Month 12 Budget Update

North West London Month 12 Budget Update SaHF & NWL Strategy and Transformation Programmes April 2016 1

Summary This paper provides the month 12 budget update for NWLwide financial strategy/ SaHF including Strategy & Transformation programmes. The main points to note are: 1. Sources of funding and total budget, including split across the programmes, has remained the same from last month; 2. The S&T year end position is an overspend of 0.2m due to a higher than expected bill for staff retention payments from LNWH Trust. The Collaboration Board are asked to: a) Note the final 15/16 Year end position; 2

Contents 1 Sources of funding 2 3 Applications of funding Budget analysis 4 Year end outturn 5 Appendix A Consultancy contracts let 3

Sources of funding TOTAL CCGs contribution to the programme 1 55.1m NHSE contribution (including extra 1m from NHSE to Support SaHF) 14.6m Total resource available 69.7m 1 The proposed application of this resource is as per the previous papers: 30m to Strategy & Transformation; 37.7m to Provider support; 2.5m to Harrow CCG. The overcommitment of 0.5m is covered by carried forward underspend from 14/15. An update on each of these areas is given in the following slides. 1 Hounslow CCG did not require the full 5.4m of Part C support and were able to return 1.7m. West London CCG did not require any funding back so Brent CCG as the other large contributor was refunded the surplus value, reducing their overall contribution to Part C from 10.2m to 8.5m. 4

Application of funds (1) The budget allocations for Strategy and Transformation are shown in the table below: Total Budget Plan Central Team Returned to CCGs (agreed September 2015). Total S&T projects m m m Enhanced Integration/Whole Systems 3.3 6.8 10.0 Primary care transformation 2.3 2.0 4.3 SaHF implementation 6.8 6.8 Transforming Mental Health Services 1.5 2.5 Other costs (core team, nonpay, events) 6.4 6.4 Total 20.3 9.8 30.0 5

Application of funds (2) Provider support The provider support costs as at M12 is shown in the table below. The final outturn was an overspend of 0.2m, due to a higher than expected bill for staff retention payments to London North West Hospitals Trust. This was in relation to the maternity transition and was billed very late, thus had not been included in previous forecasts. Provider support Forecast outturn at M10 Actual spend M12 Variance m m m Maternity* 6.8 7.0 (0.2) Paediatrics* 5.9 5.9 0.0 Main SaHF Double running: a) THH 3.0 3.0 0.0 b) Chel West 2.3 2.3 0.0 c) LNWHT 1 1 0.0 CW/ West Mid merger 4.0 4.0 0.0 ImBC costs 0.7 0.7 0.0 Trust support to CIP identification process 0.6 0.6 0.0 Trust ImBC support 3.3 3.3 0.0 Delivery Architecture 0.2 0.2 0.0 Total 37.7 37.9 (0.2) *Further detail provided on next slide 6

Application of funds (3) Provider support The following table provides a breakdown of the payments made to support the maternity and paediatric transitions in 15/16: m Reason for payment Maternity costs: WMUH 2.9 Lease on temporary maternity unit ICHT 0.75m CNST, 0.25m midwife ramp up costs THH 0.8 Midwifery ramp up costs, ward improvements LNWHT (EHT) 1.3 Income support, medical rota support, agency premium for transition period LNWHT (NWP) 0.3 Midwife support packages (inc. retention premia for transition) WMUH 0.3 Midwifery ramp up costs All trusts 0.4 Transitional estates costs to support new community clinics Subtotal Maternity 7.0 Paediatric costs: THH 3.3 Capacity investment to support paediatric changes LNWHT 1.3 Capacity investment to support paediatric changes WMUH 1.5 Paediatric investment support PDC request refused Subtotal Paediatrics 6.1

Month 12 S&T budget report Year end outturn BUDGET ANNUAL m BUDGET YTD m ACTUAL YTD m VARIANCE YTD m 1 Whole Systems Integrated Care Transition and Shadow Running (to CCG s) Whole systems implementation Workforce & Change Academy TOTAL 6.8 2.5 0.7 10.0 6.8 2.5 0.7 10.0 6.8 1.2 8.0 (1.3) (0.7) (2.0) 2 Primary Care Transformation Primary Care Network Support (to CCG s) Primary Care System Wide Support Hub OBC Development TOTAL 2.0 1.3 4.3 2.0 1.3 4.3 2.0 1.4 4.4 0.4 (0.3) 0.1 3 Acute Reconfiguration ImBC and OBC Development Paediatric Implementation Maternity Implementation System Wide Support & Ops Leadership TOTAL 3.7 1.3 0.8 6.8 3.7 1.3 0.8 6.8 4.4 1.4 0.8 6.6 0.7 0.1 () (0.2) 4 Mental Health Transformation Mental Health Wellbeing & Strategy Mental Health Urgent Care Mental Health Transformation (to CCG s) TOTAL 1.5 2.5 1.5 2.5 1.7 2.7 0.2 0.2 5 Cross Cutting and Core Team Communications and Engagement 5 Year Strategy Core Team, nonpay, events Informatics TOTAL 0.5 4.2 0.7 6.4 0.5 4.2 0.7 6.4 1.4 1.6 4.4 0.9 8.3 0.4 1.1 0.2 0.2 1.9 Total 30.0 30.0 30.0 0.0 8

M12 S&T budget report Variances 1. Whole systems Integrated Support ( 2m underspend): Change academy contract Phase 1 contract was not approved, thus preventing investment in Phase 2; Planned investment in consultancy support was halted due to NHSE restrictions. 2. Primary Care transformation ( 0.1m overspend): Underspend on Hub business cases due to length of time taken to get Business Case approval was used to support CCGs in development of Primary Care Model of Care. 3. Acute reconfiguration ( 0.2m underspend): System wide support budget was used to support the ImBC and OBC development costs. 4. Mental Health Transformation ( 0.2m overspend): Overspend due to unaccrued costs from previous years. 5. Cross cutting and Core team ( 1.9m overspend); Communications overspend due to initial high rate of interim staff, substantive recruitment largely complete by March 2016; 5 year strategy overspend due to the increase in support required for 7 day services, both within the central team and in provider Trusts. Also includes cost for support to the Sustainability and Transformation Plan, Urgent and emergency care, and Community Paediatric services; Core team costs overspend due to an increase in accommodation costs; and Informatics overspend due to increase in contract with SECSU to support the Whole Systems Data Warehouse project.

North West London Appendix A Month 12 Budget Update Consultancy Contracts Let SaHF & NWL Strategy and Transformation Programmes April 2016 10

S&T consultancy contracts let since 1 st April 2015 (1/6) Contract Let Contract Value Provider Decisionmaking panel NHSE Contract Summary Jun 2015 WSIC Early Adopters Go Live 206,985 McKinsey Single Tender Waiver 1 Signed by C Parker (AO) and R O Hare (Chair) Contract to support handover of Data Warehouse from McKinsey to CCG/Strategy and Transformation team; Jun 2015 SaHF ImBC Development Joint PMO b 190,500 Moorhouse Single Tender Waiver 2 Signed by C Parker (AO) and R O Hare (Chair) Contracts to support the ImBC refresh in July/August; Jun 2015 SaHF ImBC Development Productivity Analysis 791,778 McKinsey Single Tender Waiver 2 Signed by C Parker (AO) and R O Hare (Chair) Contracts to support the ImBC refresh in July/August; Jun 2015 SaHF ImBC Development Financials 203,145 NEL CSU (Deloitte) Single Tender Waiver 2 Signed by C Parker (AO) and R O Hare (Chair) SLA signed by C Parker plus Finance Director NELCSU Contracts to support the ImBC refresh in July/August; Jun 2015 SaHF ImBC Development Rewrite 17,351 Carnall Farrar Signed by C Parker (AO) N/A as below 50k threshold Contracts to support the ImBC refresh in July/August; Aug 2015 Portfolio and PMO Support for S&T Directorate 863,604 PA Consulting Evaluation panel: Director of S&T (acting), Deputy Director S&T, Deputy Director Reconfiguration (S&T), Programme Director Reconfiguration (S&T), Deputy CFO CWHHE, and two Lay Members Contract to support Portfolio Management Office in Strategy & Transformation to March 16, to allow time for recruitment to substantive roles;

S&T consultancy contracts let since 1 st April 2015 (2/6) Contract Let Contract Value Provider Decisionmaking panel NHSE Contract Summary Aug 2015 SaHF ImBC Development Joint PMO (extension to Jun 2015 letting) 35,200 Moorhouse Single Tender Waiver 1 Signed by C Parker (AO) N/A as below 50k threshold Contracts to support the ImBC refresh in July/August; Aug 2015 Delivery Architecture 549,828 McKinsey Evaluation panel: Director of S&T (acting), Deputy Director Strategic Financial Planning (S&T), Deputy Director S&T (WSIC), Deputy Director Reconfiguration (S&T), Lay Member. Contracts to support the creation of the NWL Delivery Architecture to allow the delivery of pan NWL savings across agreed areas of joint working; Sept 2015 SaHF ImBC Additional Support for Finance Plans for 8 NWL CCGs 50,000 Deloitte LLP Single Tender Waiver 2 Signed by Clare Parker N/A as below 50k threshold Contract to create model required to allow consolidation of 8 CCG 5year financial plans; Oct 2015 Supporting SaHF Programme CCG QIPP Plan for CWHHE and BHH 208,733 GE Healthcare Finnamore Single Tender Waiver 1 Signed by Clare Parker, CFO, and Chair, CLCCG Contract to support consolidation of QIPP plans and benefits realised to support ImBC process;

S&T consultancy contracts let since 1 st April 2015 (3/6) Contract Let Contract Value Provider Decisionmaking panel NHSE Contract Summary Oct 2015 Delivery Architecture Bridging to Implementation 263,250 McKinsey & Company Single Tender Waiver 1 Signed by Clare Parker Contracts to support the creation of the NWL Delivery Architecture to allow the delivery of pannwl savings across agreed areas of joint working; Oct 2015 Change Academy 690,921 GE Healthcare Finnamore Contract Evaluation panel: Director of S&T (acting), Deputy Director S&T, Work Force Lead S&T, Head of Education Transformation ICH, Clinical lead HENWL and one Lay Member Not approved Contract to support Organisational Development for new ways of working in an Whole Systems environment. (NOT AWARDED) Oct 2015 New Models of Primary Care 471,645 PA Consulting Contract Evaluation Panel: Director of S&T (acting), Deputy Director Strategic Financial Planning, Deputy Director S&T, MD, West London CCG, 2 Lay members Not approved Contract to support development of locallydesigned primary care offer initially taking forward the work of 3 NWL CCGs focusing on the design and rollout of new models of primary care, aligned to the Strategic Commissioning Framework (NOT AWARDED) Nov 2015 Support to ImBC Out of Hospital Plans 49,900 GE Healthcare Finnamore Single Tender Waiver 2 N/A as below 50k threshold Contract to Support the development of Strategic Outline Case level models for OOH delivery Nov 2015 Review of the 2015 Maternity Services Transition in North West London 49,750 GE Healthcare Finnamore Contract Evaluation panel: Director of S&T (acting), Programme Director Reconfiguration, Deputy Director Reconfiguration. N/A as below 50k threshold Contract to conduct a review of the changes as a result of the planned closure of birthing services at Ealing Hospital. Nov 2015 Support to S&T Supporting SaHF programme 49,000 GE Healthcare Finnamore Contract Evaluation panel: Director of S&T (acting), Programme Director Reconfiguration, Deputy Director Reconfiguration. N/A as below 50k threshold Contract to provide strategic support to the reconfiguration programme by K. Atkin

S&T consultancy contracts let since 1 st April 2015 (4/6) Contract Let Contract Value Provider Decisionmaking panel NHSE Contract Summary Nov 2015 Support to S&T Supporting SaHF programme 49,000 GE Healthcare Finnamore Contract Evaluation panel: Director of S&T (acting), Programme Director Reconfiguration, Deputy Director Reconfiguration. N/A as below 50k threshold Contract to provide strategic support to the reconfiguration programme by K. Atkin Nov 2015 Dec 2015 Equalities Review for Paediatric Transition Development of PIDs, Option Appraisal and OBC s for OOH Hubs 29,918 Deloitte LLP Contract Evaluation Panel: Director of S&T (acting), Assistant Director Communications and Engagement 499,999 PA Consulting Contract (Signing in process) Evaluation Panel: Deputy Director of Reconfiguration (S&T), Head of Strategic Estates Development CLCCG, Deputy Director of Strategic Financial Planning Dec 2015 PTS Survey 35,544 365Response Contract Evaluation Panel: Assistant Director Communications & Engagement, Travel & Transport Lead, Travel Adviser N/A, as below 50k threshold N/A, as below the threshold of 50k Contract to provide support for the transition of paediatric inpatient services from Ealing Hospital, specifically with regard to the impact on protected characteristics, inequality of access and inequality of outcomes. Contract to improve condition of OOH estates, expand hospital capacity, maximise benefits of colocation of health and social care services and continue consistency of care and improved clinical standards Contract to provide survey In the area of patient travel services, data capture, handling of patients, collate and analyse patient travel experiences.

S&T consultancy contracts let since 1 st April 2015 (5/6) Contract Let Contract Value Provider Decisionmaking panel NHSE Contract Summary Dec 2015 Finance and Activity work stream for the SaHF ImBC (through Hammersmith & Fulham CCG) 585,000 Deloitte Contract Evaluation Panel: CFO for BHH, Lay Member, Financial Adviser SaHF, Director of Financial Strategy NHSE Contract to provide services in the following key activities: preparation/planning phase collection and analysis to feed into the ImBC support to postimbc submission response to queries etc. Dec 2015 Like Minded Children and Young People (through West London CCG) 352,687 The Anna Freud Centre Contract Evaluation Panel: Senior Children s Joint Commissioning Manager (West, Central H&F CCGs), CAMHS Project Lead, Assistant Director, WSIC, Lead CYP, Central London GP Clinical Lead, Deputy Head Teacher Cannon s High School, Headteacher Roxeth Primary School, Children s Commissioner Harrow LA. Submitted to NHSE on 18/02/2015 decision awaited Contract to provide services for: Children and Young People s Mental Health and Wellbeing needs assessment, supporting coproduction, workforce development & training, redesigning pathways, support for learning disabilities, crisis and urgent care pathways children and young people s workforce training and development needs analysis Feb 2016 Health Coaching Training Existing Trainers and Coaches 36,990 Osca Agency Contract Evaluation Panel: Assistant Director Workforce and OD (S&T), Workstream Lead (Darzi Fellow) S&T, Lay Partner, Clinical Lead for Self Care CLCCG N/A, as below the threshold of 50k Training programme to convert current clinicians who have Coach Trainer qualifications to become Health Coach Trainers able to train people to become Health Coaches and Health Coaches Trainers

S&T consultancy contracts let since 1 st April 2015 (6/6) Contract Let Feb 2016 Health Coaching Training the Clinicians March 2016 Contract Value Provid er Support for Paediatric Transition Activity Model Review 49,840 Osca Agency 19,999 Deloitte LLP Decisionmaking panel NHSE Contract Summary Contract Evaluation Panel: Assistant Director Workforce and OD (S&T), Workstream Lead (Darzi Fellow) S&T, Lay Partner, Clinical Lead for Self Care CLCCG Deputy Director Reconfiguration, Programme Director, Assurance Lead, Head of Reconfiguration NHSE N/A, as below the threshold of 50k N/A below the threshold of 50K To create a sustainable programme that equips our front line clinicians with coaching skills so they can have better conversations with their patients to empower them to make more meaningful changes to their health related behaviours and lifestyle to lead to better health outcomes Changes, as part of the SaHF programme, were agreed relating to maternity, paediatrics and gynaecology services. The proposals included: Consolidation of maternity and neonatal services from seven to six sites to provide comprehensive obstetric and midwifeled delivery care and neonatal care. Consolidation of paediatric inpatient services from six sites to five sites to incorporate paediatric emergency care, inpatients and short stay /ambulatory facilities. TOTAL (including awarded contracts only) 5,188,001 Single Tender Waivers have been agreed in line with the CLCCG Prime Financial Policies section 14 for the following reasons: 1 When the task is essential to complete the project, and arises as a consequence of a recently completed assignment and engaging different consultants for the new task would be inappropriate (Para 14.8.7); 2 Where the timescale genuinely precludes competitive tendering (Para 14.8.5).