Arden & GEM CSU
Papers available here: https://www.england.nhs.uk/2015/12/15/board-meeting-17-nov-2015/
Video: https://www.england.nhs.uk/2016/01/07/board-vids-171215/
Agenda
Item 3: Chief Executive’s Report (verbal)
Item 4: Strategy for Allocations to Support Delivery of the Five Year Forward View in 2016-17
Item 5: Mandate, NHS Planning Guidance and CCG Assessment Framework
Item 6: NHS Performance Report
Item 7: Month 7 Finance report
Item 8: Reports from board committees
- Commissioning committee 25.11.15
- Commissioning committee 13.11.15
- Investment committee
3. Chief Executive’s report
- Simon Stevens outlined the importance of the outcomes of the Spending Review for the NHS going forward, in particular the front loaded settlement to support the Five year Forward View (FYFV).
- Relating to the Commissioning Allocation (agenda item 4) he discussed the importance of stabilising performance and fund the FYFV, the need for reasonable funding for reasonable local funding (especially primary care), and a continuing push to reduce inequalities in funding.
- Devolution – NHS England is working to set up criteria around local devolution of services following examples in Greater Manchester and London.
- NHS Planning guidance will be published in the next few days.
All allocations presented here are at high, not local trust, level.
The strategy is premised upon reducing inequalities across the system and on moving to fairer allocations using place based allocations.[1]
Following the five year funding settlement, NHS England has set five year allocations for commissioners, comprising 3 years of firm allocations followed by 2 years of indicative allocations for commissioners.
This paper sets out recommendations in three sections regarding:
- the distribution of funds at commissioning stream level;
- the distribution of funds within each commissioning stream, including proposed changes to funding formulae; and
- the approach to pace-of-change in order to support the development of place-based commissioning.
- The Sustainability element is to support NHS Improvement to bring the provider trust sector back to financial balance in year.
- The Transformation element of the Fund is to support the ongoing development of new models of care along with the investment identified to begin implementation of policy commitments in areas such as 7 day services, GP access, Cancer, Mental health and prevention.
- Table 2: Commissioning stream allocations.
The Board proposed to keep the inequalities adjustment at current levels for CCGs and for primary care and a new target formula for specialised services.
- The underlying data behind the CCG calculation have been updated and incorporate a number of changes to the formula: i. introduction of a sparsity adjustment; ii. refresh of the emergency ambulance cost adjustment (EACA); and iii. revision to application of inequalities.
- Primary care – proposed to move away from Carr Hill to the inclusion of new estimates of stratified workload per patient for GPs.
- To support the transparency of comprehensive place-based expenditure, the actual allocation at a local geography level will be used for non-medical primary care services (principally community pharmacy, dentistry and optical services) and apportioned to CCGs on a per capita basis.
- Specialised commissioning. A needs-based specialised formula has been developed at a CCG level. This does not transfer of responsibility for commissioning, but facilitate collaborative commissioning between CCGs and NHS England. Some specialised commissioning will be managed at a national level and not included in local allocations.
- The place based allocations will be published during the first week of January 2016.
- The Board agreed a hybrid option to bring CCGs to target funding as quickly as possible which focuses on alignment with holistic place-based targets but subject to applying rules limiting the volatility and unintended consequences in individual commissioning streams.
- The Board agreed a rapid pace-of-change option which aims to ensure that the total allocation to each CCG is no more than 2.5% below target by 2010/21. This has implications for CCGs currently at 5% over target but, when taking into account Sustanability and Transformation funding every CCG will get a real terms funding increase in 2016/17.
- Table 4: Pace-of-change allocative decision rules by commissioning stream.
The forthcoming NHS planning guidance will set out the business rules for commissioners. These will underline the importance of a robust Local Health Economy Strategic plan during 2016/17 to underpin real terms element of growth in allocations from 2017/18 and access to the Sustainability and Transformation Fund.
Aligning allocations, devolution and planning policies
- The Board agreed on the principle that providers should also be incentivised, as signatories to the Local Health Economy Strategic plan providing access to sustainability and transformation funding.
- The Board agreed to explore “the potential to allow commissioners and providers who wish to work together as a local health economy to operate to a combined financial control total.”
- The Board agreed to support any proposals from groups of CCGs, particularly in areas working towards devolution, who wish to implement a more accelerated internal pace-of change policy by mutual agreement.
Mandate to NHS England 2016/17 (published 17 December 2015) https://www.gov.uk/government/publications/nhs-mandate-2016-to-2017 )
Includes:
Appendix B: Actions in place to drive improved early discharge and reduce delayed transfers of care.
Appendix C: High impact resilience interventions
Appendix D: High impact ambulance interventions
Appendix E: Key priority cancer actions
Date of Next NHS England Board meeting: Thursday 28 January 2015
[1] “place based commissioning – where different commissioners come together to jointly agree commissioning strategies and plans across a range of services for a diverse local population” https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/03/spec-serv-collabrtv-comms-guid.pdf
- The Mandate differs significantly from the previous Mandate, is shorter and more focused, and clearly lays out longer-term goals and 16/17 deliverables. It also uses the Mandate to set broader system objectives requiring partnership action by NHS Improvement, Public Health England, Health Education England and the Department of Health itself.
- The Guidance will ask the NHS to produce two separate but interconnected plans: (i) a strategic “Sustainability and Transformation” plan by local health and care system, for sign off by July 2016. Local bodies will be expected to spend the next six months planning properly for the next five years; (ii) a plan by organisation for 2016/17, to reflect the emerging strategy. The quality of these plans will determine transformation funding levels for spread of new care models, enhanced access to General Practice and technology.
- There will be a short list of “must do’s” for 2016/17
- Progress will be monitored through a new local health system Improvement and Assessment Framework. The framework, or “CCG scorecard” is the new version of CCG assurance, and it will apply from 2016/17. Consultation will be in January 2016, and align with the planning guidance.
Includes:
Appendix B: Actions in place to drive improved early discharge and reduce delayed transfers of care.
Appendix C: High impact resilience interventions
Appendix D: High impact ambulance interventions
Appendix E: Key priority cancer actions
Date of Next NHS England Board meeting: Thursday 28 January 2015
[1] “place based commissioning – where different commissioners come together to jointly agree commissioning strategies and plans across a range of services for a diverse local population” https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/03/spec-serv-collabrtv-comms-guid.pdf
