2016/17 Financial Plan

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Charlotte Rice
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1 2016/17 Financial Plan Louis Kamfer Chief Finance Officer May 2016

2 Contents 2016/17 Financial Plan: Financial Plan Risks and Mitigations Key Planning Assumptions 5 year view QIPP Dashboard Contracting update

3 2016/17 Financial Plan Table 1 Changes in Allocation Growth and Expenditure in 2016/17 Deficit Position 16/17 'M as % 15/16 Programme Allocation as % 16/17 Programme Allocation The final financial plan was submitted to NHS England on 18 th May Table 1 shows the allocation increase from 2015/16 and the use of funds in 2016/17. Allocation Increase % 4.9% In Year Deficit 15/ % -2.0% GPIT % -0.2% ETO % -0.3% CAMHS % -0.2% CEOV 0.3 Transformation Funds % -1.0% Fines & Penalties % -0.5% Other % -0.5% Tariff inflator (PBR) % -1.1% Demographic Growth % -0.6% Non Demographic Growth % -2.2% CHC Risk Pool % -0.2% Contingency 0.5% % -0.5% QIPP Required % 3.5% In year suplus/deficit 2016/ NHS England approved an in year deficit of 2.5M for Basildon and Brentwood CCG in 2016/17 with a QIPP requirement of M. The CCG currently has 7.903M of identified QIPP schemes, 3.889M (33%) is still unidentified. QIPP has been risk rated. The CCG made an in year deficit of 6.5M in 2015/16. As a result of national changes, the CCG will not have access to 1% transformation funds ( 3.3M) in 2016/17. The CCG will not have the ability to apply fines and penalties where providers have signed up to the Sustainability Transformation Funds (STF). The value of fines and penalties applied in 2015/16 was 1.8M. The CHC risk pool ( 0.8M 2016/17) was previously offset against the 1% transformation funds but this will not be possible in 2016/17.

4 2016/17 Risks and Mitigations Table 1 Additional Risk / Opportunities in 2016/2017 Value 'M Risk Weighting Total 'M Risks SEPT Rebasing % -0.7 Unidentified QIPP (excl. SRP) % -3.9 Other QIP under delivery % -0.5 CHC % -0.5 Prescribing % -0.4 EAST Additional Investment % -0.6 Acute overperformance % % -7.0 Mitigations Contingency (0.5% mandated) % 1.7 Other contract contingencies % 1.6 Property Services % % 3.6 Table 1 shows the outstanding risks and opportunities for 2016/17 as submitted to NHS England on 18 th May. Key Risks: SEPT Rebasing rebase over 3 years rather than 1 year Unidentified QIPP no schemes currently identified (33%) Other QIPP under delivery QIPP identified 7.9M key risks Intermediate Care Bed Review, Service Restrictions, CHC and Prescribing CHC Providers seeking uplifts linked to Minimum Wage Increase, National Tariff Increase and CCG allocation increase. Prescribing risk of increase in prescribing costs EAST Additional investment investment required to increase performance Acute over performance BARTS, BHRT and Private Providers do not have block contracts. Unmitigated Risk

5 Key Planning Assumptions The financial plan for 2016/17 is based on the 2015/16 forecast outturn to which a series of agreed principles and key assumptions are applied as laid out in the tables below. The starting point for the financial plan for 2017/18 is the planned 2016/17 position and 2018/19 the planned 2017/18 position. Table 1 Growth Assumptions Allocation Growth 5.00% 2.11% 2.34% Net Tariff Inflator* 0.80% 0.00% 0.00% CNST Uplift 0.70% 0.00% 0.00% Acute 4.70% 4.70% 4.70% Community PbR 1.50% 0.00% 0.00% Community Non PbR 0.00% 0.00% 0.00% Mental Health 3.00% 3.00% 3.00% Continuing Healthcare 5.00% 5.00% 5.00% Primary Care 0.00% 0.00% 0.00% Primary Care Prescribing 4.50% 4.50% 4.50% Table 2 Business Rules Non Recurrent Funding 1.00% 1.00% 1.00% CCG Surplus 1.00% 1.00% 1.00% Contingency 0.50% 0.50% 0.50% Table 3 Tariff Inflator Demographic Growth Non Demographic Growth Acute 1.50% 0.70% 2.50% 4.70% Community (NELFT/SEPT) 1.50% 0.00% 0.00% 1.50% Continuing Healthcare 0.00% 0.70% 4.30% 5.00% Mental Health 1.50% 0.70% 0.80% 3.00% Prescribing 0.00% 0.70% 3.80% 4.50% Primary Care 0.00% 0.00% 0.00% 0.00% Total

6 2016/17 Financial Plan 5 year view Table 1 shows the 5 year view for Basildon and Brentwood CCG. Table /17 to 2018/19 Plans (Based on M12) 2015/ / / / / /21 m m m m m m In year surplus/(deficit) - m (6.52) (2.50) Surplus/(Deficit) brought forward (3.66) (10.18) (12.68) (10.95) (7.42) (3.79) Cumulative Surplus/(Deficit) (10.18) (12.68) (10.95) (7.42) (3.79) 4.87 QIPP required to deliver planned position : QIPP requirement as a % of RRL 3.9% 3.5% 1.9% 0.9% 0.3% 0.0% QIPP identified % of QIPP unidentified 0% 33.0% 100.0% 0% 0% 0%

7 QIPP Programme. Basildon & Brentwood CCG 2016/17 QIPP Programme Dashboard Variance from TARGET FULL YEAR RISK ADJUSTED PROVIDER AFFECTED CCG AFFECTED KEY Portfolio Project Current Delivery Confidence Gateway / Status Savings expected to start from Gross Planned FY Saving Cost FY Total Net Planned FY Saving FOT Variance % of Delivery Likely Net Expected Savings Risk Adjusted BTUH NELFT SEPT MID SUHFT BHRT TCCG S'end CPR Mid NEE West 15/16 PYE Children's VSOs B Benefits Realisation Apr-16 6,793-6,793 6, % 6, /16 PYE Mildmay Hospital B Benefits Realisation Apr-16 24,720-24,720 24, % 24, /16 PYE Service Cessation (DV,SB,ES&CC) B Benefits Realisation Apr , , ,865-91% 285, /16 PYE GP Demand Management A Live Apr , , ,000-50% 150, ICB Intermediate Care Beds Review A Live Apr-16 1,310, , , ,979-70% 567, BCH BCH, Space and Estates A Programming Jan , , ,000-71% 211, Children's Better Use of Technology (Skype) n/a Programming Apr % Contract BTUH (Contract Negotiations 16/17) G Programming Mar-17 1,783,000-1,783,000 1,783, % 1,783, Contract Mayflower Dermatology (Contract Negotiations 16/17) A Programming Apr , , , % 150, Contract EEAST Rebasing (Contract Negotiations 16/17) A Programming - 230, , , % 230, Contract SEPT Re-allocation (Contract Negotiations 16/17) A Programming Mar-17 1,482,000-1,482,000 1,482,000-74% 1,100, Contract SEPT-Merger with NEPT (Contract Negotiations 16/17) A Programming - 50,000-50,000 50,000-0% Contract St Lukes Rebasing (Contract Negotiations 16/17) G Programming - 130, , , % 139, Contract Thames Rebasing (Contract Negotiations 16/17) A Programming - 100, , ,000-51% 51, Contract NELFT Contract A Programming Apr , , ,000-75% 731, Contract Service Restriction Policy (IVF & further enhancements) R Programming Oct-16 2,252,000-2,252,000 2,252,000-56% 1,261, Decommissioning Outlook Care G Programming Mar , , ,000-97% 325, Medicines ManageCMPA Prescribing 16/17 R Programming Jan-17 33,000-33,000 33,000-75% 22, Medicines ManageMedicines Optimisation in Primary Care Prescribing R Programming Apr , , ,000-60% 339, Medicines ManageMeds Management Rebates G Programming Mar-17 50,000-50,000 50, % 50, Medicines ManageStoma and Continence Appliances R Programming - 120, , ,000-70% 90, MH & LD Personal Health Budgets (Mental Health) G Programming Apr-16 55,000-55,000 55,000-88% 55, MH & LD Estuary & MCCH A Programming Apr-16 80,000-80,000 80, % 80, CHC CHC (further savings) R Scoping/ Opportunities - 300, , ,000-84% 250, Contract MSK Rheumatology & Pain Management n/a Scoping/ Opportunities % /16 PYE Pathology Continuation n/a Removed % /16 PYE Outsourcing of Dispensing Outpatient Drugs (BTUH) n/a Removed % /16 PYE Specialist Nursing (Dietetics) n/a Removed % Children's Asthma (increasing education) n/a Removed % Children's Specialist Development Groups n/a Removed % Contract MSK (Contract Negotiations 16/17) n/a Removed % Contract BPT reviews / Provider duplication n/a Removed % Contract NELFT Rebasing (Contract Negotiations 16/17) n/a Removed % Contract Removal of Mede System n/a Removed % Contract BTUH RAID (Contract Negotiations 16/17) n/a Removed % Medicines ManageCoeliac prescriptions n/a Removed % MH & LD Section 12 Approved Clinician n/a Removed % Procurement HEF n/a Removed % RAG (Project Status) Benefits Realisation Project is complete and in benefits realisation Live Project is Live and in implementation Programming Scoping is complete and Business Case is in development Scoping / Opportunities Business Case still requires scoping. May include initial assessment of savings Removed Project Removed Current Delivery Confidence B Project saving sercured G Project Low Risk A Project Medium Risk R Project High Risk 10,939, ,000 10,439,357 10,439,357-7,902,893 Target 11,792,000 Target 11,792,000 67% +/- TARGET +/- TARGET (1,352,643) (3,889,107)

8 2016/17 Contracts - Progress update TYPE PROVIDER CURRENT STATUS Acute BTUH Contract signed 19 th May Detail activity plan to be agreed by 30 th June CONTRACT VALUE 117,078,542 BHRT Cost and volume Contract Signed 10th May ,325,535 BARTS Cost and volume Contract value agreed 4,450,134 Mid Essex Block contract Signed 10th May ,611,429 Southend Community NELFT Mental Health SEPT Block Contract Value agreed, contract signed. Year 3 of a 3 Year Block contract - Currently working on a deed of variation with the Host commissioner Year 3 of a 3 Year Block contract - Currently working on a deed of variation with the Host commissioner contract signed 10,986,000 25,786,798 27,876,772 Ambulance EEAST Year 2 of a 3 Year Block contract - Currently working on a deed of variation with the Host commissioner 8,388,477

9 2016/17 Contract negotiation current identified risks Current Risk Mitigation BTUH BBCCG and the Trust are working collaboratively to agree a detailed activity plan by the 30th June Other Areas that need agreement are: CDU AEC Critical Care activity outside the Critical Care Unit SRP DEXA tariff for Nurse Led Clinic QIPP Schemes to be agreed EEAST NELFT BBCCG has been asked by NHS England to part fund a package for additional private ambulance and agency staff capacity (currently valued in the plan at 21m) in order to support the Remedial Action Plan. The CCG is working with EEAST and other commissioners to understand the financial impact. (BBCCG received communication from the lead commissioner that the maximum investment required for BBCCG would be 431k) BBCCG and Thurrock CCG are meeting with NELFT on 20 May 2016 to finalise the contract value for the 2016/17 financial year. BBCCG continue to negotiate the values and timeframe for the areas of decommissioning

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