Northern Lincolnshire Healthy Lives Healthy Futures Programme NEL

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Northern Lincolnshire Healthy Lives Healthy Futures Programme NEL Partnership Board May 2014

Northern Lincolnshire Healthy Lives Healthy Futures Programme NEL Partnership Board May 2014

Healthy Lives, Healthy Futures Journey • Background – what were we trying to achieve?

Healthy Lives, Healthy Futures Journey • Background – what were we trying to achieve? • One year on, where are we against those objectives? • What is left to do?

Northern Lincolnshire facing challenges Northern Lincolnshire ity al Qu Rising quality standards Cost constraints

Northern Lincolnshire facing challenges Northern Lincolnshire ity al Qu Rising quality standards Cost constraints

The Quality Challenge Public health (e. g. smoking) Rapidly aging population Quality challenge (SHMI)

The Quality Challenge Public health (e. g. smoking) Rapidly aging population Quality challenge (SHMI) Intermediate services (e. g. Rehab) Shorter life expectancy in deprived areas GP service (variable patient satisfaction)

The Financial Challenge £M An £ 80 m financial challenge was identified for 2017

The Financial Challenge £M An £ 80 m financial challenge was identified for 2017 550 ~£ 80 M ~£ 50 M 500 Spend ~£ 20 M £ 0 M 450 Increased demand • More older people • Growing population Flat cash • Nicholson challenge • Budget reallocation Available spend 400 12/13 13/14 14/15 15/16 16/17 Financial year Note: Assumptions on projected healthcare cost drivers: -1. 3% annual allocation decrease from 2014/15 onwards; Inflation: +4. 0% cost inflation by 2016/17 (Based on Monitor recommendations) Population growth: 1% p. a. Excludes transition, capital and running costs Source: NEL CCG Budget to 2013/14; NL CCG Budget to 2013 -14; Monitor inflation rates; ONS population data

Similar challenge for both CCGs Forecast spend in 'do nothing' scenario Allocation ~£ 450

Similar challenge for both CCGs Forecast spend in 'do nothing' scenario Allocation ~£ 450 m The gap NL ~£ 40 m The Gap ~£ 80 m NEL ~£ 40 m Note: Assumptions on projected healthcare cost drivers: -1. 3% annual allocation decrease from 2014/15 onwards; Inflation: +4. 0% cost inflation by 2016/17 (Based on Monitor recommendations) Population growth: 1% p. a. Excludes transition, capital and running costs Source: NEL CCG Budget to 2013/14; NL CCG MTFP-3 Yr Summary 2012 -13 to 2014/15; NL CCG Budget Breakdown 2013 -14; Monitor inflation rates; ONS population data

The Commissioner Approach (June 13) The challenge y alit Qu Principles for the solution

The Commissioner Approach (June 13) The challenge y alit Qu Principles for the solution Primary/ Community • Consistently high quality for all • Local where possible Affordability Pathway redesign Reduce average cost Over next ~3 months • Only essential / appropriate admissions to secondary care Initiate primary care & community service improvements • Tertiary & low volume go off patch • Senior led high quality care Address urgent quality areas 2 o/3 o Northern Lincolnshire Approach • Unplanned care, end of life • Integrated/wrap around • Self management & long term conditions Continue to drive cost reduction Over next ~9 months • Secondary care efficiency Review areas possibly requiring consultation • Non-secondary care efficiency Consider new configurations of delivery

One year on – where are we against those challenges?

One year on – where are we against those challenges?

Meeting the challenges

Meeting the challenges

PMO / local teams focus PMO: • Work with clinical teams to prepare the

PMO / local teams focus PMO: • Work with clinical teams to prepare the business case and reports for consultation content • Complete financial & activity modelling for consultation areas • Manage process for decision making & ratification • Prepare consultation process & documentation • Manage consultation Local teams: • Complete activity and financial modelling for QIPP schemes • Manage delivery and implementation of QIPP schemes

Indicative Health Community Savings as at April 14 Currently £ 38 m against the

Indicative Health Community Savings as at April 14 Currently £ 38 m against the £ 76 m is “on the table” being worked through Originally £ 30 m was attributed to HLHF and £ 50 m to QIPP and organisational efficiencies. HLHF and QIPP are interlinked, so we have taken a health community view against the £ 76 rather than separating out the £ 30 m and £ 50 m

Financial commentary • These savings do not include 13/14 savings, BCG analysis assumed that

Financial commentary • These savings do not include 13/14 savings, BCG analysis assumed that all organisations would break even in 13/14 so this is reflected in the calculation of the £ 76 m gap. • CCG savings shown as net values. These are indicative figures pending completion of contract negotiations • Schemes are only worked up in this level of detail for the next 2 years (although this includes a single 2016/17 NEL CCG scheme) • Provider cost base savings are based on NLa. G CIP riskadjusted savings estimates. This figure does not include other provider savings, e. g. NAVIGO, Care. Plus at this stage • Provider savings are the total of estimated cost savings for 14/15, 15/16 and 16/17

What has been delivered? • Sound programme governance structure has been implemented with programme

What has been delivered? • Sound programme governance structure has been implemented with programme board, sub groups of the board (Clinical Advisory Group, Financial Modelling Group, Communications and Engagement Group, Assurance Group, Transport Group) • PMO resourced and established • A case for change (BCG team) • Joint agreed vision developed and adapted as appropriate • Public engagement on the case for change and vision & feedback report • Financial assessment of health community QIPP & CIP schemes • Support for financial and activity modelling commissioner QIPP schemes • Public engagement “moving the conversation on” & feedback report • Health needs assessment • Transport analysis • Full options appraisal for hyper-acute stroke • Gateway review

What is planned? • Programme Board scoring of options • COMs and Governing Body/Partnership

What is planned? • Programme Board scoring of options • COMs and Governing Body/Partnership Board review of scoring • Clinical Senate view on the options appraisal • OSC review & confirmation of appropriate options consideration • Public consultation on options • Development of PID for 2 nd phase of the programme • Review of PMO and support function

Gateway review recommendations • Commendation on the communications & engagement processes • Recognition that

Gateway review recommendations • Commendation on the communications & engagement processes • Recognition that phase 2 will look quite different to build on the work from this year – Reforecast the financial gap and phasing – Model in the impact of the QIPP and BCF – Prepare a new PID for the 2 nd phase with clear finance focus to meet the remaining gap – Review the Programme Management arrangements to support this work – Review the CAG to take more of a leadership role in the next phase

Hyper-acute stroke – options appraisal Includes: • Introduction / background to the service •

Hyper-acute stroke – options appraisal Includes: • Introduction / background to the service • Health needs assessment • National best practice & recommendations • Current service provision • Communication & engagement regarding stroke • Travel & transport analysis • Evaluation mechanisms • Equality Impact Assessment • Options • Appendices

Hyper-acute stroke options 1. 2. 3. 4. Decentralise the service Centralise the service on

Hyper-acute stroke options 1. 2. 3. 4. Decentralise the service Centralise the service on the SGH site Centralise the service on the DPOW site Decommission the local service (send to HEY) Options include: Assumptions, risks/issues, benefits, EQIA analysis Appendices include the full papers

Next steps & timeline • Aiming for beginning of June launch of next phase

Next steps & timeline • Aiming for beginning of June launch of next phase • Aiming for beginning of July consultation • Options appraisal for Hyper-acute stroke being reviewed currently by COMs and Partnership Board • Options appraisal for ENT and Children’s surgery being prepared • Scoring the evaluation criteria by the programme board before coming to COM and Partnership Board for decision on consultation content