NHS England Board meeting, 17 December 2014
Papers available here: http://www.england.nhs.uk/2014/12/12/board-meet-17-dec14 Agenda
• Item 1 Agenda – Public meeting December
• Item 2 Public board minutes November
• Item 3 Chief Executives report
• Item 4 Planning guidance
• Item 5 Allocations
• Item 6 Performance report
• Item 7 update on NHS preparedness for winter 2014/15
• Item 8 Urgent and emergency care review
• Item 9 Investing in specialised services
• Item 10a Efficiency controls
• Item 10b Congenital heart disease task and finish group feedback
• Item 10c Finance and Investment Committee
Highlights
Item 3 Chief Executives report
The CE outlined the focus on current operational delivery, the 2015/16 commissioning round and the longer term path for improvement and sustainability as articulated in the NHS Five Year Forward View (FYFV).
NHS performance (see Item 6)
- Oversight of the ECIST best practice team is moving to TDA on behalf of the tripartite of NHS England, Monitor and TDA.
- Primary care funding should be increased by at least as much as local CCG-commissioned community and hospital allocations.
- The extra frontline funding routed via CCGs should particularly be used to move parts of the country furthest below their ‘fair share’ of NHS funding towards it at a faster pace than was possible under the previously notified 2015/16 allocations.
- To avoid the risk of any in-year top slicing of CCG allocations, specialised commissioning growth should be funded at a realistic level - while also, crucially, providing CCGs for the first time the ability to share in-year savings in 2015/16 if they can help manage actual specialised services growth to below the budgeted amount (using the new joint CCG/NHS England specialised co-commissioning offer).
2015/16 commissioning round.
- Three consultation documents which will help commissioners and providers prepare for 2015/16: the proposed tariff for 2015/16, a long term pricing strategy and the refreshed draft NHS standard contract for 2015/16.
- The draft contract includes important new provisions to move the NHS towards better use of technology; to claw back redundancy payments from senior NHS managers re-employed in the NHS; to better incentivise responsive and safe emergency and elective care; to promote workplace race equality; and to support improve health and nutrition in hospitals.
- These publications will be complemented by the publication of joint NHS planning guidance (expected publication date 19 December 2014 - see http://www.england.nhs.uk/wp-content/uploads/2014/12/forward-view-plning.pdf)
- Proposed public consultation paper on the future approach to prioritising new spending in the specialised commissioning portfolio.
- NHS England and Monitor have proposed a risk share for next year between commissioners and providers based on this year’s planned level of activity.
- Work with patient groups, medical practitioners and CCGs to combine local responsiveness and national consistency in specialised service commissioning – including through CCG co commissioning with NHS England.
- Action to put the Cancer Drugs Fund on a more sustainable basis.
- Cancer: NHS England intends to develop a shared new cancer strategy for the NHS for the period to 2020.
This paper outlines the proposed approach to the NHS planning guidance for 2015/16 due to be published 19 December 2014 (see http://www.england.nhs.uk/wp-content/uploads/2014/12/forward-view-plning.pdf)
Proposed content includes Progressing FYFV, integration, introduction of waiting time standards for mental health services, workplace health, supporting carers, workforce race equality, developing the model for the new national diabetes prevention programme, empowering patients through information, expand personal health budgets, integrated personalised commissioning
Delivering the NHS MandateCommissioners will be expected to refresh plans to ensure delivery of Mandate objectives.
- Introduction of new access standards for mental health covering early intervention in psychosis, liaison psychiatry, and improving access to psychological therapies.
- New national CQUIN indicators to tackle sepsis and acute kidney injury (Note: retirement of CQUINS for NHS thermometer and FFT for hospitals)
- A new quality premium indicator to tackle resistance to antibiotics.
New models of care:
- The radical nature of the new models of care will require support to unblock local challenges, a level of urgency and the importance of digital services which underpin them. These will be provided by a national support programme including ALBs and the six national bodies
- Realism around whole system improvement and the need for investment is key to support this “monumental behavioural change that does not start at the centre”
- National bodies will work with local organisations in a more nuanced and multi-faceted way.
- With the reduction in organisational capacity, the new transformational monies will only allow NHS England to offer support to the vanguard economies to distil lessons learnt and to support the underperforming economies.
- Indicative decisions made in December 2013 are retained.
- There will be no additional resources available through the year.
- For the first time seasonal resilience funding is included in the allocation, and no further monies will be available.
- £1.98bn of additional investment in the NHS in England was announced by the Chancellor in the Autumn Statement on 3 December 2014 to support activity of the FYFV including the transformational programmes, a step change in primary and community care infrastructure, increase in investments in mental health access; and funding pressures on front-line services.
- 2015/16 costs and pressures factored into modelling include parity of esteem between mental and physical health services, Better Care Fund, Winter resilience, Specialised services, Litigation costs, Legacy continuing healthcare claims.
- Option 1: The extra money newly available for CCGs is distributed uniformly on top of the previously announced allocations in proportion to their unweighted population.
- Option 2: A funding floor of 1.94% is introduced, which is the combination of real terms growth and all CCGs receiving their fair share of the £350m resilience funding for CCGs. The additional resources are used to provide more resources for pace-of-change, allowing us to reduce the number of CCGs more than 5 percentage points below their target allocations from 34 to 17.
Allocations will be published Friday 19 December 2014 (see http://www.england.nhs.uk/resources/resources-for-ccgs/#finance)
Item 7 Update on NHS preparedness for winter 2014/15
The Urgent and Emergency Care Review proposes a fundamental shift in the way urgent and emergency care services are provided, towards an approach of developing urgent and emergency care networks.
To do this requires change across the urgent and emergency care system through:
Item 7 Update on NHS preparedness for winter 2014/15
- Following the pressure experienced during the winter of 2012/13, national and regional ‘A&E tripartite’ panels were put in place, comprising representatives from NHS England, the NHS TDA, Monitor, and the ADASS
- Focus expanded from ‘winter’ to ‘operational resilience’ in 2014/15, to establish sustainable, year-round delivery with capacity planning which is ongoing, robust and works in line with planning processes already undertaken by local systems.
- Operational Resilience and Capacity Planning
- Urgent Care Working Groups - remit of these groups was expanded to cover elective care, and renamed System Resilience Groups (SRGs).
- SRG plans had to demonstrate comprehensive planning incorporating both elective and non-elective care ‘best practice’ developed in conjunction with the intensive support teams (ISTs) from NHS IMAS, as well as with the College of Emergency Medicine.
- Annex A gives a breakdown of the £700m
- Monthly funding submissions through winter will measure the impact of these initiatives, to monitor progress and performance.
The Urgent and Emergency Care Review proposes a fundamental shift in the way urgent and emergency care services are provided, towards an approach of developing urgent and emergency care networks.
To do this requires change across the urgent and emergency care system through:
- better support for people to self-care;
- get the right advice in the right place, first time
- providing highly responsive services outside of hospital;
- ensuring that those people with life threatening emergency care needs receive treatment in centres with the right facilities and expertise in order to maximise chances of survival and a good recovery; and connecting all urgent and emergency care services together
- Providing highly responsive urgent care services outside of hospital will mean:
- putting in place faster and consistent same-day, every-day access to general practitioners, primary care and community services such as local mental health teams and community nurses to address urgent care needs; harnessing the skills, experience and accessibility of community pharmacists;
- developing our 999 ambulance service into a mobile urgent treatment service.
Implementation Plan
- NHS England will establish arrangements through its regional and sub-regional field force to support commissioners, providers and System Resilience Group members to understand the implications of the Review
- Forthcoming planning guidance to set out expectations of commissioners and providers
- Appendix A: Products to support implementation phase
- enhanced Ambulance See and Treat and Hear and Treat
- further roll out of Personalised Care PlanningEmergency Centre/Specialised Emergency Centre
- Minor Ailments Scheme - extended to all Community Pharmacies
- NHS England is carrying out a review of its approach to decision making in specialised services and is to consult on the staged process it has developed to test and develop interventions that might be commissioned.
