Mar 31, 2016 - the finance and activity information from associate CCGs has been received. .... Midland and Arden Commis
DUDLEY CLINICAL COMMISSIONING GROUP EXTRA ORDINARY BOARD AGENDA Thursday 31 March 2016 1.00pm – 4.00pm Boardroom, Brierley Hill Health and Social Care Centre, Venture Way, Brierley Hill, DY5 1RU QUORACY Meetings will be quorate when four elected GP clinical members and one other Board member are present, (one of whom shall be the CCG Chair, Chief Officer or Chief Finance Officer) Time 1.00pm
Agenda Item
Attachment
Presented By
1.
Apologies
2.
Declarations of Interest To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration for discussion or vote on any questions relating to that item.
1.05pm
3.
Chief Executive Officer Update
Verbal
Mr P Maubach
1.20pm
4.
Financial Plan/Budget Book 2016/17
Enclosed
Mr M Hartland
1.50pm
5.
CCG Operational Plan 2016/17
Enclosed
Mr N Bucktin
2.20pm
6.
Business Continuity Plan
Enclosed
Mr M Hartland
2.45pm
7.
Sustainability and Transformation Plan
Enclosed
Mr P Maubach
3.15pm
8.
Procurement Strategy
Enclosed
Mr M Hartland
3.35pm
9.
IT Procurement
Enclosed
Mr P Maubach
3.45pm
10.
MCP Procurement
Enclosed
Mr N Bucktin
4.00pm
Close
1.00pm
11.
For Information
11.1 Glossary Date and Time of Next Meeting Thursday 12 May 2016 1pm – 4pm Boardroom, Brierley Hill Health and Social Care Centre
Enclosed
DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Report: 31 March 2016 Report: CCG Financial Budgets 2016/17 Agenda item No: 4.0
TITLE OF REPORT:
CCG Financial Budgets 2016/17
PURPOSE OF REPORT:
To present baseline budgets for the financial year 2016/17
AUTHOR OF REPORT:
Mr J Smith, Head of Financial Management – Corporate Mr M Gamage, Head of Financial Management - Commissioning
MANAGEMENT LEAD:
Mr M Hartland, Chief Finance Officer
CLINICAL LEAD:
Dr J Darby, Clinical Executive • • • •
KEY POINTS: • • •
RECOMMENDATION:
All financial targets to be achieved Planned Revenue Surplus £6,337,000 QIPP/savings programme of £14,000,000 in 2016/17 Financial risk of up to £5m across the portfolio of CCG managed budgets 1% Transition Reserve risk NHS England approved financial plan Notional specialised services budget allocated
The Board is requested to approve the budgets for the CCG for the 2016/17 financial year as set out in this paper.
FINANCIAL IMPLICATIONS:
See key points.
ACTION REQUIRED:
Decision Approval Assurance
Page 1 of 15
DUDLEY CCG FINANCIAL BUDGETS FOR THE PERIOD 1ST APRIL 2016 TO 31ST MARCH 2017
1. 2. 3. 4.
5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
CONTENTS Introduction Financial Overview Financial Framework Financial Plan 2016/17 4.1 Sources of funding 4.2 Financial structure 4.3 Planned Expenditure 4.3.1 Acute Services 4.3.2 Mental Health 4.3.3 Primary Care Development 4.3.4 Drugs & GP Prescribing 4.3.5 Continuing Healthcare 4.3.6 Community Services 4.3.7 Other Commissioning & Reserves 4.3.8 Corporate Services 4.3.9 Primary Care Co-commissioning Long Term Financial View 2016/17-2020/21 Sustainability and Transformation Plan (STP) New Model of Care / Vanguard Better Care Fund Quality, Innovation, Productivity, Prevention (QIPP) Risk Management Contingency/1% Non-Recurrent Expenditure Planning Capital Balance Sheet Cash Limit Summary/Conclusion Recommendation
APPENDICES 1. Revenue Resource Limit 2. Financial Summary Report 2016/17 2a Financial Detail Report 2016/17 3. Savings Plan / QIPP schemes 2016/17 4. Summary Sources & Applications Statement 5. Statement of Financial Position for 2016/17 6. Cash Plan for 2016/17 7. Budgets by Budget Holder 8. Contract Lead Commissioners 9. Services within New Care Model 10. Better Care Fund Services 11. Long Term Financial Outlook
Page 2 of 15
1.0
INTRODUCTION This paper sets out the proposed budgets of Dudley CCG for 2016/17. It provides an overview of the resource environment for the NHS and outlines key financial targets the CCG must achieve, together with an assessment of the financial risks to the CCG. The CCG has three financial statutory targets:• • •
to achieve revenue breakeven or better to achieve capital breakeven against the capital resource limit to achieve a breakeven on the cash limit.
The CCG is also expected to comply with the Public Sector Payment Policy (also known as the Better Payment Practice Code) which requires the CCG to pay 95% of valid invoices within 30 days of their receipt or the receipt of goods or services (whichever is the later) unless other payment terms have been agreed. The CCG is also required to ensure that cash balances at month end are within 1.25% of the cash requested and drawn down from NHS England. The budget book builds upon the ‘Delivering the Forward View’ published on 22nd December 2015 and additional supporting technical guidance issued by NHS England. 2.0
FINANCIAL OVERVIEW The CCG’s revenue start point baseline in 2016/17 is £458m. This consists of £411.3m core CCG funding; £39.9m for the procurement of primary care and £6.8m running costs. Despite a challenging year for the CCG, Dudley is expected to meet its planned surplus costs of £6.3m in 2016/17 and carry this forward into 2017/18. As explained below, the CCG has used current guidance from NHS England to plan anticipated resource increases within this plan. The budget book presented to the Committee identifies a balanced financial plan for 2016/17, with plans to achieve a surplus of £6.3m in 2016/17. This is in line with the control total set by NHS England. It also reflects NHS England requirements in respect of key planning assumptions and business rules. The new planning rule regarding the 1% transformation reserve will make 2016/17 a much more challenging year than recently experienced. The context within which the CCG will need to operate financially will be challenging, requiring effective reinvestment, caution and prudence. Stringent controls on expenditure and performance management will be required in order to ensure the CCG resources are directed to services providing maximum quality and value. For this reason a new financial framework was adopted in 2015/16 and will continue to operate in 2016/17 and embeds a focus on the financial impact of all decisions made throughout the organisation.
3.0
FINANCIAL FRAMEWORK The 2016/17 financial year will be a more difficult financial year for the CCG due to the continuing transfer of funding to Dudley MBC for the Better Care Fund; potential claw-back of the 1% transition reserve; increasing pressure of acute services; taking full delegated responsibility for cocommissioning of primary care services; risks relating to QIPP delivery and pressures on running costs due to new structures and vanguard work streams. The Finance and Performance Committee/Clinical Development Committee have agreed a number of actions to reduce the financial risk moving forward, such as return to ‘invest to save’ principles for Page 3 of 15
developments and service change; the development of an investment/disinvestment’ prioritisation tool for all services and the adoption of some financial recovery techniques. It also fundamentally amended the financial framework in which the organisation operated. Focus on the financial impact of all decisions made throughout the organisation is undertaken by empowering commissioners and budget holders. Expanding commissioners and budget holders authority to commit resources, in line with budgets approved by the Governing Body in this Budget Book, is the adopted approach. A key factor in implementing the model is the redefinition of the framework in which the CCG operates including the ‘streamlining’ of approval processes to enable commissioners/budget holders to commit resources and make the required service changes as efficiently as possible. This has required a refresh of our Scheme of Delegation and Procurement Strategy to empower commissioners/budget holders to take full responsibility for their portfolio. Budgets by Budget Holder can found in Appendix 7. It is important for the Board to recognise, however, that with responsibility comes accountability. Management of a portfolio’s total financial position will continue to be delegated to the commissioner/budget holder and where appropriate responsible clinical lead. In addition, commissioners/budget holders will be responsible for the delivery of all QIPP and service change initiatives within their portfolio, and all performance and KPIs metrics for such services. To aide this, a list of contracts by lead commissioner has been constructed and can be found in Appendix 8 Commissioners/budget holders have been aligned with finance staff and other CCG staff who provide an enabling function. This approach requires a change in behaviour in ways of working between staff across teams ‘without walls’ in the CCG and a development programme continues to be established. Appropriate Committees will be required to approve plans for the forthcoming year for each portfolio. This should include detailed budget plans and spend profiles; QIPP/service change programme for the year; investment/disinvestment/decommissioning plans; plans for improvements in Constitution requirements and quality improvements. When these are approved, the implementation of schemes to deliver the plan will be approved with a significantly reduced process as long as the proposal is within predetermined tolerances. This should increase the speed in which service change can happen. The framework requires increased focus on QIPP delivery. Commissioners and budget holders are responsible, and will be held to account for the delivery of all QIPP schemes. In 2016/17 this will also include providers where appropriate. The scope of the current QIPP challenge day is to be expanded. It is proposed to utilise the day to challenge commissioners and linked finance staff collectively on all financial, QIPP, performance (and potentially quality issues) within their portfolio. 4.0
FINANCIAL PLAN 2016/17
4.1
Sources of Funding The CCG will receive the majority of its funding from NHS England in the form of a resource limit. Appendix 1 provides a summary regarding the composition of the total resource limit the CCG is planning on receiving in 2016/17 and is summarised in the following table:
Page 4 of 15
CCG PROGRAMME ALLOCATION CCG Starpoint 2015/16 Programme Resource Allocation
Total Budget (£000's) 390,386
1.39% Policy Commitments included within Growth 16/17
5,426
2.34% Balance of Growth 16/17
9,149
Anticipated 15/16 Surplus
6,337
TOTAL 2016/17 PROGRAMME ALLOCATION
CCG RUNNING COST ALLOCATION
411,298
Total (£000's)
CCG Starpoint 2015/16 Running Cost Allocation
6,851
Running Cost Reduction
(62)
TOTAL 2016/17 RUNNING COST ALLOCATION
PRIMARY CARE CO-COMMISSIONING ALLOCATION CCG startpoint 2015/16 Primary Care Co-commissioning Allocation
6,789
Total Budget (£000's) 38,241
4.24% Growth 16/17
1,622
CCG RESOURCE LIMIT 2016/17 : PRIMARY CARE CO-COMMISSIONING
39,863
TOTAL CCG RESOURCE LIMIT 2016/17
457,950
PLANNED EXPENDITURE
451,613
SURPLUS / (DEFICIT)
6,337
This can be summarised as follows:£ 390.4m
Detail National resource allocation set by NHS England for programme (commissioning) expenditure. This includes £7.2m passthrough allocation from NHS E for the Better Care Fund and £2m for winter funding.
5.4m
1.39% Growth on programme resource allocation for Other Policy Commitments for 2016/17. Relates to CAMHs, GP IT and increase Pension costs.
9.1m
2.34% Balance of Growth funding on programme resource allocation for 2016/17.
39.9m
National Resource Allocation set by NHS England for Primary Care Commissioning expenditure
6.3m
Projected surplus carried forward from 2015/16
6.8m
National resource allocation set by NHS England for administration (running cost) expenditure.
457.9m
Total Funding 2016/17
79.4m
National resource allocation set by NHS England for Specialised Services expenditure.
537.3m
Total 'Place Based' Funding
For the first time in 2016/17 NHS England has published notional allocations for specialised services at a local population (CCG) level. For Dudley this is £79.4m resulting in a total population budget of £537.3m. It is important for the Board to note however that £457.9m is the sum delegated to the CCG and is the statutory sum to be spent in 2016/17.
Page 5 of 15
The financial plan submitted has been prepared taking into account NHS England specific business rules and assumptions around growth and inflation for 2016/17 and these are summarised in the table below. NHS ENGLAND PLANNING ASSUMPTIONS & BUSINESS RULES
Business Rules
Growth & Inflation Assumptions
Running Costs
Minimum 0.5% Contingency Fund Held 1% Surplus Carry Forward 2% Underlying Surplus 1% Non-Recurrent Spend 16/17 to be uncommitted at start of year Demographic Growth-local determination based on ONS age profiled weighted population projections Prescribing Inflation-expected range 4%-7% Mental Health Parity of Esteem - 3.6% Net QIPP Savings- greater than 2.5% Remain within Admin Allocation
CCG PLAN AS SUBMITTED 0.50% 1.50% 2.20% 1% and uncommitted 1.24% range 6.50% 4.00% 3.10% Achieved £22.07 per head of population
There is one significant change from previous years. The CCG has historically retained its contingency uncommitted. Business rules for this planning period state that the same principle must be applied for the 1% non-recurrent reserve the CCG is mandated to hold. The view is that NHS England intends to utilise this resource as flexibility to manage risk across the NHS. This adds a financial risk to the CCG, or curtails proposed investment, as it cannot be committed at this stage Outlined in the next section are the proposed budgets for the CCG for 2016/17. 4.2
Financial Structure 2016/17 Financial management and reporting within the CCG has been on a divisional basis reflecting key CCG responsibilities. Currently the main divisions are:1. Acute Services – to reflect expenditure on Acute Commissioning, Planned and Urgent care, mostly with NHS and independent providers. 2. Mental Health – to reflect the commissioning of Mental Health; Learning Difficulties; and Dementia services 3. Primary Care Development – to reflect investment in membership support of Dudley GP member practices. 4. Drugs and GP Prescribing – to reflect GP prescribing and drugs spend; and medicines management and support. 5. Intermediate and Continuing Healthcare - to reflect expenditure on continuing healthcare and intermediate care services. This includes both personal health budgets and payments to independent providers. 6. Community Services - to reflect the commissioning of Community and Children’s Services 7. Other – to reflect Safeguarding expenditure; property costs for commissioned services; Better Care Fund transfer for Social Care Services and Reserves and Investments such as the contingency reserve, 1% Non-Recurrent spend and target surplus for 2016/17. 8. Corporate Services – this represents the running costs of the CCG and contains the majority of CCG staff and establishment costs plus charges from the Commissioning Support Unit (CSU). In 2016/17 this budget equates to £22.07 per head of the CCG population. 9. Primary Care – this represents the delegated responsibility of the CCG for the commissioning of Primary Care services to reflect GP Contract payments; Rent Reimbursement; Rent Reimbursements and Local Enhanced Services Page 6 of 15
In 2016/17 the delegation of responsibility for financial decision-making and performance to lead clinicians will continue. The detail of the disaggregation of budgets to this level will be finalised when the finance and activity information from associate CCGs has been received. During 2016/17 the CCG will also categorise commissioning expenditure between Multispecialty Community Provide (MCP)/non-MCP. 4.3
Planned Expenditure The budgets contained in this paper represent planned expenditure to maintain services and invest in agreed priorities set out in the CCG’s Strategic Plan. Detailed budgets are shown in Appendices 2a A budget summary is shown below. WTE Budget Acute Services Mental Health Services Primary Care Development Drugs And GP Prescribing Intermediate & Continuing Healthcare Community Services Other Commissioning Surplus Target TOTAL COMMISSIONING Corporate Services TOTAL RUNNING COSTS
0.84 17.65 8.00 26.49 86.90 86.90
GP Contract QOF Local Enhanced Services Premises Other TOTAL PRIMARY CARE CO-COMMISSIONING
TOTAL
4.3.1
-
113.39
Pay Budget (£000's)
Non Pay Budget (£000's)
Income Budget (£000's)
Total Budget (£000's)
55 751 1,120 -
229,210 37,202 1,979 56,785 15,872 32,508 29,924 6,337
(18) (164) (264) -
229,192 37,202 2,034 56,621 16,624 32,245 31,043 6,337
1,926
409,818
(446)
411,298
5,007
1,817
(35)
6,789
5,007
1,817
(35)
6,789
-
26,011 4,366 1,957 5,092 2,437
-
26,011 4,366 1,957 5,092 2,437
-
39,863
-
39,863
451,498
(481)
457,950
6,933
Acute Services Activity plans are based upon agreed activity trajectories and costs reflect draft 2016/17 Payment by Results rules and tariffs. The contract values for the CCG’s main providers including Dudley Group Foundation Trust (DGFT) are based on the latest offers received. The contract with DGFT will be on a block basis which includes QIPP and a risk share agreement. This will provide some financial certainty for both the CGG and provider in the lead up to a Multispecialty Community Provider (MCP) from 1 April 2017. It also allows organisations to focus on the development of the New Care Model (NCM) and associated financial arrangements. Contract negotiations with other non-Dudley providers, led by other CCGs are still in their final stages and therefore the latest contract offer has been used or an estimate based on the forecast outturn in 2015/16, adjusted for growth and net inflation. The expectation is that the final deadline for signing contracts is 31 March; however we expect that the final contract documentation will not be available until early April. Contracts for 2016/17 include, where possible, the application of the CCG’s commissioning intentions, which are intended to achieve the CCG’s strategic goals whilst providing improved efficiency and form part of the 2016/17 QIPP programme. These are described later in the paper.
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4.3.2
Mental Health Services Mental Health contracts are on track to be agreed before 31 March and the budget book reflects the latest contract offers. In 2016/17 the contract with Dudley and Walsall Mental Health Partnership NHS Trust will be a block contract. This again provides both the CCG and Trust with some financial certainty in the lead up to a new MCP model from 1 April 2017 whilst allowing both organisations to focus on developing the NCM.
4.3.3
Primary Care Development The CCG intends to continue to invest in primary care initiatives within its control to ensure national and local initiatives are delivered. Training, support and mentorship schemes have been established with further investment in GPs with Specialist Interest being planned in 2016/17.
4.3.4
Drugs and GP Prescribing Forecast PPA prescribing data at month 9 has been used as the basis for the 2016/17 baseline. Net inflation and ONS growth of 3.5% has been applied with a further £1.5m identified as a QIPP target. The medicines management team have produced a work plan to ensure the target is achieved.
4.3.5
Continuing Healthcare Continuing healthcare providers will receive an inflationary uplift of 1.1% in 2016/17, an increase that is reflected in budget book figures. The CCG will also continue to roll out Personal Health Budgets, with new clients expected to come on stream in addition to the full year effect of clients who started receiving their budgets in 2015/16.
4.3.6
Community Services The tariff inflator has been applied to the community NHS contracts where appropriate. DGFT contracted activity is based on a similar level to last year’s contract. This is higher than the forecast outturn for 2015/16 and reflects the additional activity anticipated as a result of the full establishment of the rapid response team.
4.3.7
Other Commissioning and Reserves In support of the financial planning assumptions made in the CCG’s financial plan, under mandate from NHS England the CCG are required to create a 1% non-recurrent spend reserve and a 0.5% contingency reserve. These are to remain uncommitted at the start of the financial year to potentially support failing providers within the STP footprint and mitigate future risks the CCG may be required to manage. Further analysis of other spend can be found in Appendix 2a, which includes the charge the CCG will receive for the premises costs associated with commissioned services space that are owned and maintained by NHS Property Services and Community Health Partnerships (in relation to LIFT buildings). Planned Surplus/Deficit - the planned surplus for 2016/17 is £6.3m, equating to 1.5% of recurrent revenue resource.
4.3.8
Corporate Services This reflects corporate functions managed within the running cost allowance given to CCGs of £22.07 per head of population. ‘Running costs’ include any costs incurred that are not a direct payment for the provision of healthcare or healthcare related services, including all costs associated with the corporate and operational management of the CCG. These costs will be closely monitored Page 8 of 15
against target. Appendix 2a illustrates the planned running costs for the CCG for 2016/17 which are based on current structures, adjusted for the impact of organisational change already incurred where appropriate. The agreed contract value for services to be purchased from NHS Greater East Midland and Arden Commissioning Support Unit (CSU) is also included in full. In order for the CCG to achieve its running cost allowance in 2016/17 it has been necessary to maintain a 3% cost improvement target across all departments. This is in the main due to required structure changes following the CCG taking full delegated responsibility for primary care commissioning services and increased capacity pressures from being a Vanguard flagship for the new model of care MCP. 4.3.9
Primary Care Co-commissioning The CCG acquired delegated responsibility for the co-commissioning of Primary Care services from NHS England on 1 April 2015. Growth of 4.24% has been applied to the 2015/16 allocation with net inflation and ONS growth of 2.41% being applied to contracts and remaining balance being reinvested in Primary Care initiatives throughout the year. The new Long Term Conditions Framework, otherwise known as Dudley Outcomes for Health, represents a new way of providing primary care for patients with long term conditions in Dudley and is designed to replace both the Quality and Outcomes Framework and a selection of the current Directed Enhanced Services and Local Improvement Schemes. As part of a pilot year for the programme in 2016/17, practices have been offered the opportunity to opt-out of providing these services and work to the new indicators. The current budgets that will be subsumed into Dudley Outcomes for Health, subject to the level of sign-up from practices, are:
Reporting Area
Local Improvement Schemes COPD
CCG Local Improvement Schemes
Primary Care Co-Commissioning
329
Care Homes
191
Diabetes
708
Palliative Care
214
QOF
4,366
Unplanned Admissions DES
900
Learning Disabilities DES
32
PMS Premium
465
Total
5.0
Budget (£000's)
7,205
LONG TERM FINANCIAL VIEW 2017/18 - 2020/21 The CCG received its allocations on 8 January 2016. Firm allocations have been received for 2016/17, 2017/18 and 2018/19, with indicative allocations for 2019/20 and 2020/21. Key points to note are: • • •
The formula on which allocations are based remains unchanged, but base data has been updated. Populations are at October 2015 list size with predicted ONS growth for the next 5 years. Revised allocations are to ensure no CCG in England is more than 5% away from their target core allocation. NHS England deem within 5% to be ‘reasonable and within Page 9 of 15
• • • •
appropriate statistical boundaries to conclude that an area is appropriately funded to meet health need’. There has been included a ‘sparsity adjustment’ for remote areas ‘Place based’ allocations are included, noting formula-based notional allocations for specialized services Revised formula for primary care, based on estimate of stratified workload per GP Running cost target not reduced by 5%, but rebased.
The table below identifies the allocations, and associated metrics, for the next 5 years.
CCG Allocation Allocation per capita per capita Target Target per capita Opening Closing
Primary Medical Allocation Allocation per capita per capita Target Target per capita Opening Closing
Specialised Allocation £k Allocation per capita £ Growth per capita growth Target £k Target per capita £ Opening DfT Closing DfT
2015-16 74,090
2.3%
2016-17 79,398 251 7.2% 6.9% 77,582 245 3.1% 2.3%
2017-18 82,837 261 4.3% 4.0% 80,942 255 3.1% 2.3%
2018-19 86,180 271 4.0% 3.7% 84,206 265 3.1% 2.3%
2019-20 89,674 281 4.1% 3.7% 87,620 275 3.1% 2.3%
2020-21 93,824 293 4.6% 4.3% 91,672 286 3.1% 2.3%
2017-18
2018-19
2019-20
2020-21
6,735
6,710
6,686
Total Programme Allocation Allocation per capita per capita Target Target per capita Opening Closing
Running Costs
2015-16
2016-17
Allocation £k
7,647
6,789
6,762
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Population
2015-16
2016-17
2017-18
2018-19
2019-20
2020-21
Population projection Population growth
315,497
316,363 0.3%
317,279 0.3%
318,213 0.3%
319,179 0.3%
320,151 0.3%
Key headlines from the above are: • • • • • • •
The CCG has received a slightly higher core growth percentage than neighbouring CCGs due to the population impact on the allocation formula (3.7% in 2016/17) Growth reduces to 2% in 2017/18. This is due mainly to a 1.4% immediate call on 2016/17 growth for additional employer pension contributions. Distance from target increases from 2.9% below target to 3.2% below target in 2016/17. This then reduces, however, to 2.2% in 2020/21 Primary care allocation growth of 4.2% in 2016/17, reducing to 1.8% in 2017/18 Primary care distance from target begins 2016/17 at -1.7%, but this increases to -3.5% by 2020/21 Running costs fall slightly in 2016/17, then remain fairly flat Population is expected to increase by 0.3% per annum
A long term financial model has been developed that meets the required financial targets set out in the business rules, but also enables the quality of commissioned healthcare and outcomes for patients to be improved. The table below, which is an extract from NHS England’s financial plan) identifies the summary financial outlook for the CCG for the next 5 years, drawing attention to the key changes in income available to the CCG and how this will be utilised. Further detail of the key financial headlines for the CCG is illustrated in Appendix 11. Revenue Resource Limit £ 000 Recurrent Non-Recurrent Total
2015/16 435,209 11,923 447,132
2016/17 451,613 6,337 457,950
2017/18 460,430 6,337 466,767
2018/19 469,394 6,337 475,731
2019/20 479,301 6,337 485,638
2020/21 496,619 6,337 502,956
Income and Expenditure £ 000 Acute Mental Health Community Continuing Care Primary Care Other Programme Primary Care Co-Commissioning Total Programme Costs
2015/16 225,552 36,593 36,667 13,300 58,675 22,790 38,125 431,702
2016/17 228,754 37,451 39,361 13,851 59,221 24,066 39,863 442,566
2017/18 231,213 38,199 41,692 14,128 60,515 25,023 40,596 451,366
2018/19 234,322 38,964 43,573 14,412 61,426 26,236 41,380 460,312
2019/20 238,370 39,783 45,035 14,715 62,628 27,108 42,556 470,195
2020/21 244,139 40,754 46,666 15,024 63,905 32,804 44,158 487,450
Running Costs
6,851
6,789
6,762
6,735
6,710
6,686
Contingency
2,242
2,258
2,302
2,347
2,397
2,483
440,795
451,613
460,430
469,394
479,301
496,619
Total Costs
£ 000 Surplus/(Deficit) In-Year Movement Surplus/(Deficit) Cumulative Surplus/(Deficit) % Surplus (RAG)
6.0
2015/16 0 6,337 1.55% GREEN
2016/17
2017/18
2018/19
2019/20
2020/21
0 6,337 1.5% GREEN
0 6,337 1.5% GREEN
0 6,337 1.5% GREEN
0 6,337 1.5% GREEN
0 6,337 1.4% GREEN
SUSTAINABILITY AND TRANSFORMATION PLAN (STP) Dudley CCG is a constituent member of the Black Country STP footprint consisting of the CCGs, NHS providers and Local Authorities of Dudley, Wolverhampton, Sandwell and West Birmingham and Walsall.
Page 11 of 15
The aim of the STP process is to require every health and care system to work together to produce a multi-year STP, showing how local services will evolve and become sustainable over the next five years – ultimately delivering the Five Year Forward View vision. We are required to submit our initial submission in April followed by a more detailed submission in June. This provides a financial risk to the CCG. As described elsewhere in the report, the CCG cannot commit its 1% non-recurrent reserve as it must remain uncommitted to potentially supporting financial deficits in any NHS organisation within the STP footprint. The CCG has challenged the appropriateness of this, particularly as it does not equally support the transformation agenda, but as an STP footprint we are intending to submit a request to NHS England and NHS Improvement to have local ownership and management of a fund that is likely to be of the sum of £20 million. This will include a proportion to support the national requirements, a proportion to support local transformation and a proportion to establish a risk pool, similar in nature that that the currently exists for CCG’s. 7.0
NEW MODEL OF CARE/VANGUARD The CCG continues to be an MCP Vanguard and our operational plan describes the steps being undertaken to implement the new model of care and multi-specialty community provider. As a vanguard, we are able to bid for funds from NHS England to support the MCP’s development and implementation. This is received non-recurrently and within this budget plan neither spend or income assumed with Vanguard funding are included.
8.0
BETTER CARE FUND 2016/17 represents the second year of the Better Care Fund Pooled Budget arrangements with Dudley MBC. The final value of the fund for 2015/16 was £56.4m. This is forecast to over-perform by £1.6m as a result of increased expenditure on social care budgets. This reports a forecast outturn of £58.1m. The section 75 agreement for 2015/16 stated that any under/over performances would be reflected in the accounts of the lead commissioner for the service. Therefore, the CCG is not required to contribute towards the social care over-performance; however it was agreed to underwrite the £1.625m pay for performance fund in full to ensure the council could continue the flow of discharges from the hospital. The indicative total value of the pool for 2016/17 is £62.1m. This is based on the latest values within contract demand models and 2015/16 outturn for council led services to be updated on receipt of their final financial budgets. The CCG is contributing £38.9m to the total fund which is £17.9m above the minimum requirement by NHS England. The CCG contribution includes a baseline transfer of £3m to be used for the protection of adult social care and a £1.625m (previously used for pay for performance) as a contribution towards the on-going implementation of the integrated discharge pathway. A schedule of services, with associated values, can be found in Appendix 10.
9.0
QUALITY, INNOVATION, PRODUCTIVITY AND PREVENTION (QIPP) A programme of service change has been established which will deliver the CCG’s QIPP target in 2016/17. The sum of £14m is the value required to meet the funding gap and create recurrent headroom to fund future growth in activity and invest in new services. The main QIPP schemes in 2016/17 are triage of all outpatient referrals through the e-referrals system, emergency admissions Page 12 of 15
from care homes, Prescribing and the expansion of the Rapid Response Team service. A schedule of all schemes for 2016/17 can be found in Appendix 3. The QIPP plan equates to 3.1% of total commissioning resource in 2016/17. The CCG’s QIPP initiatives have been shared with providers and included in the contract activity plans where appropriate. 10.0
RISK MANAGEMENT The CCG will need to plan appropriately to manage in-year financial risk. A key determinant of this is the ability to obtain early indications of adverse variations within budgets. The diagram below illustrates the sensitivity of the main risks facing the CCG and the impact on the CCG’s £6.3m surplus if the probability of those risks occurring increases or decreases from the base case level of the potential risk.
Non Return of Surplus
Non Dudley Acute SLAs
QIPP Under-Delivery
Prescribing
Pre committed vanguard spend 9,000 Reduced Probability of Risk
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
Total Impact on Surplus / (Deficit) (£)
Increased Probability of Risk
Outlined below are some of the key risks identified to date for 2016/17:•
Acute and Primary Care – winter pressures
•
1% Non-Recurrent Transformation funds uncommitted and used to support failing providers and CCG is no longer able to use to mitigate future risks.
•
QIPP Schemes - delays to the introduction of service changes from commissioning intentions may result in subsequent savings not being realised. An integral part of the QIPP for 2016/17 is the reduction of spend on emergency admissions planned to be achieved through the Rapid Response Team, Care Home initiatives, MDTs and the Long term conditions framework.
•
Prescribing budgets are based on 2015/16 outturn at month 9, but spend can be volatile.
•
2015/16 Surplus – the associated risk of the surplus from 2015/16 not being returned to the CCG but instead being retained to support centrally commissioned services.
•
Continued increases in acute and non-acute activity in excess of growth estimates and over performance reserves.
•
There is a risk that the £1.625m transfer to Dudley MBC for the integrated discharge pathway does not achieve the reduction in the delayed transfers of care.
Page 13 of 15
•
The CCG have made a pre commitment of spend in 2015/16 to progress the NCM for Dudley, there is a risk that the Value Proposition Bid submitted for 2016/17 is not approved in totality and may present a risk against the CCG’s core allocation or will significantly change the delivery of the NCM that it becomes unviable to delivery within the resource.
To mitigate the above risks the following actions will be implemented:• • • • • •
11.0
Savings/QIPP Challenge – continuation of the QIPP challenge model, potentially expanding to other key performance indicators. Acceleration of savings schemes originally identified for implementation in 2017/18. Contingency reserve to remain unallocated until October 2016 to mitigate pressures outlined above. Delay and reduce non-recurrent investment plans Further disinvestment and potential decommissioning of existing services if required. The CCG will work with Adult Social Care to agree appropriate risk sharing arrangements and mitigation through the Better Care Fund
CONTINGENCY/1% NON-RECURRENT EXPENDITURE In line with planning guidance a 0.5% contingency reserve has been established within the plan and is, as in prior years, prudently entirely uncommitted and is expected to fund any unforeseen pressures that the CCG may face or be required to fund during 2016/17. This will remain uncommitted in the first six months of the year and will only be released for investment in the second half of the year if it is not required to meet statutory financial targets or to mitigate risks. The CCG has also been required to identify 1% of its recurrent resource limit to spend nonrecurrently. The CCG have been mandated by NHS England to hold the 1% non-recurrent transformation fund totally uncommitted to potentially support failing providers within the STP footprint. The CCG have always held this fund uncommitted at the beginning of the financial and has in the past been utilised to pump-prime QIPP initiatives, improving performance against contractual/quality targets, transitional support for providers, risk management and other relevant non-recurrent expenditure. The CCG is challenging the proposed use of the fund and are developing a local model to manage risk and fund transformation. The potential for it to be accepted is unknown.
12.0
CAPITAL The CCG has submitted capital bids equating in total to £475,000, of this £200,000 relates to the provision of purchasing network switches for GP practices to enable the effective roll out of Wi-Fi across all practices within Dudley. The remaining £275,000 relates to premises improvements within NHS Property Services owned buildings to ensure they comply with DDA and statutory standards.
13.0
STATEMENT OF FINANCIAL POSITION Appendix 5 shows the forecast balance sheet position for 2016/17.
14.0
CASH LIMIT The detailed forecast cash plan is shown in Appendix 6 and is based on the NHS England notified cash limit adjusted for expected receipts and anticipated revenue resource allocations.
Page 14 of 15
15.0
SUMMARY/CONCLUSION This paper presents a final budget for 2016/17 to Dudley CCG Board for approval. Delivery of the proposed budget will be challenging, but its delivery will support the CCG in meeting its goals and outcomes as outlined in the QIPP System Plan. Anticipated within the plan is a net savings target of £14.0m for which robust performance management will be required. A number of risks remain evident for which contingencies will need to be established to meet the CCG’s financial target of £6.3m surplus and other financial statutory duties.
16.0
RECOMMENDATION The Board is requested to approve the budgets for the CCG for the 2016/17 financial year as set out in this paper.
M Hartland Chief Operating and Finance Officer March 2016
Page 15 of 15
Appendix 1: Revenue Resource Limit Period : Baseline 2016/17
PROGRAMME TOTAL 14/15 NOTIFIED RESOURCE ALLOCATION 2.7% Growth 15/16 Winter Resilience BCF Funding Tier 3 Neurology Commissioning Responsibility Transfer from NHSE Tier 3 Specialist Wheelchairs Commissioning Responsibility Transfer from NHSE Chemotherapy Activity transfer to Specialised Services Revised Baseline adjustment TOTAL 15/16 NOTIFIED RESOURCE ALLOCATION 1.39% Policy Commitments included within Growth 16/17 2.34% Balance of Growth 16/17 Total Notified Resource Allocation Anticipated 15/16 Surplus Total Anticipated Resource Allocation
CCG RESOURCE LIMIT 2016/17 : PROGRAMME
RUNNING COSTS
Non Recurring (£000's)
Recurring (£000's) 370,804
Total (£000's) 0
10,130 2,016 7,157 2 72 (64) 269
370,804 10,130 2,016 7,157 2 72 (64) 269
390,386
0
390,386
0
0 6,337 6,337
5,426 9,149 14,575 6,337 6,337
404,961
6,337
411,298
5,426 9,149 14,575
Recurring (£000's)
Non Recurring (£000's)
Total (£000's)
TOTAL 14/15 NOTIFIED RESOURCE ALLOCATION Running Cost Reduction
7,647 (796)
0
7,647 (796)
TOTAL 15/16 NOTIFIED RESOURCE ALLOCATION Running Cost Reduction
6,851 (62)
0
6,851 (62)
CCG RESOURCE LIMIT 2016/17 : ADMIN
6,789
0
6,789
PRIMARY CARE CO-COMMISSIONING
Recurring (£000's)
Non Recurring (£000's)
Total (£000's)
TOTAL 15/16 NOTIFIED RESOURCE ALLOCATION Co-commissioning Outturn adjustments PMS PA Fees and Rates Increase Allocation TOTAL 15/16 NOTIFIED RESOURCE ALLOCATION 4.24% Growth 16/17
38,112 (82) 211 38,241 1,622
0
CCG RESOURCE LIMIT 2016/17 : PRIMARY CARE CO-COMMISSIONING
39,863
0
39,863
451,613
6,337
457,950
TOTAL CCG RESOURCE LIMIT 2016/17
0
38,112 (82) 211 38,241 1,622
Appendix 2: Financial Summary Report 2016/17 Period: Baseline 2016-2017 WTE Budget Commissioning Acute Services Mental Health Services Primary Care Development Drugs And GP Prescribing Intermediate & Continuing Healthcare Community Services Other Commissioning Surplus Target TOTAL COMMISSIONING Running Costs Clinical Management Other Board Organisational Development CCG Management Team Communications & Engagement Finance & Performance Administration & Business Support Commissioning Membership Development & Primary Care IM&T Support Quality IM&T Projects Contracting Governance Innovation Fund Procurement Estates and Facilities Corporate Costs & Services GP Mentor Support CIP / Vacancy Factor TOTAL RUNNING COSTS
Pay Budget (£000's)
0.84 17.65 8.00 26.49
4.00 0.75 1.00 8.00 7.35 21.65 14.60 10.65 4.00 4.00 6.00 0.00 4.90 0.00 0.00 0.00 0.00 0.00 0.00 0.00 86.90
Primary Care Co-Commissioning GP Contract QOF Local Enhanced Services Premises Other TOTAL PRIMARY CARE CO-COMMISSIONING TOTAL
113.39
Non Pay Budget (£000's)
Income Budget (£000's)
Total Budget (£000's)
55 751 1,120 -
229,210 37,202 1,979 56,785 15,872 32,508 29,924 6,337
(18) (164) (264) -
229,192 37,202 2,034 56,621 16,624 32,245 31,043 6,337
1,926
409,818
(446)
411,298
745 10 61 925 219 1,110 388 663 181 209 289 206 -
(11) 99 63 94 127 88 81 10 3 116 21 1 280 1 200 1,239 29 (625)
(35) -
699 109 124 1,019 347 1,198 468 674 184 326 310 207 280 1 200 1,239 29 (625)
5,007
1,817
(35)
6,789
-
26,011 4,366 1,957 5,092 2,437
-
26,011 4,366 1,957 5,092 2,437
-
39,863
-
39,863
451,498
(481)
457,950
6,933
Appendix 2a: Financial Detail Report 2016/17 Period: Baseline 2016-2017 Commissioning
WTE Budget
Pay Budget (£000's)
Non Pay Budget (£000's)
Income Budget (£000's)
Total Budget (£000's)
ACUTE SERVICES Acute Commissioning Ambulance Services Planned Care NHS 111 Urgent Care Winter Resilience
-
209,708 8,727 2,514 2,190 1,008 3,005 2,058
(18) -
209,708 8,727 2,514 2,172 1,008 3,005 2,058
ACUTE SERVICES TOTAL
-
229,210
(18)
229,192
Mental Health Contracts Dementia Learning Difficulties Mental Health Services – Adults Mental Health Services - Collaborative Commissioning Mental Health Services – Not Contracted Activity Mental Health Services – Other Mental Health Services - Specialist Services Mental Capacity Act Child and Adolescent Mental Health
-
24,945 188 6,313 901 121 53 305 211 35 4,129
-
24,945 188 6,313 901 121 53 305 211 35 4,129
MENTAL HEALTH SERVICES TOTAL
-
37,202
-
37,202
55 -
70 1,178 141 591
-
70 1,178 196 591
55
1,979
-
2,034
Central Drugs Medicines Management - Clinical Home Oxygen Prescribing
-
2,716 567 600 52,902
(164)
2,716 567 600 52,738
DRUGS AND GP PRESCRIBING TOTAL
-
56,785
(164)
56,621
7,142 870 103 3,372 4,386
-
7,142 870 855 3,372 4,386
NCAs
MENTAL HEALTH SERVICES
PRIMARY CARE DEVELOPMENT GP Practice Training Primary Care IT - Programme GPwSI & Nurse Mentors Practice Engagement LES PRIMARY CARE DEVELOPMENT TOTAL
0.84
0.84
DRUGS AND GP PRESCRIBING
INTERMEDIATE & CONTINUING HEALTHCARE CHC Adult Fully Funded CHC Adult Fully Funded Personal Health Budgets Continuing Healthcare Assessment & Support Funded Nursing Care Intermediate Care
17.65
751 -
INTERMEDIATE & CONTINUING HEALTHCARE TOTAL
17.65
751
15,872
-
16,624
Community Services Acute Childrens Services CHC Children CHC Children Personal Health Budgets
-
24,462 173 7,260 614
(52) (212)
24,462 173 7,208 402
COMMUNITY SERVICES TOTAL
-
32,508
(264)
32,245
162 958 -
11,782 1,681 4,991 4,118 1,646 3,001 102 2,603
-
11,782 1,681 4,991 4,118 1,646 3,001 264 958 2,603
1,120
29,924
-
31,043
COMMUNITY SERVICES
OTHER COMMISSIONING Better Care Fund Local Enhanced Services Statutory Reserves Non Recurrent Reserve Patient Transport NHS PS & CHP Property Charges Safeguarding Intergrated Clinical Leads Other OTHER COMMISSIONING TOTAL
3.00 5.00
8.00
SURPLUS Surplus
-
6,337
-
6,337
SURPLUS TARGET TOTAL
-
6,337
-
6,337
409,818
(446)
411,298
TOTAL COMMISSIONING
26.49
1,926
Appendix 2a: Financial Detail Report 2016/17 Period: Baseline 2016-2017 Running Costs
WTE Budget
Pay Budget (£000's)
Non Pay Budget (£000's)
Income Budget (£000's)
Total Budget (£000's)
CORPORATE SERVICES Other Corporate Support Services
86.90
5,007
1,817
(35)
6,789
RUNNING COST TOTAL
86.90
5,007
1,817
(35)
6,789
Primary Care Co-Commissioning
WTE Budget
Pay Budget (£000's)
Non Pay Budget (£000's)
Income Budget (£000's)
Total Budget (£000's)
GP COMMISSIONED SERVICES General Practice - GMS General Practice - APMS General Practice - PMS QOF Local Enhanced Services Premises Cost Reimbursement Other Premises Costs Collaborative Payments Dispensing/Prescribing Drs Other GP Services
-
25,565 446 4,366 1,957 5,032 60 116 248 2,073
-
25,565 446 4,366 1,957 5,032 60 116 248 2,073
PRIMARY CARE CO-COMMISSIONING TOTAL
-
39,863
-
39,863
451,498
(481)
457,950
TOTAL
113.39
6,933
Appendix 3: Savings Plan / QIPP Schemes 2016/17 Period: Baseline 2016-2017
Main QIPP Programme
Description
Targeted Saving
Rapid Response Team
This saving reflects the full year effect of a new service where ANPs intercept ambulance callouts preventing the need for a conveyance to hospital. The additional savings will arise through the recruitment of additional ANPs and service reconfiguration.
Emergency Admissions
Urgent Care Centre
The opening of the new Urgent Care Centre in 2015/16 has resulted in a reduction of Type 1 A&E attendances at a local acute trust. It is expected that further savings can be made through the refinement of the front of house streaming process.
Elective Pathways
Commissioning Lead
2016/17 £000's
Andrew Hindle
(750)
A&E Attendances
Jason Evans
(500)
Reduction in outpatient attendances as a result of improved advice and guidance, triage and adherence to the PLCV/aesthetic policies
Outpatient Attendances
Mark Curran
(2,000)
Better Prescribing
Prescribing work programme led by the Prescribing team, includes work on repeat prescribing, waste medicines, reduction in prescribing of steroids in COPD, Nutrition and Hydration education.
Primary Care Prescribing
Clair Huckerby / Duncan Jenkins
(1,500)
Long Term Conditions Framework
The new long term conditions framework has been introduced as part of the new MCP model to improve the care of long term conditions within a Emergency Admissions primary care setting. This will impact on a number of areas for improvement identified within the Right Care Commisisoning for Value pack.
Daniel King
(2,520)
Primary Care Target
Primary Care efficiencies through the development of the new MCP model and LTCF
Primary Care
Daniel King
(1,200)
Reduction in Running Costs
Reduction in running costs
Running Costs
Matthew Hartland
(200)
Mental Health Inpatient Beds
Reduction in the use of inpatient beds for Mental Health Services through increased provision in the community.
Mental Health Inpatients
Trish Taylor
(200)
Rehabilitation
Review of acute rehabilitation services, which includes the coding of rehab activity and the potential to move patients to a more suitable community service.
Rehab Bed days
Jenny Cale
(500)
Falls Prevention
Commissioning of a new fracture liaison service and development of a falls risk register will help to reduce the level of emergency admissions for falls.
Emergency Admissions
Tapiwa Mtemachani
(700)
Elderly Frail
Improved service provision within care homes, increased education, new electronic palllitiative care system and imprved discharges through a discharge to assess model.
Emergency Admissions
Andrew Hindle
MDT's
Multi Disciplinary Teams have now been established within each of our primary care practices. Ambulatory Care Sensitive Conditions admissions Emergency Admissions performance reporting will be shared across these teams to enable them to identify areas for improved joined up care and upstream preventions.
Neill Bucktin
(980)
Integration Plus
Voluntary Sector link workers have been commissioned as part of our new model of care to ensure that all Dudley Residents have access to available services within the community. This will not only help to prevent emergency Various areas admissions but will also add significant social benefit which will in turn improve peoples health.
Neill Bucktin
(1,000)
Balance of Schemes under 100k TOTAL * Schemes providing a quality improvement but no financial impact in 2015/16
Various areas
(1,000)
(950) (14,000)
Appendix 4: Summary Sources and Applications Statement Period: Baseline 2016-2017
2016-17 Recurring £'000
Baseline Commissioning Allocation Baseline Running Cost Allocation BCF Allocation Primary Care Co-Commissioning Allocation
383,229 6,789 7,157 39,863
Total Baseline Allocation
437,038
Non Recurring £'000
TOTAL £'000
383,229 6,789 7,157 39,863 0
437,038
6,337
6,337 14,575
6,337
20,912
New Sources / Reduction of Funds Surplus c/f DH Growth
14,575
Total Income
14,575
Application of Funds Acute Commissioning Growth / Demographics / HRG 4 Acute Cost pressures
8,900 3,942
8,900 3,942
Contract Inflation Community Services Continuing Care Mental Health Continuing Healthcare Risk Pool IT Strategy Winter CAMHs Transformation GP IT Other
11,443 500 176 891 512 500
11,443 500 176 891 512 500 0 691 825 195
Total Expenditure
27,563
1,012
28,575
Gap
-12,988
2,465
-13,464
QIPP Schemes Price Efficiencies
-14,000 0
Total Expenditure
13,563
1,012
14,575
Surplus / (Deficit)
1,012
5,325
6,337
Pressures/Committed
0 0 691 825 195
-14,000 0
Appendix 5: Statement of Financial Position for 2016/17 Period: Baseline 2016-2017 2015/16 Outturn (£000)
SoFP
2016/17 Plan (£000)
March
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Assets Non Current Assets Opening Balance Depreciation Additions
216
216
216
216
216 (18)
216
216 (18)
366
491
491 (19)
491
591
691 (19)
216
216
216
216
198
216
198
366
491
472
491
591
672
Current Assets Inventories NHS Trade and Other Receivables Non NHS Trade and Other Receivables Cash and Cash Equivalents
0 125 1,954 75
125 1,487 268
125 1,599 288
125 1,620 323
125 1,507 203
125 1,676 288
125 1,796 120
125 1,694 343
125 1,710 105
125 1,841 164
125 1,819 211
125 1,858 111
125 1,996 78
Total Current Assets
2,154
1,880
2,012
2,068
1,835
2,089
2,041
2,162
1,940
2,130
2,155
2,094
2,199
Total Assets
2,370
2,096
2,228
2,284
2,033
2,305
2,239
2,528
2,431
2,602
2,646
2,685
2,871
-
-
-
-
-
-
-
-
-
-
-
-
-
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (883) (883) (883) (883) (833) (833) (783) (783) (703) (663) (663) (27,312) (27,830) (27,666) (27,510) (27,229) (28,446) (29,295) (28,870) (29,303) (28,631) (28,769) 0 0 0 0 0 0 0 0 0 0 0
0 0 (863) (29,859) 0
Long Term Receivables Total Non Current Assets
Liabilities Non Current Liabilities Borrowings Deferred Income (non current) Provisions (non current) Trade and Other Payables (non current) Finance Leases (non current) Total Non Current Liabilities Current Liabilities Borrowings Deferred Income (current) Provisions (current) Trade and Other Payables (current) Finance Leases (current)
(883) (28,705)
Total Current Liabilities
(29,588)
(28,195) (28,713) (28,549) (28,393) (28,062) (29,279) (30,078) (29,653) (30,006) (29,294) (29,432)
(30,722)
Total Liabilities
(29,588)
(28,195) (28,713) (28,549) (28,393) (28,062) (29,279) (30,078) (29,653) (30,006) (29,294) (29,432)
(30,722)
TOTAL ASSETS EMPLOYED
(27,218)
(26,099) (26,485) (26,265) (26,360) (25,757) (27,040) (27,550) (27,222) (27,404) (26,648) (26,747)
(27,851)
(23,513)
(26,099) (26,485) (26,265) (26,360) (25,757) (27,040) (27,550) (27,222) (27,404) (26,648) (26,747)
(27,851)
(23,513)
(26,099) (26,485) (26,265) (26,360) (25,757) (27,040) (27,550) (27,222) (27,404) (26,648) (26,747)
(27,851)
Taxpayers' Equity General Fund Retained Earnings (Accumulated Losses) Revaluation Reserve Other Reserves
TOTAL ASSETS EMPLOYED
Appendix 6: Cashflow for 2016/17 Period: Baseline 2016-2017 2016/17
April £000
May £000
June £000
July £000
August £000
September £000
October £000
Nov £000
Dec £000
January £000
February £000
March £000
Total £000
Receipts Balance b/fwd BACS CHAPS CCG-Drawdown CCG-Drawdown additional Other PCS Payments Reimbursements VAT Capital Receipts Total Receipts Payments Creditors NHS Creditors CHAPS Salary CHAPS Pensions Tax & NI Standing Orders /Direct Debits PCS Payments Other Capital Payments Total -Expenditure
Balance c/fwd
100
268
288
323
203
288
120
343
105
164
211
111
85
20
20
85
20
20
85
20
20
85
20
20
31,300
30,800
32,700
31,150
30,150
31,200
31,380
32,150
33,300
31,985
32,200
39,472
30
30
30
30
30
30
30
30
30
30
30
30
25 -
25 -
25 -
25 -
25 -
25 -
25 -
25 -
25 -
25 -
25 -
25 -
31,540
31,143
33,063
31,613
30,428
31,563
31,640
32,568
33,480
32,289
32,486
39,658
388,947
22,939 7,905 225 64 107 2
22,939 7,490 225 64 107 -
24,087 8,217 230 66 110 -
23,267 7,705 230 66 110 2
23,215 6,481 235 67 112 -
23,117 7,882 235 67 112 -
22,933 7,911 240 69 112 2
23,233 8,776 240 69 115 -
23,233 9,629 240 69 115 -
24,233 7,389 240 69 115 2
24,133 7,788 240 69 115 -
27,233 11,893 240 69 115 -
30
30
30
30
30
30
30
30
30
30
30
30
284,562 99,066 2,820 808 1,345 8 360 -
31,272
30,855
32,740
31,410
30,140
31,443
31,297
32,463
33,316
32,078
32,375
39,580
268
288
323
203
288
120
343
105
164
211
111
78
500 387,787 360 300 -
388,969
Appendix 7: Financial Budget Summary - Budgets by Budget Holder (at total contract value) Period: Baseline 2016-2017 WTE Budget
Non Pay Budget (£000's)
Pay Budget (£000's)
Income Budget (£000's)
Total Budget (£000's)
ANDREW HINDLE Dementia Home Oxygen Community Services Hospices Long Term Conditions Palliative Care Local Enhanced Services
-
-
188 600 24,462 829 1,064 614 1,681
-
188 600 24,462 829 1,064 614 1,681
TOTAL
-
-
29,438
-
29,438
ANTHONY NICHOLLS Contracting Procurement
4.90 0.00
206 -
1 1
-
207 1
TOTAL
4.90
206
2
-
208
CAROLINE BRUNT Safeguarding Quality
3.00 6.00
162 289
102 21
-
264 310
TOTAL
9.00
451
123
-
574
DAN KING GP Practice Training Primary Care Investments GPwSI & Nurse Mentors Practice Engagement LES Membership Development & Primary Care GP Mentor Support General Practice - APMS General Practice - GMS QOF Local Enhanced Services Premises Cost Reimbursement Other Premises Costs Collaborative Payments Dispensing/Prescribing Drs Other GP Services
0.84 4.00 -
55 181 -
70 141 591 3 29 446 25,565 4,366 1,957 5,032 60 116 248 2,073
-
70 196 591 184 29 446 25,565 4,366 1,957 5,032 60 116 248 2,073
TOTAL
4.84
236
40,697
-
40,932
JASON EVANS Ambulance Services NHS 111 Urgent Care Winter Resilience
-
-
8,727 1,008 3,005 2,058
-
8,727 1,008 3,005 2,058
TOTAL
-
-
14,799
-
14,799
JENNY CALE CHC Adult Fully Funded CHC Adult Fully Funded Personal Health Budgets Continuing Healthcare Assessment & Support Funded Nursing Care Intermediate Care
17.65 -
751 -
7,142 870 103 3,372 4,386
-
7,142 870 855 3,372 4,386
TOTAL
17.65
751
15,872
-
16,624
LAURA BROSTER Communications & Engagement
7.35
219
127
-
347
TOTAL
7.35
219
127
-
347
LINDA CROPPER Child and Adolescent Mental Health Acute Childrens Services CHC Children CHC Children Personal Health Budgets
-
-
4,129 173 7,260 614
(52) (212)
4,129 173 7,208 402
TOTAL
-
-
12,175
(264)
11,911
Appendix 7: Financial Budget Summary - Budgets by Budget Holder (at total contract value) Period: Baseline 2016-2017 WTE Budget
Non Pay Budget (£000's)
Pay Budget (£000's)
Income Budget (£000's)
Total Budget (£000's)
MARK CURRAN NCAs Planned Care High Cost Drugs Patient Transport
-
-
2,514 2,190 64 1,646
(18) -
2,514 2,172 64 1,646
TOTAL
-
-
6,413
(18)
6,395
MATTHEW HARTLAND Commissioning Reserve Non Recurrent Reserve NHS PS & CHP Property Charges Surplus Clinical Management Other Board Finance & Performance Governance Estates and Facilities Corporate Costs & Services
4.00 0.75 21.65 -
745 10 1,110 -
4,991 4,118 3,001 6,337 (11) 99 88 280 200 614
(35) -
4,991 4,118 3,001 6,337 699 109 1,198 280 200 614
TOTAL
26.40
1,865
19,716
(35)
21,546
NEILL BUCKTIN Better Care Fund Collaborative Commissioning Integrated Clinical Leads Commissioning Team Acute Commissioning Learning Difficulties Central Drugs Medicines Management - Clinical Prescribing
5.00 10.65 -
958 663 -
11,782 33 10 209,708 6,313 2,716 567 52,902
(164)
11,782 33 958 674 209,708 6,313 2,716 567 52,738
TOTAL
15.65
1,621
284,031
(164)
285,488
8.00 4.00 -
925 209 -
94 116 1,178
-
1,019 326 1,178
TOTAL
12.00
1,134
1,388
-
2,523
STEPH CARTWRIGHT Organisational Development Administration & Business Support
1.00 14.60
61 388
63 81
-
124 468
TOTAL
15.60
448
144
-
592
PAUL MAUBACH CCG Management Team IM&T Support Primary Care IT - Programme
TRISH TAYLOR Mental Health Contracts Mental Health Services – Adults Mental Health Services - Collaborative Commissioning Mental Health Services – Not Contracted Activity Mental Health Services – Other Mental Health Services - Specialist Services Mental Capacity Act
-
-
24,945 901 121 53 305 211 35
-
24,945 901 121 53 305 211 35
TOTAL
-
-
26,572
-
26,572
TOTAL
113.39
6,933
451,498
(481)
457,950
Appendix 8: Contract Lead Commissioners Period: Baseline 2016-2017
Provider
Contract Type
The Dudley Group Dudley and Walsall Mental Health Black Country Partnerships West Midlands Ambulance Univerity Hospital Birmingham The Royal Wolverhampton West Midlands Hospital Sandwell & West Birmingham Royal Orthopaedic Urgent Care Centre Birmingham Children's Hospital NHS 111 Birmingham Women's Hospital Worcestershire Acute South Staffordshire and Shropshire MH Heart of England FT Birmingham and Solihull Mental Health University Hospital North Midlands Walsall Healthcare Shrewsbury & Telford Robert Jones & Agnes Hunt Birmingham Community NHS Trust Worcestershire Health and Care NHS Trust TOTAL
Acute/Community Mental Health Community/LD/Mental Health Ambulance Acute Acute/Community Acute Acute/Community Acute Other Acute Other Acute Acute Mental Health Acute Mental Health Acute Acute & Community Acute Acute Community Community/Mental Health
Lead Commissioner
Lead Commissioner Neill Bucktin Trish Taylor Linda Cropper Jason Evans Mark Curran Mark Curran Mark Curran Jason Evans Mark Curran Jason Evans Linda Cropper Jason Evans Mark Curran Mark Curran Trish Taylor Mark Curran Trish Taylor Mark Curran Mark Curran Mark Curran Mark Curran Andrew Hindle Andrew Hindle
8,534
Non Electives 58,337
256 357
1,949 2,160
358
834 121
97
510
149
513 366
40
138
8 29 25
39 52 121 3
£9,852
£65,143
A&E
Jason Evans
Jason Evans
Indicative Value (£'000) Electives/ Mental Ambulance Community Outpatients Other Daycases Health/LD Services Services 32,090 32,265 23,413 38,622 26,130 5,766 5,558 8,514 2,126 1,406 1,739 1,985 1,170 663 983 5,139 1,883 246 699 1,464 154 1,396 2,321 448 551 2,927 524 210 299 1,008 168 255 209 154 204 132 450 125 94 87 284 31 10 114 51 38 15 41 34 33 18 72 33 30 212 131 144 £45,520 £39,513 £32,761 £8,514 £30,158 £48,400 Mark Curran Mark Curran
Trish Taylor
Jason Evans
Andrew Hindle
Mark Curran
CQUIN
Total
4,573 653 283 213 158 161 116 90 73 41 25 24 11 12 7 6 5 3 5 7 £6,467 Caroline Brunt
197,835 26,783 11,607 8,727 7,475 7,476 7,429 5,021 3,530 3,000 1,681 1,008 1,169 1,031 462 497 291 202 231 236 141 217 282 £286,330
Appendix 9: Services Within New Care Model Period: Baseline 2016-2017 SERVICE AREA Accident and Emergency ACM Clinic Acquired Brain Injury Acute Internal Medicine Aftercare Ambulance Services Anaesthetics Anticoagulation Anti-Coagulation & Phlebotomy Aquired Brain Injury Audiology Basket of Procedures Biological Mesh Blood Products Bone Breast Surgery CAMHS Cardiology Carers Chemical Pathology Child Development Childrens Haemoglobin Team Childrens Nursing Childrens Physical Health Service Chiropody Clinical Haematology Clinical Immunology and Allergy Clinical Pharmacology Colorectal Surgery Community Recovery Service Continence Continuing Care Critical Care Cystic Fibrosis Day Care Attenders Dermatology Diabetic Medicine Diagnostic Imaging Dietetics Direct Access Diagnostics Direct Referrals District Nursing Drugs Eating Disorders Elderly Frail Elective Emergency Unit Local Adjustments Employment Services Endocrinology ENT Equipment Erectile Dysfunction FH Gastroenterology General Medicine General Surgery Gynaecological Oncology Gynaecology Gynaecology Oncology Haematology Haemoglobinopathy with Procedure Heart Failure Hepatobiliary & Pancreatic Surgery Hepatology Hospital at Home Hospital Liason Team Hypertension Infectious Diseases Integrated Living Team Intermediate Care Interventional Radiology IVF
MCP £000's
Non MCP £000's 0 0 110 0 0 8,768 0 1,180 199 133 1,522 84 0 0 0 0 2,903 3,002 204 216 334 60 119 313 52 1,370 237 0 0 0 1,142 10,892 0 0 522 1,944 2,634 0 630 7,198 0 9,656 0 84 5,132 0 0 126 1,310 286 1,654 33 38 1,285 18,879 0 42 1,667 1 0 0 686 0 0 26 126 76 0 126 4,593 0 0
13,315 5 0 183 0 0 10 0 0 0 0 0 40 0 80 1,403 0 1,373 0 36 0 0 0 0 0 1,626 11 9 646 0 0 0 5,198 0 0 411 78 0 0 0 2 0 7,715 0 206 0 62 0 179 3,303 47 0 0 3,850 91 13,413 44 3,455 0 3 5 0 186 105 0 0 0 11 0 0 39 314
Primary Care £000's 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 54,513 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Appendix 9: Services Within New Care Model Period: Baseline 2016-2017 SERVICE AREA
MCP £000's
Joint Finance Learning Disabilities Leg Ulcer Service Maternity Mental Health - Acute Mental Health - Community Mental Health - Early Intervention Mental Health - Older Adults Mental Health Placements Mental Health Rehabilitation Mental Health Sections Minor Surgery Need Split Neonatology Nephrology Neuro-Disability Neurology Neurosurgery NHS111 Occupational Therapy Oncology Ophthalmology Optometry Orthoptics Orthotics Other Outpatient Services Outpatient Diagnostics Oxygen Paediatric Surgery Paediatrics Pain Management Palliative Medicine Patient transport Physiotherapy Plastic Surgery Podiatric Surgery Podiatry Practice Engagement Pre Operative assessments Primary Care Radiology Rapid Response Team Rehabilitation Respiratory Medicine Rheumatology Safeguarding Sleep Studies Speech & Language Therapy Spinal Surgery Service Stroke Medicine System Resilience Termination of Pregnancy Thoracic Medicine Thoracic Surgery Tissue Viability Trauma & Orthopaedics Unallocated Upper Gastrointestinal Surgery Upper Limb Urgent Care Centre Urology Vascular Surgery Warehouse Microbiology Wheelchair Services Wheelchairs Technical/Other
GRAND TOTAL 15/16 budget Proportion
Indicative split for 2016/17 Note : Source - Mapping Exercise undertaken November 2015
Non MCP £000's
Primary Care £000's
286 4,394 316 0 8,754 8,027 2,016 6,329 260 655 140 177 807 165 1,184 420 1,553 0 1,008 1,490 465 16 55 512 1,058 0 0 685 0 3,991 328 3,626 1,593 3,097 0 434 1,985 493 0 0 0 503 5,500 3,043 1,625 910 0 2,301 0 2,404 2,016 442 0 0 79 381 17 0 0 3,044 150 517 0 693 0 31,664
0 0 0 13,349 0 0 0 0 0 0 0 0 659 11 1,320 0 82 72 0 0 1,442 7,048 0 0 0 105 4,232 0 342 140 851 0 0 0 3,033 0 54 0 327 0 25 0 125 296 1,196 0 8 0 637 0 0 0 9 7 0 25,718 (7) 53 31 0 5,464 2,044 6 0 0 562
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38,033 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
203,202
126,694
92,546
48.10%
29.99%
21.91%
217,017
135,307
98,838
Appendix 10: Better Care Fund Services Period: Baseline 2016-2017 AREA Dudley Group Foundation Trust District Nursing Rehab - T&O Virtual Ward/Assertive Case Managers Rehab - Stroke Rehab - Other Respiratory specialist nurses - Outpatient Firsts Respiratory specialist nurses - Outpatient Follow ups Physiotherapy MSK Locality Wide Continence Pass Through Community Heart Failure Community Stroke Rehabilitation Specialist Nursing-Diabetes Community Rapid Response Team OT Primary Care Intermediate Care Team - OT Macmillan Specialist Team Palliative Care Nursing Team Primary Care Neurology Team Locality Wide Continence Activity District Nursing - Oncology Outreach Leg Ulcer Intermediate Care Team - Physio District Nursing - VIV Speech Therapy Adults Advanced Nurse Practitioners/Care Homes Intermediate Care Team - Nursing Tissue Viability Stepdown Medical Cover District Nursing - OPAT Expansion
TOTAL Other Baseline Transfer Discharge to Assess (Risk share condition) Previous Section 256 monies (NHSE) GP Locality Leads Alzeimers Carer Family Support Service Crossroads Dudley Cancer Support Halesowen care and disability advice line Intermediate Care - BUPA Intermediate Care - Leyton Healthcare Community Equipment Stores Intermediate Packages of Care Palliative Care Front End Intermediate Care - Shaw GP Respite Beds Intermediate Care - Other Private Care Homes Dementia Service A&E Diversion Intermediate Care Support - Dr Plant
Indicative Value (£) 7,805,129 1,768,212 1,423,412 1,304,100 1,069,812 201,445 329,517 852,526 809,569 564,488 551,596 529,966 503,318 473,569 462,713 460,103 405,548 377,326 331,917 320,925 316,298 229,380 201,145 185,283 154,958 112,184 78,682 58,899 49,442
21,931,462 3,000,000 1,625,000 7,157,400 173,845 13,602 77,970 53,010 16,630 1,429,392 736,790 478,090 560,000 208,000 467,135 362,888 66,750 186,651 141,540 62,144
TOTAL
16,816,837
GRAND TOTAL
38,748,299
Note :- Indicative, subject to final clarification
Appendix 11: Long Term Financial Outlook Period: Baseline 2016-2017 DUDLEY CCG
2015/16 FOT (M10)
2016/17 Plan
£m 451.61
NonRecurrent £m £m 451.61 0.00
3.72 0.77 0.00 0.00 0.00 1.98 3.92 0.00 1.63 0.69 0.00 1.28 0.34 0.00
228.75 37.45 39.36 13.85 56.62 2.60 6.67 7.16 5.58 39.53 4.45 0.51 6.79 2.29
228.75 37.45 39.36 13.85 56.62 2.60 6.51 7.16 3.96 39.53 0.00 0.00 6.79 0.00
0.00
0.00
0.00
440.79
426.47
14.32
In Year Surplus
0.00
8.80
Surplus/(Deficit) brought forward Cumulative Surplus/(Deficit)
6.34 6.34
8.80
1.57%
2.02%
Sign
Source and Application of Funds ALLOCATION Acute services Mental Health Services Community Health services Continuing Care services Prescribing Other Primary Care Other Programme services BCF (base level) BCF Spend above allocation (inc any support for Adult Soc Care) Co-commissioning spend (current cohort only) Other In year and NR adjustments CHC Risk Share contribution Running costs Contingency (0.5%) Unidenfied QIPP (matches unidentified on QIPP scheme tab)
+ + + + + + + + + + +/+ + + -
APPLICATION OF FUNDS
Cumulative Surplus/(Deficit) Metric (% of Total Allocation)
QIPP as a percentage of Core Resource Limit
%
£m 440.80
NonRecurrent £m £m 435.27 5.52
227.71 37.59 34.57 13.33 54.27 4.93 8.33 7.16 4.63 38.13 0.00 1.28 6.85 2.02
223.99 36.82 34.57 13.33 54.27 2.95 4.41 7.16 3.00 37.44 0.00 0.00 6.51 2.02
0.00
2017/18 Plan
Total
(1.63%)
Recurrent
Total
Recurrent
Total
Recurrent
2018/19
NonRecurrent £m
2019/20
2020/21
Plan: Total £m 469.39
Plan: Total £m 479.30
Plan: Total £m 496.62
1.63 0.41 4.20
234.32 38.96 43.57 14.41 58.72 2.70 9.19 7.16 5.60 41.38 4.28
238.37 39.78 45.03 14.71 59.82 2.81 9.97 7.16 5.61 42.56 4.37
244.14 40.75 46.67 15.02 60.98 2.93 15.50 7.16 5.62 44.16 4.52
2.30
6.74 2.35
6.71 2.40
6.69 2.48
£m 460.43
£m 460.43
0.00 0.00 0.00 0.00 0.00 0.00 0.16 0.00 1.63 0.00 4.45 0.51 0.00 2.29
231.21 38.20 41.69 14.13 57.88 2.63 8.07 7.16 5.59 40.60 4.20
231.21 38.20 41.69 14.13 57.88 2.63 7.42 7.16 3.97 40.19
6.76 2.30
6.76
0.00
0.00
0.00
451.62
442.59
9.03
460.43
451.24
9.19
469.39
479.30
496.62
(8.80)
(0.00)
9.03
(9.03)
0.00
9.19
(9.19)
0.00
(0.00)
(0.00)
6.34 (2.46)
6.34 6.33
9.03
6.34 (2.69)
6.33 6.34
9.19
6.33 (2.85)
6.34 6.34
6.34 6.34
6.34 6.34
1.54%
2.00%
1.51%
2.00%
1.48%
1.45%
1.40%
(3.09%) 14,527
(3.10%) 14,859
(3.10%) 15,395
(3.10%) 14,000
(3.10%) 14,293
0.66
DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Report: 31 March 2016 Report: CCG Operational Plan Agenda item No: 5.0
TITLE OF REPORT:
CCG Operational Plan 2016/17
PURPOSE OF REPORT:
To approve arrangements for finalising the Operational Plan for 2016/17
AUTHOR OF REPORT:
Mr N Bucktin, Head of Commissioning
MANAGEMENT LEAD:
Mr N Bucktin, Head of Commissioning
CLINICAL LEAD:
KEY POINTS:
Dr S Mann, Clinical Executive Acute and Community Services 1. The Board approved the draft Operational Plan for 2016/17 at its meeting on 10 March 2016. 2. The final Operational Plan must be submitted to NHS England by 11 April 2016. 3. Feedback has now been received from NHS England on the draft plan. The plan is described as “good” and subject to some revisions in relation to our plans to improve the dementia diagnosis rate and reflect the process around the Black Country System Transformation Plan (STP), NHS England state that there is no reason why the plan cannot be fully assured following resubmission on 11 April 2016. 4. Delegated authority is sought to revise and submit the final plan to reflect the points identified at 4. above and the final position in relation to contracts that are in the process of being signed off.
RECOMMENDATION:
That the Chief Executive Officer be delegated authority to approve the final Operational Plan to be submitted to NHS England by 11 April 2016.
FINANCIAL IMPLICATIONS:
The financial implications of the plan are addressed in the CCG’s financial plan
WHAT ENGAGEMENT HAS The final plan will be subject to a one month consultation process. TAKEN PLACE: ACTION REQUIRED:
Decision Approval Assurance
1|Page
DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 31 March 2016 Report: CCG Business Continuity Arrangements Agenda item No: 6.0 TITLE OF REPORT:
CCG Business Continuity Arrangements
PURPOSE OF REPORT:
To advise the Board of the approval of the Business Continuity Policy, Strategy and Plan by the Audit Committee
AUTHOR OF REPORT:
Mr M Hartland, Chief Operating and Finance Officer
MANAGEMENT LEAD:
Mr M Hartland, Chief Operating and Finance Officer Mrs J Jasper, Chair – Audit Committee
CLINICAL LEAD:
Dr J Darby, Clinical Executive •
Under the Civil Contingencies Act 2004, NHS organisations must show that they can deal with major incidents whilst maintaining key services. This work is referred to as Emergency Preparedness, Resilience and Response (EPRR).
•
The CCG’s Business Continuity Policy, Strategy and Plan (including the Crisis Management Plan) represent the CCG’s response to this requirement. These were approved by the Audit Committee at its meeting on the 17 March 2016 under its delegated authority for Business Continuity.
RECOMMENDATION:
•
That the Board receives this report for assurance
FINANCIAL IMPLICATIONS:
None determined, but future costs may be incurred in ensuring appropriate contingency arrangements are put into place.
WHAT ENGAGEMENT HAS TAKEN PLACE:
Relevant CCG staff were involved in the development of Business Impact Assessments for each of the CCG Teams. These fed the development of the overall Strategy and Plan.
KEY POINTS:
ACTION REQUIRED:
Decision Approval Assurance
DUDLEY CLINICAL COMMISSIONING GROUP BOARD - 31 MARCH 2016 BUSINESS CONTINUITY ARRANGEMENTS
1.0
INTRODUCTION Under the Civil Contingencies Act 2004, NHS organisations must show that they can deal with major incidents whilst maintaining key services. This work is referred to as Emergency Preparedness, Resilience and Response (EPRR). The CCG’s Business Continuity Policy, Strategy and Plan (including the Crisis Management Plan) represent the CCG’s response to this requirement. These were approved by the Audit Committee at its meeting on the 17th March 2016 under its delegated authority for Business Continuity. The Business Continuity Plan outlines the strategies to be undertaken to mitigate the loss of Premises; Data/Voice; People/Skills and Supply Chain Partners It is recognised that these documents are new and require refinement, testing and embedding. Therefore an early review date of 31 July 2016 has been agreed by the Audit Committee. The external facing documents (i.e. without staff telephone numbers) may be viewed in the CCG’s Publication Scheme under ‘Our policies and procedures/Policies and procedures relating to the conduct of business and the provision of services’
2.0
RECOMMENDATION That the Board receives this report for assurance.
M Hartland Chief Operating and Finance Officer March 2016
DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 31 March 2016 Report: Sustainability and Transformation Plan Agenda item No: 7.0
TITLE OF REPORT:
Sustainability and Transformation Plan
PURPOSE OF REPORT:
To inform Board of the proposed Memorandum of Understanding to support the STP process.
AUTHOR OF REPORT:
Paul Maubach, Chief Executive Officer
MANAGEMENT LEAD:
Paul Maubach, Chief Executive Officer
CLINICAL LEAD:
David Hegarty, Chair
KEY POINTS:
RECOMMENDATION:
• Dudley CCG part of the Black Country STP Footprint • Draft Governance Structure to be Established • MOU received to be agreed by all Members of STP
To consider the attached MOU
FINANCIAL IMPLICATIONS:
WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED:
None Decision Approval Assurance
1|Page
Memorandum of Understanding Between the following organisations Birmingham City Council Birmingham Community Health Care NHS Trust Black Country Partnership NHS Foundation Trust City of Wolverhampton Council Dudley and Walsall Mental Health NHS Trust Dudley Group of Hospitals NHS Trust Dudley Metropolitan Borough Council NHS Dudley CCG NHS Sandwell and West Birmingham CCG NHS Walsall CCG NHS West Midlands NHS Wolverhampton CCG Royal Wolverhampton NHS Trust Sandwell and West Birmingham Hospitals NHS Trust Sandwell Metropolitan Borough Council Walsall Hospital NHS Trust Walsall Metropolitan Borough Council This Memorandum of Understanding (MOU) sets for the terms and understanding between Birmingham City Council, Birmingham Community Health Care NHS Trust, Black Country Partnership NHS Foundation Trust, City of Wolverhampton Council, Dudley and Walsall Mental Health NHS Trust, Dudley Group of Hospitals NHS Trust, Dudley Metropolitan Borough Council, NHS Dudley CCG, NHS Sandwell and West Birmingham CCG, NHS Walsall CCG, NHS West Midlands, NHS Wolverhampton CCG, Royal Wolverhampton NHS Trust, Sandwell and West Birmingham Hospitals NHS Trust, Sandwell Metropolitan Borough Council, Walsall Hospital NHS Trust and Walsall Metropolitan Borough Council (“the partners”) to develop and agree a Sustainability and Transformation Plan (“the STP”) for the Black Country Footprint. 1.
Background
1.1.
Following the publication of the Five Year Forward View in October 2014 and the planning guidance for 2016/17 in December 2015, health and social care organisations are required to work together to produce a place based STP. The STP will describe how organisations will work together to accelerate delivery of the Five Year Forward View.
1.2.
Organisations were asked to come together to develop proposals for a geographical footprint for the STP based on natural communities and existing working relationships, taking into account the scale needed to deliver the transformation required. A footprint for the Black Country covering Dudley, Sandwell and West Birmingham, Walsall and Wolverhampton has been agreed and the partners will be working together to produce the STP.
2.
Purpose
2.1.
This MOU sets out how the partners will work together in order to develop the STP. This includes both the key principles to be followed and the governance and accountability arrangements that will be in place.
2.2.
These arrangements will support the partners in ensuring that the STP is agreed and submitted by the end of June 2016 in line with the required national timeline. In order to achieve this, the partners will work together to ensure that the STP is agreed through the internal governance processes of all the partners prior to submission.
3.
Key Principles
3.1.
The overarching principle of this MOU is that the work to develop the STP will be undertaken jointly, with shared accountability for ensuring that it is agreed by all the partners. This will include jointly funding any specific pieces of work or support required to support the process andeach partner will ensure that they participate fully in the process.
3.2.
The partners have also agreed the following key principles to guide the work to develop the content of the STP:• The STP will recognise and build on existing local partnerships and commissioning arrangements across the STP footprint. • The partners will work together to optimise opportunities to access development funding to maximise individual and collective benefits. • The STP will recognise the key interrelationships individual partners have with other STP footprints (including but not limited to Staffordshire, Wyre Forest and Birmingham).
4.
Governance and Decision Making
4.1.
The partners have agreed that the work to produce the STP will be overseen by a Sponsoring Group made up of leaders from each of the partners that will have overall accountability for ensuring the STP is signed off in line with the required national timescale. There will also be an Operational Group which will manage the day to day work required to produce the plan and a Finance Group to oversee the financial elements of the plan.
4.2.
The key roles undertaken by the Sponsoring Group will be:• To set the overall strategic aims and objectives for the STP; • To agree the overall resource level allocated to the development of the STP; • To discuss and agree how any financial risks and issues arising from the STP will be managed; • To agree any joint communications arising from the development of the STP; and • To consider any other issues escalated from the operational group.
4.3.
The key roles undertaken by the Operational Group will be:• To allocate specific tasks to organisations or individuals to support the development of the STP; • To manage the delivery of work allocated to support the development of the STP; • To agree the allocation of resources within the overall levels agreed by the Sponsoring Group; • To understand and manage any risks associated with the development of the STP; and • To escalate to the Sponsoring Group any issues requiring decisions by Senior Leaders.
4.4.
The key roles undertaken by the Finance Group will be:• To lead on the delivery of the financial analysis required to support the development of the STP; • To develop assessments of how to meet the financial challenges outlined in the STP; and • To support the alignment of planning assumptions across the partners.
4.5.
Detailed Terms of Reference for these groups, setting out membership and decision making arrangements are appended to this MOU.
4.6.
Any decisions that are required in relation to the development of the STP that are outside the boundaries defined in their terms of reference must be referred to the internal governance arrangements of the partners. This includes the final agreement of the STP prior to submission.
4.7.
Each of the partners will be responsible for making appropriate arrangements to report back on the work to develop the STP through their internal governance arrangements.
5.
Duration and Review
5.1.
This MOU is initially established for the purpose of producing the STP in line with the timetable set out in the national planning guidance and will be reviewed once the STP has been agreed, submitted and agreed.
5.2.
Governance arrangements for the on-going management and delivery of the STP will form part of its development and will be a key consideration of the review of this MOU.
Signed for and on behalf of the partners
Organisation Birmingham City Council Birmingham Community Health Care NHS Trust Black Country Partnership NHS Foundation Trust City of Wolverhampton Council Dudley and Walsall Mental Health NHS Trust Dudley Group of Hospitals NHS Trust Dudley Metropolitan Borough Council NHS Dudley CCG NHS Sandwell and West Birmingham CCG NHS Walsall CCG NHS West Midlands NHS Wolverhampton CCG Royal Wolverhampton NHS Trust Sandwell and West Birmingham Hospitals NHS Trust Sandwell Metropolitan Borough Council Walsall Hospital NHS Trust Walsall Metropolitan Borough Council
Name and Position of Signatory
Date Signed
Master Sign Off Sheet Contact Information
Partner name
Name of Signatory
Position
E-mail address
Signature
Date
Please return to xxx
Appendix 1 Black Country Sustainability and Transformation Plan Sponsoring Group Terms of Reference 1.
Purpose The Sponsoring Group has been established to oversee the development of the Sustainability and Transformation Plan for the Black Country on behalf of the partner organisations. The group will have the overall accountability for ensuring the STP is signed off in line with the timescales set out in the national planning guidance.
2.
Membership The Group will be made up of a nominated Senior Leader from each of the following partner organisations:• Birmingham City Council • Birmingham Community Health Care NHS Trust • Black Country Partnership NHS Foundation Trust • City of Wolverhampton Council • Dudley and Walsall Mental Health NHS Trust • Dudley Group of Hospitals NHS Trust • Dudley Metropolitan Borough Council • NHS Dudley CCG • NHS Sandwell and West Birmingham CCG • NHS Walsall CCG • NHS West Midlands • NHS Wolverhampton CCG • Royal Wolverhampton NHS Trust • Sandwell and West Birmingham Hospitals NHS Trust • Sandwell Metropolitan Borough Council • Walsall Hospital NHS Trust • Walsall Metropolitan Borough Council
3.
Key Responsibilities The group will have the following key responsibilities:• To set the overall strategic aims and objectives for the STP; • To agree the overall resource level allocated to the development of the STP; • To discuss and agree how any financial risks and issues arising from the STP will be managed; • To agree any joint communications arising from the development of the STP; • To consider any issues escalated from the operational group; and
•
4.
To determine issues that require referral back to partner organisations for consideration.
Meeting Arrangements Meetings of the group will be chaired by the Accountable Officer of NHS Sandwell and West Birmingham CCG who will be responsible for arranging appropriate administrative support for:• Arranging meetings and notifying attendees • Circulating Agendas and supporting papers • Producing and circulating actions following the meeting In line with the expectation for full participation outlined in the MOU, members must make every effort to attend meetings of the group however if they are not able to attend, they will be able to nominate a substitute by informing the Chair prior to the meeting beginning. Meetings will be quorate provided that more than 50% of the members (or nominated substitutes) are in attendance.
5.
Decision Making In line with the principle of joint working, decisions made by the group must be reached by consensus. For decisions requiring agreement of all partners (such as financial issues or joint communications), consent must also be sought from organisations not represented at the meeting. Should urgent decisions be required outside of the meeting, the chair will be responsible for ensuring the views of all organisations are sought via email. Members of the group will be responsible for feeding back on any issues referred by the group to the partner organisations for decision.
Appendix 2 Black Country Sustainability and Transformation Plan Operational Group Terms of Reference
1.
Purpose The Operational Group has been established to support the development of the Sustainability and Transformation Plan for the Black Country on behalf of the Sponsoring Group and the partner organisations.
2.
Membership The Group will be made up of a nominated representative from each of the following partner organisations:• Birmingham City Council • Birmingham Community Health Care NHS Trust • Black Country Partnership NHS Foundation Trust • City of Wolverhampton Council • Dudley and Walsall Mental Health NHS Trust • Dudley Group of Hospitals NHS Trust • Dudley Metropolitan Borough Council • NHS Dudley CCG • NHS Sandwell and West Birmingham CCG • NHS Walsall CCG • NHS West Midlands • NHS Wolverhampton CCG • Royal Wolverhampton NHS Trust • Sandwell and West Birmingham Hospitals NHS Trust • Sandwell Metropolitan Borough Council • Walsall Hospital NHS Trust • Walsall Metropolitan Borough Council
3.
Key Responsibilities The group will have the following key responsibilities:• To allocate specific tasks to organisations or individuals to support the development of the STP; • To manage the delivery of work allocated to support the development of the STP; • To agree the allocation of resources within the overall levels agreed by the Sponsoring Group; • To understand and manage any risks associated with the development of the STP; and
•
4.
To escalate to the Sponsoring Group any issues requiring decisions by Senior Leaders.
Meeting Arrangements Meetings of the group will be chaired by [TBC – ideally a member of the Sponsoring Group] who will be responsible for arranging appropriate administrative support for:• Arranging meetings and notifying attendees • Circulating Agendas and supporting papers • Producing and circulating actions following the meeting In line with the expectation for full participation outlined in the MOU, members must make every effort to attend meetings of the group however if they are not able to attend, they will be able to nominate a substitute by informing the Chair prior to the meeting beginning. Meetings will be quorate provided that more than 50% of the members (or nominated substitutes) are in attendance.
5.
Decision Making In line with the principle of joint working, decisions made by the group must be reached by consensus. In the event of the group being unable to reach a consensus, the chair will refer the issue to the Sponsoring group. Should urgent decisions be required outside of the meeting, the chair will be responsible for ensuring the views of all organisations are sought via email. The Chair will be responsible for feeding back on any issues referred by the group to the Sponsoring Group for decision.
Appendix 3 Black Country Sustainability and Transformation Plan Finance Group Terms of Reference
1.
Purpose The Finance Group has been established to oversee the development of the finance components Sustainability and Transformation Plan for the Black Country on behalf of the Sponsoring Group and the partner organisations.
2.
Membership The Group will be made up of the Directors of Finance/Chief Finance Officers (or their nominated representative) from each of the following partner organisations:• Birmingham City Council • Birmingham Community Health Care NHS Trust • Black Country Partnership NHS Foundation Trust • City of Wolverhampton Council • Dudley and Walsall Mental Health NHS Trust • Dudley Group of Hospitals NHS Trust • Dudley Metropolitan Borough Council • NHS Dudley CCG • NHS Sandwell and West Birmingham CCG • NHS Walsall CCG • NHS West Midlands • NHS Wolverhampton CCG • Royal Wolverhampton NHS Trust • Sandwell and West Birmingham Hospitals NHS Trust • Sandwell Metropolitan Borough Council • Walsall Hospital NHS Trust • Walsall Metropolitan Borough Council In addition, lead representatives from the Operational Group and from the Vanguard projects will be invited to attend the group.
3.
Principles In addition to the overall principles outlined in the Memorandum of Understanding between the partners, the group has established the following additional principles that will apply to its work:• Each partner will contribute to the work of the group in an open and transparent manner; and • Each partner will respond to requests for information/ data to support the work of the group within agreed timeframes to avoid causing delays.
4.
Key Responsibilities The group will have the following key responsibilities:• To lead on the delivery of the financial analysis required to support the development of the STP, including:o A forecast of Income and Expenditure across all organisations within the Black Country to 2020/21 o Determination of the gross financial challenge o To understand and take account of options for closing the financial gap that have already identified by the partners • To develop assessments of how to meet the financial challenges outlined in the STP; • To support the alignment of planning assumptions across the partners; • To allocate and oversee specific pieces of work required to develop the financial elements of the STP; and • To escalate any issues to the Operational or Sponsoring Groups as required.
5.
Meeting Arrangements Meetings of the group will be held fortnightly at Wolverhampton CCG Offices and will be chaired by [TBC] who will be responsible for arranging appropriate administrative support for:• Circulating Agendas and supporting papers • Producing and circulating actions following the meeting • Arranging any additional meetings as required In line with the expectation for full participation outlined in the MOU, members must make every effort to attend meetings of the group however if they are not able to attend, they will be able to nominate a substitute by informing the Chair prior to the meeting beginning. Meetings will be quorate provided that more than 50% of the members (or nominated substitutes) are in attendance.
6.
Decision Making In line with the principle of joint working, decisions made by the group must be reached by consensus. In the event of the group being unable to reach a consensus, the chair will refer the issue to the Operational group in the first instance. Should urgent decisions be required outside of the meeting, the chair will be responsible for ensuring the views of all organisations are sought via email. The Chair will be responsible for feeding back on any issues referred by the group to the Operational or Sponsoring Group for decision.
Sponsoring Group
Operational Group
The Triple Aims
1
2
3
Finance
Prevention- Health Outcomes and Health Gaps
Care Quality (Clinical Pathways)
Work Streams
Networked Secondary Care and urgent care
Integrated Primary and Community Care
Adult Mental Health LD
Maternity and children’s including CAMHS/ SEND
Enablers
Workforce
IM&T and data
Economic development modelling
Black Country Sustainability & Transformation Plan 11 April Submission
Black Country Sustainability & Transformation Plan - Footprint
Black Country Sustainability and Transformation Plan - Partners • Dudley MBC • Walsall MBC • Sandwell MBC • Wolverhampton City Council • Birmingham City Council • NHS England Specialised Commissioning • Dudley CCG • Walsall CCG • Wolverhampton CCG • Sandwell and West Birmingham CCG
• Black Country Partnerships Mental Health NHS Foundation Trust • Dudley and Walsall Mental Health NHS Trust • Sandwell and West Birmingham Hospitals NHS Trust • Dudley Group NHS Foundation Trust • Walsall Healthcare NHS Trust • Royal Wolverhampton Hospital NHS Trust • West Midlands Ambulance Service • Birmingham Community Health Care NHS Trust
Black Country Sustainability & Transformation Plan – The Scale of Our Challenge: a Gap Analysis • Right Care Analysis (Black Country scale) • health and wellbeing • care and quality • finance and efficiency
• Wider Financial Analysis (Black Country scale) • finance and efficiency
Black Country Sustainability & Transformation Plan - Priorities • Closing the gaps in • health and wellbeing • care and quality • finance and efficiency
• Identifying initiatives with the greatest benefit at an early stage • Engaging patients, clinicians, staff and wider partners • Spreading and connecting successful local initiatives • Platform for investment from the Sustainability and Transformation Fund
Black Country Sustainability & Transformation Plan – Closing the Gaps Gap
Priority Actions
Health & Well Being
To be determined
Care & Quality
To be determined
Finance & Efficiency
To be determined
Black Country Sustainability & Transformation Plan – Current work focused on
• Establishing inclusive groups as part of our governance which draw membership from all partners • Developing our engagement plans • Identifying how we spread and connect successful local initiatives • Identifying how we invest Sustainability & Transformation funds • Creating a Black Country STP Fund
Black Country Sustainability & Transformation Plan - Governance Sponsoring group Operational group Finance group • CSU Strategy Unit
Black Country Sustainability & Transformation Plan - Sponsoring Group •
Andy Williams (Chair), Accountable Officer, Sandwell & West Birmingham CCG
•
Salma Ali, Accountable Officer, Walsall CCG
•
Helen Hibbs, Accountable Officer, Wolverhampton CCG
•
Paul Maubach, Accountable Officer, Dudley CCG
•
Karen Dowman, CEO, Black Country Partnerships Mental Health NHS Foundation Trust
•
Mark Axcell, Acting CEO, Dudley and Walsall Mental Health NHS Trust
•
Toby Lewis, CEO, Sandwell and West Birmingham Hospitals NHS Trust
•
Paula Clark, CEO, Dudley Group NHS Foundation Trust
•
Richard Kirby, CEO, Walsall Healthcare NHS Trust
•
David Loughton, CEO, Royal Wolverhampton Hospital NHS Trust
•
Anthony Marsh, CEO, West Midlands Ambulance Service
•
Tracy Taylor, CEO, Birmingham Community Health Care NHS Trust
•
Sarah Norman, CEO, Dudley MBC
•
Paul Sheehan, CEO, Walsall MBC
•
Keith Ireland, Managing Director, Wolverhampton City Council
•
David Stevens, Director of Adult Services, Sandwell MBC
•
Alan Lotinga, Service Director, Health and Well Being, Birmingham City Council
•
Simon Collins, Associate Director, NHS England Specialised Commissioning
Black Country Sustainability & Transformation Plan – Operational Group • Representatives from •
Black Country Partnerships Mental Health NHS Foundation Trust
•
Dudley and Walsall Mental Health NHS Trust
•
Sandwell and West Birmingham Hospitals NHS Trust
•
Dudley Group NHS Foundation Trust
•
Walsall Healthcare NHS Trust
•
Royal Wolverhampton Hospital NHS Trust
•
West Midlands Ambulance Service
•
Birmingham Community Health Care NHS Trust
•
Dudley MBC
•
Walsall MBC
•
Wolverhampton City Council
•
Sandwell MBC
•
Dudley CCG
•
Sandwell & West Birmingham CCG
•
Walsall CCG
•
Wolverhampton CCG
•
Birmingham City Council
•
NHS England Specialised Commissioning
Black Country Sustainability & Transformation Plan – Finance Group •
Kevin Stringer, Royal Wolverhampton Hospitals NHS Trust
•
Paul Taylor, Dudley Group NHS Foundation Trust
•
Russell Coldicot, Walsall Healthcare NHS Trust
•
Chris Archer, Sandwell & West Birmingham Hospitals NHS Trust
•
Tracey Cotterill, Black Country Partnership NHS Foundation Trust
•
Rupert Davies, Dudley and Walsall Mental Health Trust
•
Peter Axon, Birmingham Community Health Care NHS Trust
•
Linda Millincamp, West Midlands Ambulance Service
•
Mark Taylor, Wolverhampton City Council
•
James Walsh, Walsall MBC
•
Paul Benge, Dudley MBC
•
Charlie Davey, Sandwell MBC
•
Margaret Ashton-Grey, Birmingham City Council
•
Paul Assinder, Provex
•
Matthew Hartland, Dudley CCG
•
Claire Skidmore, Wolverhampton CCG
•
Tony Gallagher, Walsall CCG
•
James Green, Sandwell & West Birmingham CCG
Black Country Sustainability & Transformation Plan - Workstreams Workstream
Lead
Narrowing the Health & Well Being Gap
Ros Jervis, Director of Public Health, Wolverhampton City Council
Narrowing the Care & Quality Gap
Dr David Hegarty, Chair, Dudley CCG
Narrowing the Finance & Efficiency Gap
James Green, Chief Finance Officer, Sandwell & West Birmingham CCG
Black Country Sustainability & Transformation Plan - Transformation Groups and Enablers Group Primary Community & Social Care Integration Urgent Care Mental Health (including Learning Disabilities) Maternity Services Specialised Services Children’s Services Cancer Elective Care Enablers: Workforce, IM&T and Data, Economic Development Modelling
Black Country Sustainability & Transformation Plan - Principles We will work at scale to develop plans and explore solutions and the partners have established a number of key principles to guide us • Subsidiarity – building on local planning arrangements and partnerships • Mutuality – acting together to maximise access to development funding • Added value – avoiding duplication or compromise of existing work/partnerships • No boundaries – not allowing the creation of the STP to create new boundaries that might compromise the delivery of care
DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 31 March 2016 Report: Procurement Strategy Agenda item No: 8.0 TITLE OF REPORT:
CCG Procurement Strategy
PURPOSE OF REPORT:
To present the revised CCG Procurement Strategy to the Board for approval
AUTHOR OF REPORT:
Mr A Nicholls, Head of Intelligence Mr R Ward, Procurement Manager, NHS Midlands and Lancashire Commissioning Support Unit (CSU).
MANAGEMENT LEAD:
Mr M Hartland, Chief Operating and Finance Officer
CLINICAL LEAD:
Dr J Darby, Clinical Executive The previous CCG Strategy has been updated in order to reflect changes in procurement rules and guidance. The major changes are summarised below: •
• • KEY POINTS:
Section 6 – New OJEU thresholds came into force from January 2016 for Goods and Non-healthcare Services Procurement. For expenditure above £164,176 a full OJEU compliant competitive process must take place. Section 6 – Revision of Procurement thresholds moving to a £50,000 limit for Competitive Quotes. Section 9.6 – Introduction of the new ‘Light Touch’ and ‘Non-Light Touch’ regimes. These regimes are already in existence but are extended to include Clinical Health Services from 18 April 2016. A contract for a Non-Light Touch service is subject to the full requirements of the regulations if the value is above the prescribed threshold. These are services such as computer and related services; accounting, auditing and book-keeping services, and management consultancy services which are required to be advertised across the EU. Services (Light Touch) are subject to the light touch regime of the Public Contract Regulations 2015. The services include those listed at Schedule 3 of the Public Contract Regulations 2015 and will include Clinical Health Services.
1|Page
RECOMMENDATION:
The Board is asked to approve the revised CCG Procurement Strategy
FINANCIAL IMPLICATIONS:
None
WHAT ENGAGEMENT HAS TAKEN PLACE:
Commissioning Support Unit and CCG collaboration.
ACTION REQUIRED:
Decision Approval Assurance
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Dudley CCG Procurement Strategy APRIL 2016
Version Control Version 0.1 0.2 0.3
Date 18/2/2013 28/2/2013 19/3/2013
Author Mike Evans Mike Evans Mike Evans
1.0 1.1
9/4/2013 20/5/2013
Mike Evans Mike Evans
1.2
27/10/2013
1.3 1.4 1.5
29/10/2013 31/10/2013 10/07/2015
Anthony Nicholls & Mike Evans Matthew Hartland Audit Committee Richard Ward
1.6
25/02/2016
Richard Ward
Changes New Draft Update to include comments from GH and LW Updated to take into account changes to the NHS (PPCC) (No 2) Regulations Minor Mods Estimated timings added to section 5. (BSC request). Risk management table deleted. Major modifications, deletions and insertions in line with CCG requirements. Strategy review, amend & sign off Approved Amendments in relation to applicable regulations – i.e. PCR 2006 superseded by PCR 2015. (Applicable to th Healthcare Services from 18 April 2016). Reference to Supply2Health replaced with Contracts Finder. Removed reference to PRCC as superseded by PPCC Regulations. Updated OJEU Thresholds (Jan 2014) Section 6 - Updated OJEU Thresholds (Jan 2016) Section 6 - CCGs are sub central government authorities – Corrected thresholds to reflect this. Section 6 – Updated Quotation threshold from £5k to £10k to reflect June 2013 CCG financial limits Section 9.6 – Updated wording and include additional detail around light touch regime. Section 5 - Amendment to diagram (Summary of procurement process) Section 5 – Additional & Amended wording to appropriately reflect LTR
Contents 1.
Introduction and Overview ............................................................................................................. 4
2.
General Procurement Principles ..................................................................................................... 5
3.
Scope and Context of the Strategy ................................................................................................. 6
4.
Dudley CCG Priorities ...................................................................................................................... 7
5.
Healthcare Services Procurement................................................................................................... 9
6.
Goods and Non-Healthcare Services Procurement ...................................................................... 17
7.
Conflicts of Interest ....................................................................................................................... 20
8.
Governance ................................................................................................................................... 21
9.
Other Considerations .................................................................................................................... 22
1. Introduction and Overview This strategy document is intended to inform the procurement decisions of the CCG and to provide assurance as to the most appropriate route to market for all types of goods and services. This strategy has been written taking into account current competition and procurement rules and will be updated in line with any changes to UK and EU legislation. For the strategy to be effective, and for procurement to make a strategic impact within the organisation, the scope and content of the strategy must be applied to all non-pay expenditure procured within the CCG. The main aims of this strategy are to make real and positive contributions to the strategic direction of the organisation in the following areas: • • • • • • • •
Supporting the savings agenda across the NHS Streamlining procurement processes Making a direct contribution to improved patient care and treatment outcomes Managing change brought about by organisational reconfiguration Enabling the organisation to be more commercially focussed Supporting collaborative procurement Enabling the organisation to support government initiatives in public procurement Effective use of resources
The CCG’s Chief Finance & Operating Officer has overall responsibility for the implementation of the strategy.
2. General Procurement Principles The following principles should govern the administration of procurement within the CCG:2.1. Procurement of healthcare services (categorised as Part B services under the Public Contracts Regulations 2006) should be conducted in accordance with The National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013, including any subsequent guidance, and in accordance with the Public Contracts Regulations 2006 insofar as they apply to Part B services*. 2.2. Procurement of non-healthcare services (i.e. goods and other services) should be conducted in accordance with the Public Contracts Regulations 2015. 2.3. Proportionality - Procurements should be carried out as cost effectively as possible. The level of resources applied should be proportionate to the value and complexity of the services to be procured. 2.4. Transparency - Procurements should be transparent. CCGs must be able to account publicly for expenditure and actions by advertising procurement opportunities, publishing evaluation and scoring criteria in procurement documents, publishing details of contract awards on Contracts Finder and OJEU, and maintaining an auditable documentation trail of key decisions. 2.5. Non-Discrimination - The specification and bidding process must not discriminate against or in favour of any particular provider or group of providers. Objective evaluation criteria must be applied to all bids. 2.6. Equality of Treatment - All potential providers must be treated the same throughout a procurement process. This means that the same information must be provided to all potential providers at the same time; and rules of engagement and evaluation criteria must be specified in advance of provider involvement and be applied in the same way to each potential provider. 2.7. Addressing Health Inequalities – one of the key priorities of Dudley CCG is closing the gap between health inequalities for the Dudley population. All procurements should have a regard for achieving this goal. 2.8. All procurements should have a regard for ‘social value’ or the collective benefit to the community in which the procured service will operate.
*Healthcare services will continue to operate on the basis of the Public Contract Regulations 2006 until 18th April 2016. After which, application of the Public Contract Regulations 2015 will apply
3. Scope and Context of the Strategy This strategy incorporates the total non-pay expenditure of the CCG which includes the procurement of all goods and services, as well as the procurement of healthcare services. There is a legislative framework within which public sector procurement operates and the CCG has a duty to meet these legislative responsibilities whilst ensuring the health needs of its population are being met. This is supported by Public Sector procurement regulations and NHS specific regulations and guidance, which includes, but is not limited to (and is subject to change): • • • • •
The National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013. The Public Contracts Regulations 2006. (Health services - applicable to the 18th April 2016 only) The Public Contract Regulations 2015 The Public Contracts (Amendment) Regulations 2009 (also known as the Remedies Directive). The Public Services (Social Value Act) 2012.
4. Dudley CCG Priorities The CCG became a statutory body on 1st April 2013. The Metropolitan Borough of Dudley is made up of the 5 localities of: Brierley Hill, Stourbridge, Dudley North, Halesowen and Sedgley. Around 305,000 people live in the Borough and the population is very diverse. There are areas of high deprivation and cultural diversity in the North of the Borough. While areas like Stourbridge are home to some of the most affluent communities in the country. We recognise that people’s health is linked to their social circumstances, with generally the poorest people having the worst health. Because of the diverse areas in Dudley, the people in the more affluent areas can expect to live 9 years longer than those in the less affluent. As a CCG we are committed to closing this gap and making sure that health inequalities are reduced and we work with partners to achieve this. The CCG has carried out a wide consultation with constituent practices, partners, patient groups and the public on what is important to them. Consultation involved face to face interaction through a number of events including a stakeholder conference entitled ‘Nothing About You, Without You. Thinking Differently’. This work has resulted in the establishment of three strategic commissioning aims for the CCG, and 10 commissioning priorities as follows: CCG Strategic Commissioning Aims • • •
To address health inequalities in Dudley To ensure that local services deliver the best possible outcomes for the whole population To improve the quality and safety of local services.
Overarching Priorities • • • •
urgent care planned care preventative reablement
Commissioning Priorities • • • • • • • •
‘Early Intervention’ and developing a Community Based model for the delivery of Children’s Services Improving Urgent Care Redesigning ‘Primary Care’ Mental Health Services Improving care for the Elderly including Elderly Mentally Ill Improving services for people with Diabetes Improving Access to Cardiology Services Reviewing Community Ophthalmology Services Developing post admission and rehab services for Stroke patients
• •
Improving Community Nursing Services Developing Psychological input to Alcohol Services
The CCG commissions all services in a way which promotes continuous improvement in quality and efficiency. In addition to service priorities the CCG will also have a range of other ‘priorities’ which are focussed on the CCG running its business effectively and efficiently. Please refer to Dudley CCG Strategic Plan 2014-2019 which can be found at http://www.dudleyccg.nhs.uk/wp-content/uploads/2013/04/Dudley-CCG-Strategic-Plan-June-20142019.pdf;
5. Healthcare Services Procurement Procurements for healthcare services must be conducted taking into consideration The National Health Service (Procurement, Patient Choice and Competition) Regulations 2013. These Regulations impose requirements on CCGs to ensure good practice when procuring health care services, to protect patients’ rights to make choices and to prevent anti-competitive behaviour. The Regulations provide scope for complaints to, and enforcement by Monitor, as an alternative to challenging decisions in the courts. The regulations formalise previous requirements set out in the Principles and Rules of Co-operation and Competition 2010. The Regulations will apply alongside the Public Contracts Regulations 2006 (Until 18th April 2016 whereby Public Contract Regulations 2015 will apply) and do not affect their application. 5.1. The National Health Service (Procurement, Patient Choice and Competition) (no 2) Regulations 2013. The key points of the legislation are as follows (for the full regulations, refer to http://www.legislation.gov.uk/uksi/2013/500/contents/made):5.1.1.Procurement: Objective When procuring health care services a CCG must act with a view to— a) securing the needs of the people who use the services, b) improving the quality of the services, and c) improving efficiency in the provision of the services. Which can include through the services being provided in an integrated way. 5.1.2.Procurement: General Requirements When procuring health care services, a CCG must:a) act in a transparent and proportionate way, and b) treat providers equally and in a non-discriminatory way, including by not treating a provider more favourably than any other provider, in particular on the basis of ownership. The CCG must procure the services from one or more providers that:a) are most capable of delivering the procurement objective (5.1.1), and b) provide best value for money in doing so. In acting with a view to improving quality and efficiency in the provision of the services the CCG must consider appropriate means of making such improvements, including through:a) the services being provided in a more integrated way, b) enabling providers to compete to provide the services, and c) allowing patients a choice of provider of the services. 5.1.3.Advertisements and Expressions of Interest
NHS England has mandated Contracts Finder as the website used for the advertising of opportunities for providers of healthcare. Where advertising an intention to seek offers, the CCG must publish a contract notice on this website which must include the criteria against which bids will be evaluated. 5.1.4.Award of a Contract Without Competition The CCG may award a new contract for healthcare services without advertising an intention to seek offers, where the CCG is satisfied that the service is capable of only being provided by that provider. 5.1.5.Conflicts of Interest The CCG must not award a contract where conflicts, or potential conflicts, between the interests involved in commissioning such services and the interests involved in providing them affect, or appear to affect, the integrity of the award of that contract. In relation to each contract that it has entered into, the CCG must maintain a record of how it managed any conflict that arose between the interests in commissioning the services and the interests involved in providing them. Please refer to the separate section of this document concerning Conflicts of Interest. 5.1.6.Anti-Competitive Behaviour When commissioning health care services a CCG must not engage in anti-competitive behaviour, unless to do so is in the interests of people who use health care services which may include: a) by the services being provided in an integrated way (including with other health care services, health-related services, or social care services); or b) by co-operation between the persons who provide the services in order to improve the quality of the services. 5.1.7.Powers of Monitor to Investigate Monitor may investigate a complaint received by it that the CCG has failed to comply with a requirement imposed by the regulations. Monitor may on its own initiative investigate whether a relevant body has failed to comply with the Anti-Competitive Behaviour requirements of the regulations. NHS England and Monitor will work on a “choice and competition framework” which will include more detail about how commissioners should work. This strategy will be updated to take into account any subsequent advice and guidance. 5.2. Procurement Options 5.2.1.Contract Variation Where there is a contract already in place, the CCG may be able to use the contract to secure incremental change to service provision, but only where change was envisaged
in the contract and where this change does not materially alter the nature of the contract as originally procured. This would be likely to be considered the case where: a) other providers would have been interested in bidding for the contract if the change had originally been part of the specification when the service was originally procured; b) the contract would have been awarded to a different provider if the change had originally been included in the original service specification; c) the change involves genuinely new services not originally within the scope of the specification; or, d) there is a significant change in the value of the contract. 5.2.2.Any Qualified Provider Under AQP, any provider who can meet quality requirements and agree to set prices is accredited to deliver the service. Providers have no volume guarantees and patients will decide which providers to be referred to. To determine whether of AQP is appropriate, the CCG must consider the characteristics of the service and the local healthcare system. This will include whether the service lends itself to patient choice. One of the key features of the suitability of AQP is whether the circumstances of the service mean that patients would be in a position to exercise choice. So, it is more suitable for planned services than emergency services. Good examples are podiatry and adult hearing services. Where AQP is used, the service specification, pricing structure, key contractual terms and assessment criteria needs to be determined before advertising. Once advertised, providers should qualify if they can: a) meet quality requirements; b) meet the Terms and Conditions of the NHS Standard Contract; c) accept the standard price for the service; and d) provide assurances that they are capable of delivering the agreed service requirements that you have 5.2.3.Competitive Tendering A competitive process will demonstrate fairness, equality, transparency and nondiscrimination in the procuring of services and will also demonstrate value for money. There are several types of competitive tendering processes that can be considered. The ultimate choice of process will be informed by market analysis. For example, if a large number of providers are likely to be interested, a multi-stage tendering process should be considered (commonly referred to as the Restricted Process) to restrict the number of providers invited to bid. This can make the process more manageable. In response to the advert, interested parties only submit pre-qualification information, and those then shortlisted receive an Invitation to Tender.
If a smaller number of providers are likely to be interested, a single stage tendering process should be considered (referred to as Open Process), where pre-qualification and tender stages are conducted together. All potential suppliers complete a tender in response to the advertisement. For a procurement where innovative solutions are being sought or the CCG needs to work with the providers to develop the service model, it may be more appropriate to use a process that allows for a dialogue with bidders, rather than just asking for bids in response to a defined specification. This is commonly referred to as Competitive Dialogue. As with AQP, all competitive tendering processes must be conducted fairly and transparently, and have clear criteria for award published in advance. From the 18th April 2016 the Public Contract Regulations 2016 will apply to Healthcare services. Healthcare services are classed under the new light touch regime which allows significant flexibility in relation to the procurement process undertaken. (See section 9.6) 5.2.4. No Competition Where it is determined that the services are capable of being provided only by one provider or there is an urgent clinical need, it may be appropriate to proceed with a single tender action, where a contract is awarded to a single provider – or a limited group of providers – without competition. (Refer to 5.1.4). 5.3 Procurement from Primary Care Providers The CCG’s primary care strategy defines the operating model by which the CCG intends to commission services. This is largely based around the locality structure. The CCG will work with NHS England to define an appropriate procurement model for services to be delivered on such a basis where appropriate. In May 2014, NHS England offered CCG’s the opportunity to take on increased responsibility, including delegated budgets and functions for the commissioning of Primary Care. Dudley CCG opted to take on this increased responsibility thereby opening up the ability to commission care for the Dudley population in a more tailored and coherent way. However, this increased responsibility brings with it a greater risk of conflicts of interest. A guidance document has been produced; ‘Managing Conflicts of Interest: Statutory Guidance for CCG’s’, NHS England 2014. Annex 4 to this guidance (Procurement Template) is included in this strategy as an appendix and will need to be completed for all procurements with the potential for GP provision or pecuniary interest. Also see section 7 ‘Conflicts of Interest’ in this strategy document. 5.4 Consultation The CCG will actively consult with member practices, localities and the public where appropriate for the proposed service change. This will be done in line with commissioning strategy and EU procurement rules.
5.5 Timeframe (Healthcare Procurement) The length of time procurement for a healthcare service will take will vary according to the requirements of the specific procurement. As an indication, an average procurement will take 5-6 months from placing the advert on Contracts Finder to awarding the contract. This does not include pre-procurement activities such as market research. A procurement could be less or more than this depending on complexity or time allowed for bidder responses and evaluation etc.
Summary of the Healthcare Procurement Decision Making Process
Have you decided that a new service model or significant additional capacity is required or has an existing contract come to the end of its term?
Yes
Can this be delivered through an existing contract without breaching procurement rules?
Yes
Implement contract variation, extension or management with existing service provider
No
Is there likely to be more than one viable provider?
No
Use Single Tender Action
Yes
Consider: Is it envisaged as part of the original procurement and contract? Would it have affected the original choice of provider? Have you taken legal advice?
Consider: Have appropriate steps been taken to identify other capable providers? Will delivery still be value for money? Have conflicts of interest been declared and dealt yes with?
Conduct competitive procurement
Is the service suitable for a local AQP Framework?
Yes
Set up AQP framework following appropriate accreditation process
No
Consider which procurement process is appropriate
Does specification require further development with providers or do you want innovation from bidders?
No
Yes
Use procurement procedure that allows for dialogue
Use simpler procurement procedure with no dialogue
Consider: Is your process transparent, proportionate and nondiscriminatory? Do you need to reduce the number of likely bidders? How will you treat all bidders equally?
Consider: Is your process transparent, proportionate and nondiscriminatory? Do you need to reduce the number of likely bidders? How will you treat all bidders equally? What are your award criteria? Where will you advertise? Have conflicts of interest been declared and dealt
When considering a contract variation, extension or management with existing provider, the commissioner should consider whether it was envisaged as part of the original procurement and contract and whether or not it have affected the original choice of provider. When considering a single tender action, consider whether appropriate steps have been taken to identify other capable providers, whether or not delivery will still represent value for money, and whether or not there a potential conflicts of interest. From the 18th April 2016, authorities will have the flexibility to use any procurement process or procedure they choose to run the procurement, as long as it respects the obligations of the light touch regime (see section 9.6). There is no requirement to use the standard EU procurement procedures (open, restricted and so on) that are available for other (non-Light Touch Regime) contracts. Authorities can use those procedures if helpful, or tailor those procedures according to their own needs, or design their own procedures altogether.
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Summary of the Procurement Process
Health Market Analysis
Service Specification
Needs Assessment
CCG Business Case
Procurement Strategy e.g. Tender process, Contract T&Cs
Tender Documents e.g. Questions, criteria, weightings etc.
Advertise
AQP
AQP Accreditation
tender Procurement Process
Contract Award
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6. Goods and Non-Healthcare Services Procurement Goods and Services procurement must be carried out in accordance with legislation (Public Contract Regulations 2015) and in accordance with the CCG’s Standing Financial Instructions (SFIs). The table below summarises the CCG’s SFIs, and corresponding procurement options based on expected value of the procurement:Table 1 Total Contract Value £0 £10,000 (see 6.1)
Type of Procurement Transactional
£10,001 to £50,000 Competitive Quotes (see 6.2) (Using quotes from suppliers in which the best one is chosen on price and product). £50,001 to £164,176 Formal quotation / mini-tender (see 6.3) (A formal statement of promise by potential suppliers at specified prices for goods and services within a specified period) >£164,176* Full competitive tender (see 6.4)
Procurement Options** NHS Supply Chain via requisition Other approved supplier via requisition Use available framework (e.g. Government Procurement Service, NHS Supply Chain) If no framework exists, obtain 3 quotations. Use available framework (e.g. Government Procurement Service, NHS Supply Chain) If no framework exists, conduct formal quotation/mini-tender process. Seek specialist procurement advice
*OJEU threshold as of 1/1/2016 (likely to be valid until 31st December 2017) When goods and services are required, the CSU Procurement Team will act on requests to order upon receiving an approved requisition. The responsibility to raise a requisition lies with the individual and/or department who require the goods or services. The CCG SFIs must be taken into account when the requisitioner is planning to raise a requisition. 6.1. For expenditure up to £10,000 The procurement should be carried out by informal price testing and a requisition being raised by the person who requires the goods or services, and should follow normal CCG requisitioning and authorisation processes. 6.2. For expenditure between £10,001 and £50,000 The procurement should be carried out by the requisitioner obtaining 3 quotations and raising a requisition following normal CCG requisitioning and authorisation processes. The quotations should be attached to the requisition. 6.3. For expenditure between £50,001 and £164,176 A formal quotation/mini-tender process (see definition of formal quotation in table 1) must take place. A requisition will be required which must be raised following the normal CCG requisitioning and authorisation processes. 17 | P a g e
6.4. For expenditure above £164,176 A full OJEU compliant competitive process must take place. A requisition will be required which must be raised following the normal CCG requisitioning and authorisation processes. 6.5. Tender Waivers If a competitive process above the value of £50,000 but below the OJEU threshold is not to be followed then a tender waiver form must be completed in accordance with CCG procedures. Any “no tender” decision that the CCG makes needs to be clearly documented to ensure that the CCG is adhering to the organisation’s SFIs and procurement law. All ‘no tender’ decisions must be documented and should represent the decision of the organisation rather than an individual. Where a need to tender is being waived, then an approved tender waiver document must be submitted by the requisitioner with the requisition. Authorisation of expenditure must be compliant with the CCG’s standing financial instructions on all occasions. 6.6. Requisitioners The CCG must ensure that all departments that are likely to need to procure goods and services, have nominated representatives who are able to raise requisitions, with appropriate approval levels for different requirement costs. The CCG will also need to notify any changes to requisitioner. 6.7. Framework Agreements Where possible, goods and services will be obtained by utilising an existing framework agreement. A framework is an agreement with suppliers to establish terms governing contracts that may be awarded during the life of the agreement. In other words, it is a general term for agreements that set out terms and conditions for making specific purchases (call-offs). A framework covers the provision of a generic group of goods, works or services (or a combination), for example: Goods – office furniture Services – consultancy Frameworks can take a number of forms, including a framework with one supplier for a specific category or a framework with a number of suppliers from which an authority can choose to purchase items or between which can choose to conduct further competition. The framework agreement itself may be a contract, but only if the agreement places an obligation to purchase. In this case, it is treated like any other contract, and the EU procurement rules apply. However a framework agreement is more likely to not be a contract itself, but merely an agreement about the terms and conditions that would apply to any order placed during its life. In this case, a contract is made only when the order is placed and each order is a separate contract. These agreements can be established on a regional or national basis under EU Procurement Rules. Numerous framework agreements are available through the Government Procurement Service and NHS Supply Chain. Purchases should be made using a framework where possible, and in accordance with access instructions. 18 | P a g e
The CCG has also developed a local framework for the use of consultancy staff in line with EU procurement and NHS England rules. 6.8. Local Contracts Goods and Services Procurement via budget holders and requisitioners will deliver local procurements processes for specific goods and services which are not available through an existing regional or national agreement or catalogue. 6.9. Timeframes (Goods and Services) Purchases requiring competitive quotes typically take 2 weeks, those requiring formal competitive quotes or mini-tender take typically 4-6 weeks and those, which are the subject of EU procurement rules, a minimum of 4-6 months. It is the responsibility of the requisitioner to take these timescales into account when planning a purchase.
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7. Conflicts of Interest The National Health Service (Procurement, Patient Choice and Competition) Regulations 2013 set out high level requirements on managing conflicts of interest for procurement of healthcare. The regulations state that a CCG must not award a contract where conflicts, or potential conflicts, exist between the interests involved in commissioning such services and the interests involved in providing them affect, or appear to affect, the integrity of the award of that contract. In relation to each contract that it has entered into, the CCG must maintain a record of how it managed any conflict that arose between the interests in commissioning the services and the interests involved in providing them. Therefore, as part of any procurement process, all participants will have to sign a Conflict of Interest Declaration before any involvement. Any conflicts or potential conflicts must be managed before the individual who has declared such conflict or potential conflict can be involved in the procurement. Examples of conflicts of interest include: • • • • • • •
Having a financial interest (e.g. holding shares or options) in a Potential Bidder or any entity involved in any bidding consortium including where such entity is a provider of primary care services or any employee or officer thereof (Bidder Party); Having a financial or any other personal interest in the outcome of the Evaluation Process; Being employed by or providing services to any Bidder Party; Receiving any kind of monetary or non-monetary payment or incentive (including hospitality) from any Bidder Party or its representatives; Canvassing, or negotiating with, any person with a view to entering into any of the arrangements outlined above; Having a close family member who falls into any of the categories outlined above; and Having any other close relationship (current or historical) with any Bidder Party.
The above is a non-exhaustive list of examples, and will be the participant’s responsibility to ensure that any and all conflicts or potential conflicts – whether or not of the type listed above – are disclosed in the declaration prior to participation in the procurement process. Any disclosure will be assessed by the CCG on a case-by-case basis. Individuals will be excluded from the procurement process where the identified conflict is in the CCG’s opinion material and cannot be mitigated or be reasonably dealt with in another way. For Primary Care procurement see the appendix to this strategy which is Annex 4 to the NHS England guidance ‘Managing Conflicts of Interest: Statutory Guidance for CCG’s’ 2014. Please refer to the CCG Conflict of Interest Policy for further information on the above.
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8. Governance The CCG Audit Committee will be responsible for ensuring this strategy is adhered to. All business cases for service change will be required to demonstrate compliance with this policy prior to approval. Non-compliance with this policy will be reported to the Audit Committee and Governing Body where appropriate.
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9. Other Considerations 9.1. Collaboration There are areas of contracts and procurement in which collaboration is likely to bring benefits, whether it is the sharing of operational resources, or commitment to specific joint projects and/or contracts. Economies of scale can be achieved in both operational activity and through leveraging collective spend. Collaborative procurement opportunities should be considered where benefits can be identified, including joint tendering opportunities where complementary service specifications exist. 9.2. The Public Services (Social Value) Act 2012 The Social Value Act 2012 came into effect on 31st January 2013. The Act requires commissioners and procurers to consider how what is to be procured may improve social, environmental and economic well being of the relevant area i.e. the area in which the commissioner operates or the area that it is procuring on behalf of. Commissioners also have an obligation to consider whether they should consult on the issue. The Act requires consideration of matters which are relevant to the services procured and then only if it is proportionate to take those matters into account. Therefore at the service conception, design, specification development stage, the CCG will ensure that it has been considered. Inclusions in a specification as a result of consideration will be taken into account during the evaluation process of the relevant procurement. The CCG should keep a formal record to show consideration has been made. 9.3. Sustainable Procurement The CCG is committed to the principles of sustainable development and demonstrating leadership in sustainable development to support central Government and Department of Health commitments in this area of policy, and the improvement of the nation’s health and wellbeing. Sustainable procurement is defined as a process whereby organisations meet their needs for goods, services, works and utilities in a way that achieves value for money on a whole life basis in terms of generating benefits not only to the organisation, but also to society and the economy, whilst minimising damage to the environment. Sustainable procurement should consider the environmental, social and economic consequences of: • Non-renewable material use, • Manufacture and production methods, • Logistics, • Service delivery, • Use / operation / maintenance / reuse / recycling and disposal options. Each supplier’s capability to address these consequences should be considered throughout the supply chain and effective procurement processes can support and encourage environmental and socially responsible procurement activity.
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9.4. Small and Medium Sized Enterprise (SME), and Third Sector Support The CCG will aim to support and encourage SME, Third Sector and voluntary organisations in bidding for contracts. The CCG will aim to support Government initiatives seeking the involvement of SME’s and the Third Sector in public service delivery without acting in contravention of public sector procurement legislation and guidance. The NHS is keen to encourage innovative approaches that could be offered by new providers – including independent sector, voluntary and third sector providers. The CCG is committed to the development of such providers. 9.5. Transparency In 2010 the Government set out the need for greater transparency across its operations to enable the public to hold public bodies and politicians to account. This includes commitments relating to public expenditure intended to help achieve better value for money. As part of the transparency agenda, the government made the following commitments with regard to procurement and contracting: • •
All new central government tender documents for contracts over £10,000 to be published on a single website from September 2010, with this information to be made available to the public free of charge. All new central government contracts to be published in full from January 2011.
9.6. OJEU Thresholds The current OJEU procurement thresholds are as follows:Type Supplies Services (NonLight Touch) Part B Services** Light Touch Services
Threshold £106,047* £106,047*
Effective Date From January 2016 From January 2016
£164,176 ***
From January 2016
£589,148
From February 2015 (And will be applicable to Healthcare Services from the 18th April 2016.
*For contract notices and contract award notices. ** Healthcare Services Only (Public Contract Regulations 2006) – applicable until 18th April 2016 only ***For contract award notices only. – applicable until 18th April 2016 only Definitions Supplies Contracts are essentially those for the supply, (and installation where appropriate), or hire of products. These are subject to the full requirements of the regulations if the value is above the prescribed threshold 23 | P a g e
A service (Non Light Touch) - A contract for a Non Light Touch service is subject to the full requirements of the regulations if the value is above the prescribed threshold. These are services such as Computer and related services; Accounting, auditing and book-keeping services, and Management consultancy services which are required to be advertised across the EU Services (Light Touch) - These services are subject to the light touch regime of the Public Contract Regulations 2015. The services include those listed at Schedule 3 of the Public Contract Regulations 2015 and will include Clinical Health Services from 18th April 2016. The following requirements will apply to applicable contracts with a total value above the light touch threshold: •
OJEU Advertising: The publication of a contract notice (CN) or prior information notice (PIN). Except where the grounds for using the negotiated procedure without a call for competition could have been used, for example where there is only one provider capable of supplying the services required.
•
The publication of a contract award notice (CAN) following each individual procurement, or if preferred, group such notices on a quarterly basis.
•
Compliance with Treaty principles of transparency and equal treatment.
•
Conduct the procurement in conformance with the information provided in the OJEU advert (CN or PIN) regarding: any conditions for participation; time limits for contacting/responding to the authority; and the award procedure to be applied.
•
Time limits imposed by authorities on suppliers, such as for responding to adverts and tenders, must be reasonable and proportionate. There are no stipulated minimum time periods in the LTR rules, so contracting authorities should use their discretion and judgement on a case by case basis.
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Appendix
Annex 4: Procurement Template To be used when commissioning services from GP practices, including provider consortia or organisations in which GPs have a financial interest. NHS Dudley Clinical Commissioning Group
Service Question
Comment/Evidence
How does the proposal deliver good or improved outcomes and value for money – what are the estimated costs and the estimated benefits? How does it reflect the CCG’s proposed commissioning priorities? How does it comply with the CCG’s commissioning obligations? How have you involved the public in the decision to commission this service? What range of health professionals have been involved in designing the proposed service? What range of potential providers have been involved in considering the proposals? How have you involved your Health and Wellbeing Board? How does the proposal support the priorities in the relevant joint health and wellbeing strategy (or strategies)? What are the proposals for monitoring the quality of service? What systems will there be to monitor and publish data on referral patterns? Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers which are publicly available? Have you recorded how you have management any conflict or potential conflict? Why have you chosen this procurement route? What additional external involvement will there be in scrutinising the proposed decisions?
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How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision-making process and award of any contract?
Additional question when qualifying a provider on a list or framework or pre-selection for tender (including, but not limited to any qualified provider) or direct award (for services where national tariffs do apply). Have you determined a fair price for the service? Additional question when qualifying a provider on a list or framework or pre-selection for tender (including but not limited to any qualified provider) where GP practices are likely to be qualified providers. How will you ensure that patients are aware of the full range of qualified providers from whom they can chose? Additional questions for proposed direct awards to GP providers What steps have been taken to demonstrate that the services to which the contract relates are capable of being provided by only one provider? In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract? What assurances will there be that a GP practice is providing high quality services under the GP contract before it has the opportunity to provide any new services?
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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 31 March 2016 Report: IT Procurement Update Agenda item No: 9.0 TITLE OF REPORT:
IT Procurement Update
PURPOSE OF REPORT:
To update the Board on procurement of IT services.
AUTHOR OF REPORT:
Mr R Corner, Alscient
MANAGEMENT LEAD:
Mr A Coote, Interim Head of IT
CLINICAL LEAD:
Dr J Darby, Clinical Executive • • • •
KEY POINTS:
• • •
RECOMMENDATION:
The existing IT Service provision (via Dudley IT Services – DITS) is being retendered to test the market for suitable alternatives The tender preparation is nearing completion and is ready for release The CCG/GPs have joined with Dudley and Walsall Mental Health Trust (DWMHT) for a combined exercise to leverage scale and create a common infrastructure to support future collaborative working The scope of service is much broader than the current service and demands a much better level of service The requirements outline a future state capable of sustaining the aspirations of the tendering organisations and leveraging latest technology and innovation The key deficiencies in the current service provision will have to be demonstrably addressed in any tender response A number of critical success factors have been defined to ensure success can be measured
The Board are required to support this paper, delegate final sign off of the key documents (ITT and scoring matrix) to the Finance and Performance Committee and give approval to proceed with the tender as planned. Current cost of service is in the order of £998,000 per annum excluding capital expenditure. The current expectation is a contract value in the order of £1.1m per annum.
FINANCIAL IMPLICATIONS:
Whilst the anticipated annual cost may initially increase, the Board are requested to consider a number of additional factors including the extended range of services to be provided, the improved service levels to the CCG and GPs, the future proofing of the architecture and its ability to support the future state ambitions and the removal of some capital expense. It should also be noted that there is currently no provision within the existing system for Disaster Recovery capability. 1|Page
• • • WHAT ENGAGEMENT HAS TAKEN PLACE:
• •
ACTION REQUIRED:
√ √
Project Board – meeting regularly to provide direction Clinical Leads – to ensure GP interests are represented GPs – presented at locality meeting for feedback (supportive and positive response) Finance and Performance Committee – sign off on key project deliverables DWMHT have also been consulted on their plans and as a result this will be a joint tender with the Mental Health Trust Decision Approval Assurance
DUDLEY CLINICAL COMMISSIONING BOARD - 31 MARCH 2016 IT PROCUREMENT UPDATE 1.0
INTRODUCTION In March 2015 the CCG formally gave notice on the existing IT Services contract currently run by Dudley IT Services (part of the Dudley Group NHS Foundation Trust – DGFT). The intention had been to test the market for the provision of the service as a result of the current contract coming to a natural breakpoint and a natural desire to explore alternatives rather than just re-let the contract. A number of issues have arisen in the intervening period which have elongated the timeline including the complexity of the procurement process and the late decision to create a joint tender with the DWMHT. This latter decision has been brought about as a result of their desire to go to tender and the broadly similar requirements of the organisations. This paper outlines the current approach and timeline and gives the Board an overview of the scope of services being tendered. In addition it sets out broadly the financial expectations and the scoring mechanism at a high level such that the Board can confirm it is comfortable to proceed or provide any additional direction required prior to letting the tender at the end of April.
2.0
UPDATE
2.1
Key Drivers for Change A number of drivers for changes have been identified and have been expressed in terms of issues and limitations of the existing service provision. These have been formulated on the basis of future requirements rather than a critical appraisal of past performance. • • • • • • • • •
2.2
The current service levels are below industry standards. The current infrastructure is more complex than it needs to be. The service has evolved over time and is inconsistent across the CCG/GP community. It is inflexible to change and won’t support the growing demand for access and technology innovation. There are single points of failure and in some areas, parts are out of support. Costs are increasing year on year at a time when the cost of technology provision is reducing. The diversity is contributing to delays and increased costs to support or change. The current service provision is perceived as poor by the customers. Security coverage is variable with many elements currently outside of the provisioned service and therefore beyond the scope of the incumbent provider.
Overview of Scope of Services and Solution For the purposes of the ITT the scope of the services required have been categorised into 5 layers. The approach is to contract with a single provider and requires full coverage across each of the layers. It is anticipated that providers fully or partially sub-contract certain aspects of the service; however, it is an important factor that the majority of the service is provisioned directly by the chosen provider.
2.3
Service Overview Whilst the current service has provided the standard technology components (email, desktop and networks) the model’s fitness for future purpose is being evaluated as part of this exercise. Critical to long term sustainability will be agility to scale quickly, flexibility to demand and ability to support the increasingly diverse application layer allowing the Consortium to fully leverage available technology. Further there is a need to have a more responsive and proactive Service Management layer aimed at setting challenging service levels and having the desire to drive down costs whilst at the same time driving up service. Within the provision of the service the following elements must be provided as part of the overall service: • • • • •
A great customer experience. A single point of contact for all incidents/requests raised. Management of 3rd parties including contracts where appropriate and service provision to SLA. Note a number of 3rd parties may not be directly contracted to the Provider (e.g. clinical system providers) Software licence management. Inclusion of currently unplanned costs.
Conceptually the landscape needs to move to a “thin” computing, on demand model where economies of scale can be fully exploited whilst the overall technology infrastructure is simplified. In short the infrastructure layer and associated services need to work effectively and free up resource to concentrate on running front line NHS services. The diagram below represents at conceptual level how the infrastructure may look.
2.4
Cultural Fit The intention is to find a strategic partner, who is able to demonstrate an understanding of the CCG/GPs, their goals and the numerous challenges they face over the coming years as pressure on the service and cost base increase. It is important that the provider can demonstrate clear alignment to the values and principles of the CCG/GPs.
2.5
Security As part of the tender the importance of security, both physical and logical, has been stressed throughout the requirements and forms a fundamental part of the scoring system. This has been linked back to governance (e.g. IG Toolkit) and regulatory (e.g. DPA) Standards.
2.6
Transition The chosen provider will be required to document, plan and execute a managed transition from the existing provider and have completed the transition by 1st April 2017. The transition must:• • • • •
2.7
Be low risk with key services protected from interruption as far as possible. Be planned around core hours (Monday – Friday 08.00 – 18.00) Have appropriate controls and checkpoints in place Be fully tested Have robust regression plans in the event of issues during any transitional phase
Success Factors In determining the success or otherwise of any new service provision the following list of success factors will be used to measure whether a successful transition and new service provision have been established. • • • • • • • • • • •
Customer Satisfaction – the satisfaction rating must show a minimum 25% improvement within the first 6 months. Support call handling – calls are being handled according to the SLA and the support given to customers has significantly improved (measure through Customer satisfaction). Reduced TCO – the overall cost of ownership across all parts must be no higher than the current TCO in the first instance and must show a reduction within 12 months. Improved levels of service – the implemented service levels must be of a higher standard than current and be consistently being met. Improved resilience and DR – availability must be improved and a demonstrable (tested) DR solution available. Speed of change – responsiveness to change must be demonstrably faster than the current service Future proofed environment. Improved security – Security must be significantly improved and within 6 months of transition confirmed via independent audit. Reduced risk profile for consortium – the existing risk profile needs to have been significantly reduced Transition completed on time. Impact of transition – the impact of transition needs to have been carefully thought through and disruption minimised. This will be measured through customer satisfaction with the process.
3.0
TIMELINE AND PROCUREMENT APPROACH
3.1
Approach The chosen procurement approach is a restricted OJEU, however, within the process there will be the following gates allowing the CCG to direct prospective providers accordingly:• • • • •
PQQ – to create a shortlist of no more than 8 prospective providers. Q&A Session – 1 hour slot per shortlisted provider to allow them to seek clarity. Supplier Presentation – 2 hour slot per shortlisted provider to confirm their proposal is consistent with the requirements. ITT Response. Scoring – to evaluate all responses.
•
Reference site visits – selected providers only to complete due diligence against tender response.
3.2
Document Sign-Off Timeline
3.3
OJEU Tender Timeline
4.0
SCORING SUMMARY Scoring has been split into two categories:• •
Financial – concerned specifically with the total cost of ownership over the life of the contract. Technical – covering functional and non-functional requirements. This also covers elements of financial incentivisation including ongoing cost reduction and risk reward type evaluation.
Weightings are summarised below:
5.0
FINANCIAL IMPLICATIONS The current cost of service is outlined below. This excludes large parts of the telephony estate (GPs are largely providing their own disparate solutions), any capital costs and upkeep of the intranet and internet.
Details
IT Service Costs Attributable to Running Costs IT Service Costs Attributable to GP IT Programme Costs Agreed Contract value with DGFT for 2016/17
Running Costs £ 000's
2016/17 CCG Core IT GP IT Programme Programme Costs Costs £ 000's £ 000's
130,901 130,901
Additional 2015/16 investments in IT Service Costs Attributable to Programme Costs
130,901
250,920 350,920
Clinical System Support costs which are outside of the scope of the IT procurement Total CCG IT Service Costs
515,769 515,769
250,920 -
Total Budgeted Cost of Service in 2016/17
100,000 100,000
130,901
350,920
Total
130,901 615,769 746,670 250,920
-
250,920
515,769
997,590
309,130
309,130
824,899
1,306,720
In addition the core service levels are below standard and the extent to which the current provision can support a future state organisation is limited without significant capital investment. There is also no current disaster recovery arrangement in place. Whilst it is difficult to do a straight comparison as the tendered service is broader than the current service for the purposes of this document an expectation in the order of £1.1m per annum is suggested. However, the Board are urged to consider the total cost of ownership over the life of the contract including the provision within the tender for a reducing cost base year on year versus the current year on year increasing model. There will be a cost associated with transition to the new provider but where possible providers will be encouraged to wrap this into the overall service cost spread over the life of the contract.
6.0
SUMMARY AND CCG BOARD ACTION REQUIRED The preparation for tendering for IT service provision is nearing completion with a target of releasing the PQQ by the end of April. The decision has been taken to partner with the DWMHT in order to leverage scale and create a consistent infrastructure landscape across the organisation to support future collaborative working. The agreed process is to use a restricted OJEU route with agreed gates during the process to test understanding and direct prospective providers accordingly to mitigate risk of unsuitable bids. Cost of service is anticipated to be in the region of £1.1m although the Board should bear in mind the broader scope and improved service when considering this against existing cost.
7.0
RECOMMENDATION The Board are required to support this paper, delegate final sign off of the key documents (ITT and scoring matrix) to the Finance and Performance Committee and give approval to proceed with the tender as planned
R Corner 17 March 2016
DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Report: 31 March 2016 Report: Multi-Specialty Community Provider (MCP) Procurement Arrangements Agenda item No: 10.0
TITLE OF REPORT:
Multi-Specialty Community Provider (MCP) – Procurement Arrangements
PURPOSE OF REPORT:
To approve arrangements to support the procurement of the MultiSpecialty Community Provider (MCP).
AUTHOR OF REPORT:
Mr N Bucktin, Head of Commissioning
MANAGEMENT LEAD:
Mr N Bucktin, Head of Commissioning
CLINICAL LEAD:
Dr S Mann, Clinical Executive 1. In order to achieve its intention of having an MCP commissioned and operational in Dudley by 1 April 2017, it will be necessary to commence a procurement process following a report to the Board in July 2017. 2. To manage the process it is proposed to establish a project team reporting to a project board. 3. The Project Board will have delegated authority to take all decisions regarding the procurement except the decision to commence procurement and the decision to award the contract. 4. The Board will be chaired by the Chief Executive Officer and the membership will consist of, inter alia, a clinical lead and a nonexecutive director. 5. Full terms of reference will be submitted to the Audit Committee. 1. That the establishment of the Project Board to oversee the management of the MCP procurement process be approved. 2. That the Audit Committee be requested to approve full terms of reference for the Project Board. 3. That the Board appoint a non-executive director to serve on the Board.
KEY POINTS:
RECOMMENDATION:
FINANCIAL IMPLICATIONS:
None arising directly from this report.
WHAT ENGAGEMENT TAKEN PLACE:
None
ACTION REQUIRED:
HAS
Decision Approval Assurance
1|Page
DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 31 MARCH 2016 MULTI-SPECIALTY COMMUNITY PROVIDER (MCP) – PROCUREMENT ARRANGEMENTS
1.0
PURPOSE OF REPORT
1.1
To approve arrangements to support the procurement of the Multi-Specialty Community Provider (MCP).
2.0
BACKGROUND
2.1
In order to achieve its intention of having an MCP commissioned and operational in Dudley by 1 April 2017, it will be necessary to commence a procurement process following a report to the Board in July 2016.
2.2
Subject to the Board’s approval it is intended to conduct a procurement process on the basis of a competitive dialogue. This process will be managed on behalf of the CCG by the Commissioning Support Unit (CSU).
2.3
This report proposes arrangements for managing the procurement process with oversight being delegated to a newly constituted Project Board.
3.0
PROCUREMENT PROCESS
3.1
There are a number of key tasks and processes involved in achieving the target commencement date of 1 April 2017. These include:• • • • • • •
3.2
specifying the scope and nature of the services to be procured and delivered by the MCP; defining the pre-qualification requirements of prospective service providers and reflecting these in a Pre-Qualification Questionnaire; assessing potential providers; entering into a “competitive dialogue” process; evaluating bids; awarding the contract; mobilisation.
It is proposed that these tasks will be led by a Project Team chaired by the Project Sponsor (Head of Commissioning). Other functions/organisations to be represented on the Project Team to include:• • • • • • • •
clinical lead commissioning finance contracting communications and engagement quality and safety CSU (project management and procurement) Dudley MBC
This team will meet on a monthly basis throughout the process leading up until 1st April 2017.
3.3
Oversight of the project will be the responsibility of the Project Board, chaired by the Chief Executive Officer. Other members of the Board will include:• • • • • • •
Head of Commissioning Clinical Lead Non-Executive Director Chief Finance and Operating Officer Patient representative Dudley MBC Mills and Reeve (legal advisers)
3.4
Following some initial discussions regarding a draft project timeline, the CSU procurement team will be reviewing this in order to see whether it may make more sense to aim to have a signed contract by 1st April 2017 with mobilisation at a later date. An update on this will be provided to the meeting.
4.0
ROLE OF PROJECT BOARD
4.1
With the exception of the decisions to:commence the procurement; award the contract; it is proposed to delegate all other decisions to the Project Board in order to ensure that the tight deadlines required to meet the procurement timetable are met. Full terms of reference will be drafted and submitted to the Audit Committee for approval.
5.0
RECOMMENDATION
5.1
That the establishment of the Project Board to oversee the management of the MCP procurement process be approved.
5.2
That the Audit Committee be requested to approve full terms of reference for the Project Board.
5.3
That the Board appoint a non-executive director to serve on the Board.
Mr N Bucktin, Head of Commissioning March 2016
GLOSSARY ABBREVIATIONS
Abbreviation
Meaning
#NOF
Fractured Neck of Femur
£K
£1,000 equivalent
A&E
Accident and Emergency
ABC / ABCD
Above and Beyond the Call of Duty (Local surveys which include praise for nominated staff members as well as assessment of services)
ACS
Acute Coronary Syndrome
AD
Assistant Director
AfC
Agenda for Change
AGM
Annual General Meeting
AHSN
Academic Health Science Networks
ALE
Auditors Local Evaluation
ALOS
Average Length of Stay (in hospital)
AMI
Acute Myocardial Infarction
AMMC
Area Medicines Management Committee
Anti-D
An antibody occurring in pregnancy
Anti-TNF
Drugs used in the treatment of rheumatoid arthritis and Crohn’s disease
ARIF
Aggressive Research Intelligence Facility
ASAP
As soon as possible
AVE
Advertising Value equivalent
BACs
Bank Automated Credit
BAF
Board Assurance Framework
BCC
Black Country Cluster
BCF
Better Care Fund
BCPFT
Black Country Partnership NHS Foundation Trust
BCUCG
Black Country Urgent Care Group
BFT
Behavioural Family Therapy
BMA
British Medical Association
BME
Black Minority Ethnic
BMJ
British Medical Journal
BPAS
British Pregnancy Advisory Board
BSCCP
British Society of Colposcopy and Cervical Pathology
1
CAB
Citizens Advise Bureau
CAO
Chief Accountable Officer
CAMHS
Children and Adolescent Mental Health Service
CASH
Contraception and Sexual Health
CCBT (CBT)
Computerised Cognitive Behavioural Therapy
CCG
Clinical Commissioning Group
CCRN
Comprehensive Clinical Research Networks
CDC
Clinical Development Committee
CDiff
Clostridium difficile
CEO
Chief Executive Officer
CFO
Chief Finance Officer
CHADD
The Churches Housing Association of Dudley & District Ltd
CHC
Continuing Healthcare
CHD
Coronary Heart Disease
CIS
Community Investment Strategy
CLT
Collaborative Leadership Team
CMO
Chief Medical Officer
CNST
Clinical Negligence Scheme for Trusts
CNT
Community Nursing Team
COSHH
Control of Substances Hazardous to Health Regulations 2002
CPA
Care Programme Approach
CPN
Community Psychiatric Nurse
CRL
Capital Resource Limit
CRRT
Community Rapid Response Team
CSU
Commissioning Support Unit
CT scan
Computer Topography
CQC
Clinical Quality Commission
CQNO
Chief Quality and Nursing Officer
CQUIN
Commissioning for Quality and Innovation
CQRM
Clinical Quality Review Meeting
CSG
Clinical Strategic Group
CVD
Cardio Vascular Disease
D&N
Dudley and Netherton (Locality)
DACHS
Directorate of Adult Children and Housing Services
DCS
Dudley Community Services
DCVS
Dudley Community Voluntary Service
DES
Directed Enhanced Service
DfES
Department for Education and Skills
DGFT
Dudley Group Foundation Trust
DMO
Designated Medical Officer
2
DNA
Did not attend
DoH
Department of Health
DoLS
Deprivation of Liberty Safeguards
DoS
Directory of Service
DPMA
Dudley Practice Managers Alliance
DSCB
Dudley Safeguarding Children’s Board
DTC
Diagnostic and Treatment Centre
DWMHPT
Dudley and Walsall Mental Health Partnership Trust
DXA
Dual X-ray Absorptiometry (measures bone density).
E&D
Equality and Diversity
EAU
Emergency Assessment Unit
ECA
Extra Care Area
ECM
Every Child Matters
ECT
Electroconvulsive Therapy
ED
Emergency Department
EI
Early Implementer
EI
Early Intervention
EMI
Elderly Mentally Ill
EMIS
Education Management Information System
EoL
End of Life
EPP
Expert Patients Programme
EPR
Electronic Patient Record
ERMA
Emergency Response & Management Arrangements
ERT
Enzyme Replacement Therapy
ESR
Electronic Staff Record
FCEs
Finished Consultant Episodes
FED
Forum for Education and Development
FFT
Friends and Family Test
FHS
Family Health Services
FMC
Facility Management Centre
FOI
Freedom of Information
FYE
Full Year Effect
FYFV
Five Year Forward View
GGI
Good Governance Institute
GMS
General Medical Services
GOWM
Government Office for the West Midlands
GP
General Practitioner
GPAQ
General Practice Assessment of Quality
GPwSI
GP with Special Interest
GU
Genito-urinary
3
GUM
Genito-urinary Medicine
H&QB
Halesowen and Quarry Bank (Locality)
HCAI
Healthcare Associated Infections
HCF
Healthcare Forum
HEE
Health Education England
HENIG
Health Economy NICE Implementation Group
HF
Heart Failure
HIC
Health Improvement Centre
HIV
Human Immunodeficiency Virus
HPA
Health Protection Agency
HPS/S
Health Promoting Schools / Service
HPU
Health Protection Unit
HR
Human Resources
HSC
Health and Safety Commission
HSCQC
Health and Social Care Quality Centre
HSE
Health and Safety Executive
HSMC
Health Services Management Centre
HT
Home Treatment
HV
Health Visitor
HWBB
Health and Well-being Board
IAPT
Improved Access to Psychological Therapies
IC
Infection Control
ICAS
Independent Complaints Advocacy Service
ICE
Integrated Commissioning Executive
ICNA
Infection Control Nurses Association
ICP
Integrated Care Pathway
IFR
Individual Funding Request
IG
Information Governance
IOSH
Institute of Occupational Safety and Health
IT
Information Technology
IUCD
Intrauterine Contraceptive Device
JCAB
Joint Clinical Advisory Board
JCC
Joint Consultative Committee
JD
Job Description
JSA
Joint Strategic Assessment
KAB
Kingswinford, Amblecote and Brierley Hill (Locality)
KLOE
Key lines of enquiry
KPI
Key Performance Indicators
LAA
Local Area Agreement
LAC
Looked After Children
4
LAT
Local Area Team
LD
Learning Disability
LDP
Local Delivery Plan
LEA
Local Education Authority
LIFT
Local Improvement Finance Trust
LIG
Local Implementation Group
LIT
Local Implementation Team
LMC
Local Medical Committee
LNG
Local Negotiating Committee
LPS
Local Pharmaceutical Scheme
LRF
Local Resilience Forum
LTC
Long Term Conditions
LVD
Left Ventricular Dysfunction
LVSD
Left Ventricular Systolic Dysfunction
MAPA
Management of Actual and Potential Aggression
MAU
Medical Assessment Unit
MBC
Metropolitan Borough Council
MCP
Multi-speciality Community Provider
MDT
Multi Disciplinary Team
MIMT
Major Incident Management Team
MIRE
Major Incident Response Executive
MLSOs
Medical Laboratory Scientific Officers
MRSA
Methicillin Resistant Staphylococcus Aureus
MSS
Medium Secure Service
NCA
Non contract activity
NCB
National Commissioning Board
NCM
New Care Model
NCRS
National Care Record System
NELHI
National Electronic Library for Health Information
NFI
National Fraud Initiative
NICE
National Institute for Clinical Excellence
NGMS
New General Medical Services
NHS
National Health Service
NHSCPT
NHS Community Practice Teacher
NHSCSP
NHS Cancer Screening Programme
NHSE
NHS England
NHSLA
NHS Litigation Authority
NHSP
National Healthy Schools Programme
NICE
National Institute for Clinical Excellence
NMC
New Model of Care/Nursing and Midwifery Council
5
NOF
New Opportunities Fund
NPfIT
National Programme for IT
NPSA
National Patient Safety Agency
NRF
Neighbourhood Renewal Fund
NRLS
National Reporting and Learning System
NSF
National Service Framework
OAT
Out of Area Treatment
OBD
Occupied Bed Day
OD
Organisational Development
ODM
Oesophageal Doppler Monitoring
OOH
Out of Hours
OPH
Office of Public Health
OSC
Overview and Scrutiny Committee
OT
Occupational Therapist
PACS
Primary and Acute Care Systems
PALS
Patient Advice and Liaison Service
PAF
Positive Assurance Framework
PAS
Patient Administration System
PAU
Paediatric Assessment Unit
PbR
Payment by Results
PC
Personal Computer
PCCC
Primary Care Commissioning Committee
PCOG
Primary Care Operational Group
PDF
Portable Document Format
PDR
Personal Development Review
PDS
Personal Dental Services
PDSA
Plan, Do, Study, Act
PDU
Professional Development Unit
PE
Pulmonary Embolism
PEAK
Database holding the main registered details of patients and associated referral, contact, caseload, outpatient, inpatient, MH Act and clinic information.
PEAT
Patient Environment Action Team
PEPP
Pooled Budget External Placement Panel
PFI
Private Finance Initiative
PGD
Patient Group Directives
PHE
Public Health England
PICU
Psychiatric Intensive Care Unit
PID
Project Initiation Document
PIN
Personal Identification Number
PMLD
Profound and Multiple Learning Difficulties
6
PMS
Primary Medical Services
POPs
Patient Opportunity Panels
PPA
Prescription Pricing Authority
PPG
Patient Participation Group
PSA
Public Service Agreement
PSHE
Personal and Social Health Education
PSIAMS
Personal Social Impact Action Measurement System
PTCA
Percutaneous Transluminary Coronary Angioplasty
Q&A
Questions and Answers
Q&S
Quality & Safety
QA
Quality Assurance
QIPP
Quality, Innovation, Productivity and Prevention
QMAS
Quality Management and Analysis System
QOF
Quality and Outcome Framework
QPDT
Quality and Practice Development Teams
RACPC
Rapid Access Chest Pain Clinic
RAS
Respiratory Assessment Service
RCA
Root Cause Analysis
RCGP
Royal College of General Practitioners
RES
Race Equality Scheme
RHH
Russells Hall Hospital
RIDDOR
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
RMO
Responsible Medical Officer
RRL
Revenue Resource Limit
RTT
Referral to Treatment
SAP
Single Assessment Process
SCG
Sedgley, Coseley and Gornal (Locality)
SCIE
Social Care Institute for Excellence
SCR
Serious Case Review
SEPIA
Mental health computer system
SFBH
Standards for Better Health
SFI
Standing Financial Instructions
SIC
Statement of Internal Control
SLA
Service Level Agreement
SPA
Single Point of Access
SRE
Sex and Relationship Education
SRG
System Resilience Group
SSD
Social Services Department
SSDP
Strategic Services Development Plan
STI
Sexually Transmitted Disease
7
STRW
Support, Time & Recovery Worker
SWL
Stourbridge, Wollescote and Lye (Locality)
SWOT
Strength, Weakness, Opportunity and Threat
TB
Tuberculosis
TIA
Transient Ischaemic Attack
TP
Teenage Pregnancy
TPT
Teenage Pregnancy Team
TTO
To Take Out
UCC
Urgent Care Centre
UHBT
University Hospital Birmingham Trust
Vaccs & Imms
Vaccinations and Immunisations
WAN
Wide Area Network
WCC
World Class Commissioning
WIC
Walk in Centre
WMAS
West Midlands Ambulance Service
WMHTAC
West Midlands Health Technology Advisory Committee
WMSCG
West Midlands Strategic Commissioning Group
WMSSA
West Midlands Specialised Services Agency
WTE
Whole Time Equivalent
YHC
Young Health Champion
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