Boards established

6 Setting the Scene

7 Setting the Scene

8 Clinical Commissioning Each CCG receives funding based on weighted capitation : Size of population Age profile of population Rurality is not taken into account

9 Clinical Commissioning Clinical Commissioning CCGs plan and purchase healthcare services for the population they cover Clinically led by local GPs, Nurses, experienced NHS senior managers Patient focused delivering services based on patient need; improving the quality of services based on patient insight Work collaboratively with other CCGs, stakeholders and providers in the area

10 Clinical Commissioning What do CCGs commission? Urgent and emergency care for example, Accident & Emergency services at NNUH, Ambulance Services Elective hospital care e.g. Outpatient services Community health services e.g. District Nursing, Integrated Support services Maternity and newborn services Mental Health and Learning Disability Services

11 Clinical Commissioning How are services paid for? Block contracts / budgets a sum of money allocated for a range of services over a specific time period Payment by Results (PbR) payments are made to providers retrospectively based on each activity or patient contact, according to a fixed price schedule Capitation providers are paid for a bundle of specified services per patient, which are weighted to take into account patients that may need additional or more costly services Case-based payments providers are paid for a fixed episode of care, rather than bundled services that they may or may not need

12 Clinical Commissioning Commissioner Provider relationship Commissioners Providers Receive budget and manage budget from Department of Health Strategically plan for how the budget will be allocated Monitor the flow of patients through current services, and the quality, safety and design of clinical pathways Commission provider organisations to provide services Manage a team of skilled professionals and personnel Respond to needs of patients and commissioners, and bid to provide NHS services Deliver services, and report on progress

13 Providers NHS Foundation Trusts Planned and created in semi-autonomous organisational units within the NHS Authorised and regulated by Monitor Quality monitored by CQC

14 Providers Other NHS Trusts and providers Managed by the NHS Trust Development Authority Community Health Trusts separated from Primary Care Trusts Ambulance Service Trusts Voluntary, Community and Charitable Sector organisations Community Interest Companies

15 Providers Relationships with Providers: Transactional: Financial, contractual and performance-related details Transformational: Strategic, pathway changes, and changes in national policy Relational: Historic relationships, communication, local knowledge and experience

16 Providers NHS and non-nhs Competition within the NHS Competition between clinical providers has been around since the 1990s Progressing over the last 15 years, non-nhs providers have been able to compete directly with NHS providers for contracts Centred around Patient Choice when, where and how soon to access the care required; varied provider network should provide choice whilst maintaining and improving quality Health and Social Care Act 2012: Monitor takes on broader, sector-wide regulatory role Roughly 10% of total commissioner spending in 2013/14 was spent on non-nhs providers

17 Financial Challenges Populations are living longer Living with long term conditions Demands on access to care across health and social care is increasing The rate of lifestyle-related health conditions continues to increase NHS faces frontline recruitment issues, particularly in Primary Care

18 Financial Challenges National Context Five Year Forward View Recognition of the rate of change within the NHS over the past 15 years Focus on sustainable development within the NHS, based on 3% efficiency Outlining that if no efficiencies were met by , there would be a 30 billion mismatch between resources available and patient needs

19 Financial Challenges National Context Health and Wellbeing Gap: Focus on prevention Encourage healthier lifestyles Reduce health inequalities Care and Quality Gap: Reduce variations in quality and safety of care Reflect the changing needs of patients Funding and Efficiency Gap: System efficiencies needed to meet demand of patient needs

20 Financial Challenges QIPP Quality, Innovation, Productivity and Prevention (QIPP) Transformation initiative introduced in 2010 Identify efficiencies within commissioning to reinvest in frontline care Thinking differently about commissioning, and putting local patients at the forefront of commissioning decisions All CCGs are tasked with developing QIPP Programmes to drive efficiency locally In the first two years, the QIPP Programme nationally delivered more than 11 billion in efficiency

21 Financial Challenges QIPP

22 Financial Challenges Local Picture What does this mean locally? CCGs are required to report a financial balanced return NHS South Norfolk CCG is developing and delivering its QIPP plan for 2015/16 A significant investment in the Better Care Fund aimed at encouraging integrated commissioning and associated services Ongoing financial pressures regarding Continuing Health Care (CHC) and prescribing

23 Financial Challenges Local Picture Our challenge as commissioners: NHS South Norfolk Clinical Commissioning Group received a budget of 251.3m in 2014/15 5.6m was allocated for running costs for the CCG The remaining ~ 245m was allocated to: Acute care (Hospital activity, ambulance services) Community Services Continuing Health Care Mental Health and Learning Disabilities Primary Care (Prescribing, Local Enhanced Services)

24 Thank you. Contact us: Ann Donkin Accountable Officer