2017/19 Draft Operating Plan Update

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Edith Matthews
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2017/19 Draft Operating Plan Update This paper is for: Information Recommendation: The Governing Body is requested to note the progress on production of the 2017/19 Draft Operating Plan.

1 2017/19 Draft Operating Plan Update This paper is for: Information Recommendation: The Governing Body is requested to note the progress on production of the 2017/19 Draft Operating Plan. For further information or for any enquiries relating to this report please contact: Adam Wickings, Chief Operating Officer (Delivery) Reg Middleton, Director of Finance Reporting Officer: Reg Middleton/Adam Wickings Lead Director: Reg Middleton/Adam Wickings Report Summary: Date: 20 December 2016 Agenda Item: 240/16 Version:1 The attached report describes the accelerated planning timetable and changed context for delivery and assessment of the CCG s Operating Plan The report describes progress on development of the draft plan (numeric submissions and narrative). FOI status: This paper is disclosable under the FOI Act Strategic objectives links: The Operating Plan will underpin delivery of all strategic objectives and the CCG s contribution to the Kent & Medway STP. Board Assurance Framework links: Identified risks & risk management actions: This paper supports the mitigation of the following strategic risk: A/C Failure to make the strategic changes needed to deliver Mapping the Future Should the CCG not provide its annual planning returns to NHS England it would be in breach of its statutory obligations. December 2016 NHS West Kent CCG

2 Resource implications: Legal implications Equality and Diversity assessment Report history: Appendices Next steps: Production of the Operating Plan will be met within existing staffing resources NHS Planning Guidance sets out detailed requirements of what should be contained within the operating plan. Later stages of programme development would include a full quality impact assessment including equality and diversity assessment where appropriate. Has an equality analysis been undertaken? Not applicable equality analyses will be undertaken on individual elements of the operating plan. Second report to the Governing Body for 2017/19 planning cycle. None Final operating plan to be submitted on 23 rd December December 2016 NHS West Kent CCG

3 Operating & Financial Plan Update December

4 Work Under Way on Improving the Plan Immediately after submitting the draft plan on the 23 rd of November we commenced work on areas we had identified for improvement (mostly congruent with those identified later by NHS England). The relationship between Local Care and the STP is being further clarified in activity-change, financial, and strategic areas. The CCG is working continuously on QIPP plans to reduce the amount of unidentified QIPP. The pathway/initiative sections are providing more detail on expected milestones, activity and finance outcomes. These are being linked as much as possible to activity, finance and constitution submissions 2

5 Timetable for Operating Plan Delivery The CCG has submitted according to the NHS England submission requirements. The Operating Plan (draft) activity, constitution and finance submissions were provided in November alongside the Operating Plan (draft) narrative. The CCG is currently negotiating contracts with providers with a view to contract agreements by the end of December. NHS England provided comments on the November submissions on the 7 th of December. Date Submission Required 8 November 2016 Activity & Constitution Template Draft 23 November Narrative Plan Draft 24 November National Finance Template Draft 24 November Local (South East) Finance & Activity Template Draft 16 December Local NHS England Finance Final Submission 23 December National NHS England Finance Final Submission 23 December Activity & Constitution Template Final 23 December Operational Plan Narrative Final 3

6 NHS England Areas for Consideration The CCG received a feedback letter from NHS England on the 7 th of December and the Accountable Officer and Chief Operating Officer (Delivery) met with NHS England Director of Assurance on 9 th December. NHS England highlighted a focus on contract agreements (by December) and proposed mediation and/or arbitration arrangements. Three main issues were raised with our submissions. Issue Technical issues with plans/trajectories Better demonstrate links between Operating Plan and STP Unaffordable plan: excessive unidentified QIPP Planned Response Under review but all believed to be only data issues The STP section will be enhanced and clearer STP links provided in the pathway tables A range of challenging options for further IPP delivery are being urgently considered. The submission on 23-December will identify some reduction in unidentified QIPP. 4

7 Key Updates of Financial Plan Operational plans for 2017/18 and 2018/19 require QIPP achievement of circa 21m and 22m Capital investment in Care Plan Management System and Digital Road Map and Southborough Hub Mental Health (MH) Expenditure is planned to maintain parity of esteem, the full scope of planned MH expenditure includes Direct Mental Health programme expenditure GP prescribing of Mental Health related drugs Continuing Healthcare Expenditure where the primary diagnosis is MH related (eg Elderly Mental Illness, Dementia) MH activity attributed inappropriately to Acute programme expenditure Planned contract values agreed with providers are within an acceptable tolerance except for: Maidstone & Tunbridge Wells NHS Trust Kent Community Healthcare Foundation Trust South East Coast Ambulance Foundation Trust Mediation dates with providers are planned for the above 5

8 Awareness of Key risks in planning Additional Financial Risks have been identified relating to Tariff & Identification Rule Changes Impact of Tariff Changes (HRG4+) WKCCG resource allocation reduction of 1.5m, but MTW 1.6m actual impact based on planned activity level WKCCG exposed to a financial impact of 3.1m, but potential full financial impact could be 2m to 4m Impact of Identification Rule (IR) Changes WKCCG resource allocation increased by 1.6m Actual impact of IR changes not known for all contracts and planning has assumed a neutral impact WKCCG exposed to a financial risk that IR change activity is greater than 1.6m Potential full financial impact 0.5m to 1m (early assessment) WKCCG had formally objected as part of consultation review to reject the above changes. However, due to insufficient CCG support nationally on the changes, a national tariff review was not triggered which would have halted the above changes. WKCCG has since submitted a statement of the potential financial risk and pressure to NHS England with regards to this issue. WKCCG will be planning for further mitigations and actions to counter the financial impacts of the above. Engagement of GP membership & minimising practice variation Activity referral rate assumptions Clinically appropriate prescribing Gatekeeper to services on a clinical basis Delivery of operational plans reflecting achievement of opportunities set out in Right Care Continuing Healthcare New models of Care, Urgent & Emergency Care, Self Care and Prevention Getting it Right First Time Assumptions that activity growth can be countered by the above opportunities and QIPP initiatives 6

9 Planning Headlines Statutory Breakeven achieved Business rules met 0.5% contingency 3m 1.0% NR requirement 0.5% risk reserve 0.5% STP transformation 2017/ m cash increase (2.6%) 2018/ m cash increase (2.6%) 2017/18 4,600 head of population increase (0.96%) 2018/19 4,600 head of population increase (0.96%) QIPP assumptions 2017/ m (3.4%) 2018/ m (3.5%) Financial Plans not yet balanced Unidentified QIPP of circa 14m still required for 2017/18/19 Further stretch across all areas to provide for mitigations against financial pressures and risks Further stretch across all areas to ensure mitigate the non-delivery of initial QIPP schemes 7

10 Next steps Principal contracts to be finalised: Mediation sessions for CCG & Maidstone & Tunbridge Wells NHS Trust CCG & Kent Community Healthcare Foundation Trust CCG & South East Coast Ambulance Foundation Trust CCG continues to work closely with MTW with regards to contract discussions Further work to reduce the level of unidentified QIPP Final Plans to be assured by NHSE 8

11 Key milestones Submission of financial operational plans 16-Dec (Local NHS England review) & 23-Dec (Final). Once the final plans are submitted 23-Dec, work to commence on production of a shorter Operational Plan narrative for public and partner audience, to be signed-off by the Governing Body. Contracts signed 23-Dec 16 Arbitrations 09-Jan 17 Development of PMO reporting for QIPP delivery Continued assurance and testing of existing QIPP assumptions Continued development of further QIPP plans 2017/18/19 9

2017/18 Financial Plan and Budgets. John Ingham, Chief Finance Officer, NHS Norwich CCG. Discussion and Approval

Agenda Item: 13 NHS Norwich CCG Governing Body Tuesday 28 th March 2017 Subject: Presented By: 2017/18 Financial Plan and Budgets John Ingham, Chief Finance Officer, NHS Norwich CCG Submitted To: NHS Norwich