CHAIRS AND CHIEF EXECUTIVES NETWORK Chris Hopson chief executive 8 December 2015
What will we cover? NHS Providers quick update Funding & Finances Regulation Workforce Five Year Forward View & Devolution
What is the current mood music? BUT ALSO LOOK TO THE HORIZON MAINTAIN FOCUS ON SHORT TERM After stabilising, must get to grips Positive outcome on spending • • with long term productivity and review frontloaded 2016/17 sustainability challenges funding Devolution & New care models Positive plan for providers • • starting to gather pace emerging for 2016/17 planning Increasing focus on systems as and tariff – the Mackey influence • the unit of planning and strategic Need to maintain financial and • change operational grip including 15/16
Things that have changed since we met in September Sustained widespread Jim Mackey financial distress appointed to NHS despite agency caps: Improvement -£1.6bn by Q2 Spending review Industrial action by results & positive, Junior Doctors called Mackey led, plan / off tariff for 2016/17 CQC state of care and Next, acute care new strategy collaborative, consultation vanguards launched
What will we cover? NHS Providers quick update Funding & Finances Regulation Workforce Five Year Forward View & Devolution
Quick NHS Providers update Successful Annual Annual lecture New 3 year Conference and with Sir David strategy being Exhibition 2015 Nicholson developed Governance Regulation survey Report on working Conference date results published with LA and HWBs set (7 July 2016) soon to be published Significant Remuneration VSM survey to lobbying on tariff survey results support policy and planning has released changes with DH borne fruit
Your views in our annual member survey – thank you 210 individual responses to our online survey, from 139 member trusts (over 60% of membership)
What will we cover? NHS Providers quick update Funding & Finances Regulation Workforce Five Year Forward View & Devolution
The 2015 Spending Review Health – NHS England £100 billion and DH £15 billion Extra £8bn funding for NHS England £100bn, with • £3.8bn frontloaded in 2016/17 25% cut to DH £15bn, impact on HEE and capital • 2017/18: nurse training from bursaries to loans and • training number caps removed; provider opportunity £600m extra mental health funding from increases • Tech funding lower than expected • Public health 3.9% real terms reduction • £2bn of land sales needed to balance books • £23.5 bn of savings needed to meet demand / cost • Social Care £6.1bn cut to local government grant by 2019/20 • Offset by 2% social care precept for adult social care, • but will not close the gap even at full whack Better care fund £1.5bn increase from local • government side by 2019/20 Preparing for Dilnot by 2020/21 •
The phasing of the extra £8bn? Slower, Front-loaded early slug to undeliverable Late slug for 7DS balance the books, looking, growth in and paperless NHS especially frontloaded to middle of the 16/17 cycle Some funding hypothecated e.g. drugs, mental health Capital stands still Conditionality on plans
Does it pass the Stevens five tests? Front-loaded investment for A service transformation (but now going on deficit recovery) New asks consistent with B phasing of funding (not yet visible) D Realistic but broad set of efficiencies Protection for social care D services Make good on the public E health opportunity
And how does it measure up more broadly? Source: Nuffield Trust COMES OUT LESS WELL AGAINST COMES OUT WELL AGAINST OBR’s extra back of sofa £27bn Constraints of deficit reduction • • NHS history (1.5% vs 3.6% p.a.) Cuts to other departmental • • What the NHS needs budgets • GDP spend per head Expectations before the review • •
What we expect from 2016/17 funding / tariff Briefing given to CEOs last Friday Tariff Funding • 5 year allocations (3 year firm, 2 outer • +1.1% net adjustment (2% efficiency years indicative) for CCGs factor and 3.1% inflation uplift) • Place-based with primary, CCG and specialised commissioned services • Inflation uplift designed to recognise full published cost of additional pension contributions • £5.4bn increase 2016/17 split between: • Mainstreamed extra funding for CCGs • Delay HRG4+, pause specialised • Central new policy initiatives marginal rate, but phase in new top-ups • Conditional stabilisation / transition (aka provider deficit reduction) & • Retain MRET @70% & move all trusts to transformation funding. More detail to ETO prices come and some tricky issues to manage • Any 15/16 deficit over £1.8bn has to be recovered from 16/17 . • A positive, some way above expectations, Jim Mackey influenced, result for 2016/17 • Buying a year to sort out serious long term efficiency savings and sustainability plans • But this only makes a previously impossible 2016/17 look very challenging
2016/17 planning (more on 18 Dec) • Support locally driven change The planning • Transcend organisational boundaries principles • Look beyond one year • Manage money and emergency care in the short term • Create conditions for transformation The focus • Agree shared objectives across larger units of planning • Place based & Multi-year: how your system will be sustainable by 2020 Sustainability & Transformation • Governance structures & shared vision needed plans • Close the 3 FYFV gaps (July 2016) • Open book planning • Self-assess capacity and capability to deliver
Expected must do’s and further improvement priorities Too many competing priorities: create very small core we have to get right. A likely further small core of things to improve over next three years. • Money – eliminate provider deficits and return to surplus • Reduce agency staff spend • Serious efficiency savings plans incorporating Carter and estates savings Must Do’s • Explicit 16/17 control total to manage to, Xmas holidays • Deliver constitutional performance standards • Agree performance recovery trajectories on A&E standard • Develop any required service redesign proposals to do difficult work in first half of parliament • Cancer: deliver Task Force recommendations; recover lost momentum • Mental health: deliver Task Force recommendations Improvement • Prevention especially obesity, diabetes wins • Seven Day Services • Availability of hospital consultants and diagnostics at weekend • Urgent and emergency care out of hospital • GP access at weekends 2016/17: deliver must do’s and make incremental progress on improvements
We also need some proper system alignment as well… We now need to ensure that every CCG in the South West is using all appropriate contractual sanctions available to incentivise providers to focus on delivery of access standards. ….I expect any fines levied are neither waived nor “reinvested” into the same provider, except in highly exceptional and fully justified circumstances… Where fines are levied the CCG is at liberty to spend this money with alternative providers to improve the delivery of the standard at a population level (for example in the Independent Sector in the case of RTT) or to use it to visibly improve your overall financial position in meeting Business Rules and delivering or improving on your Control Total.
What will we cover? NHS Providers quick update Funding & Finances Regulation Workforce Five Year Forward View & Devolution
Your views – a preview of our 2015 regulation survey 44% of respondents feel the regulatory framework is working poorly and How do you thi hink nk t the o he overa erall reg regulatory ry • nearly 90% say regulatory burden has increased. fra ramew ework rk of the he NHS is current rrently work rking ng? Regulatory environment has become much more complex over the last 12 • Very well months as Regulators balance supportive approach with formal regulatory duties • Fairly well 29% Roles of regulators becoming increasingly blurred • Increasing burden from requests for data and information from • 28% Neither well or poorly regulators, commissioners and NHS England Fairly poorly 38% Benefits to be gained by streamlining the overall regime, reducing the number • of regulators and ensuring policy priorities are consistent. Some hope that Very poorly 6% over last year, regulators have made more effort to coordinate activity (n = 69) Has the reg he regulatory ry burd rden ex en experi erienc enced ed To wha hat ex extent ent d do you thi hink nk t the he reg regulators rs by yo by your organ anisat ation increas ased, staye ayed ha have c e coord rdina nated ed thei heir a r activity ef effec ectivel ely over er the s he same, e, or r dec ecrea reased ed over t er the l he last 12 the l th last st 12 month ths? s?* month ths? s? (n = 70) 28% Very effectively 36% Decreased Fairly effectively 19% 22% Neither effectively or ineffectively Stayed the same 13% Fairly ineffectively 44% 30% Very ineffectively 12% 9% Increased 87% (n = 54) (n = 69) 2014 2015 NHS Providers Regulation Survey December 2015
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