2016/17 Financial Planning. Governing Body 1 st March 2016

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1 2016/17 Financial Planning Governing Body 1 st March 2016

2 2016/17 Financial Planning Outline Financial Planning Guidelines Business Rules National Context Comparators Local Summary Local Analysis Next Steps & Governance

3 2016/17 Financial Planning National Picture

4 Context October 2014: Five Year Forward View 2015/16 Planning: The Forward View into Action New care models Transformation in primary care, mental health and local health economies; Ambitious plans November 2015 Spending Review Basis to implement Five Year Forward; Restore and maintain financial balance Deliver core access and quality standards

5 Five Year Forward View: Strategic objectives Better prevention of ill health Empowering patients Engaging diverse communities Development of new models of care Supported by enablers of: Information technology Workforce Innovation Alongside these, delivery of the NHS Constitution With a move towards place based commissioning through: CCGs influencing primary care and specialised commissioning enhanced joint commissioning with local government, including integrated personalised commissioning and the Better Care Fund

6 2016/17 Delivering the Forward View Two separate but connected plans: A one year operational plan 2016/17 A five year Sustainability and Transformation Plan (STP) The Triple Aim: Better Health Transformed Quality of Care Delivery Sustainable Finances

7 National position /17 Place Based Allocations 16/17 proposed allocation m Increase on the 15/16 baseline % CCG s 70, Primary Care (medical) 7, Running Costs 1, Specialised 14, TOTAL PLACE BASED BUDGETS: 92, %

8 Business rules CCGs to achieve a 1% surplus CCGs to hold a 0.5% Contingency HM Treasury requirement for all NHS organisations to be in recurrent balance by March 2017 Commissioners to set aside 1% non-recurrent spend in 2016/17, for release to invest in strategic plans including the new care models. Will be subject to risk assessment and approval by NHS England. This year will be linked to HE financial balance

9 Drawdown CCGs will have access with conditions: CCG has sufficient cumulative surplus Resulting spending to be non-recurrent Business rules will be met in 2016/17 CCG s plans can be afforded by commissioning system National process to be applied in agreeing drawdown Business case for drawdowns to be completed deadlines unknown Priorities for allocation of drawdown will remain: Investment in prevention, patient empowerment, community engagement and developing new models of care Committed service reconfiguration plans that require non recurrent funding CCGs with provider reform commitments as part of a merger or acquisition not funded by the DH

10 National Tariff Proposals for 2016/17: Tariff cost uplift of 3.1% Assumed provider efficiency of 2% Resulting in a net increase of 1.1% CNST premium changes expected to display Tariff impact closer to 1.8%, not seen in modelling so far

11 2016/17 Financial Planning Local Picture

12 Local position Submission of 2016/17 Plan Headlines CCG submitted a first cut Plan on 8 February 2016 This did not meet 2 of 3 NHSE business rules - 0.5m (0.2%) surplus in plan vs 2.6m (1%) required - 0m headroom in plan vs 2.8m required QIPP of 5.6m + 1.5m 2015/16 full year effect of existing schemes is required to deliver the plan NHSE met with the Executive team on 18 February to discuss the financial position and proposed way forward, which was not accepted. The next plan submission is due on 2 nd March.

13 Local position 2016/17 proposed allocation Blackpool Increase on 2015/16 baseline Fylde and Wyre 16/17 proposed allocation Increase on 2015/16 baseline m % m % CCG Core Primary Care (medical) Specialised TOTAL PLACEBASED BUDGETS: % % Running Costs

14 Financial plan summary Blackpool Fylde & Wyre Revenue Resource Limit /15 blan k1 2015/16 blan k1 2016/17 Recurrent 231, , ,249 Non-Recurrent 10,657 8, Total 242, , ,805 Revenue Resource Limit /15 blan k1 2015/16 blan k1 2016/17 Recurrent 202, , ,139 Non-Recurrent 5,294 7,013 4,071 Total 208, , ,210 Income and Expenditure Acute 131, , ,630 Mental Health 18,106 17,989 18,481 Community 30,351 35,062 32,028 Continuing Care 11,114 11,049 11,577 Primary Care 40,974 67,112 68,789 Other Programme 4,185 4,378 8,876 Total Programme Costs 236, , ,381 Income and Expenditure Acute 107, , ,617 Mental Health 17,678 19,749 19,288 Community 18,135 22,718 23,329 Continuing Care 14,726 15,597 15,442 Primary Care 32,494 54,720 56,811 Other Programme 11,462 5,628 11,965 Total Programme Costs 201, , ,452 Running Costs 3,640 3,463 3,518 Running Costs 3,620 3,248 3,240 Contingency 0 0 1,396 Contingency 0 0 1,200 Total Costs 240, , ,295 Total Costs 205, , , / / /17 Surplus/(Deficit) In-Year Movement 26 (1,775) (46) Surplus/(Deficit) Cumulative 2, Surplus/(Deficit) % 0.96% 0.22% 0.20% / / /17 Surplus/(Deficit) In-Year Movement 895 1, Surplus/(Deficit) Cumulative 2,856 4,071 2,380 Surplus/(Deficit) % 1.40% 1.70% 1.00% Includes QIPP (5,606) Meets Business Rules Required QIPP (excluded) (3,062) Meets Business Rules Key Assumptions Reduction of contingency to 0.5% Non recurrent spend of 2.8m fully utilised in above figures 1.8% tariff uplift Surplus at 0.2% Y N N Key Assumptions Contingency of 0.5% Non recurrent spend at 2.4m modelled in the above figures 1.8% tariff uplift Surplus at 1% in line with business rules Y Y Y

15 Headline financial plan m Programme Primary Care Co-commissioning 25.0 Headroom 0.0 Surplus 0.5 Contingency 1.4 Pressures 11.7 Anticipated QIPP c5.6** Other Mitigations 3.4 Running costs 3.5 ** Note: 1.5m full year effect assumed in 2015/16 position

16 Cost pressures flowchart Demographic Pressures - Population Growth, Aging Trends, Historic Data Non Demographic Pressures -Medical Advances, Expectations, Historic Data Cost Pressures Pay, NPND, Drugs, GDP Collate, calculate and extrapolate projections and update for Service Specific Trends Service Level Projections Spend on Health care

17 Blackpool pressures Blackpool CCG Financial Position 2015/ / /16 Underlying 2016/17 Underlying m m m m Opening Position Growth funding Tariff Inflation 1.80% Activity Growth / Demographic Parity of Esteem 4.60% Other Inflation (Incl Running Costs) CHC Growth Other Pressures Establish Contingency 0.50% -1.4 QIPP (net Saving) 2.00% /16 Assumed QIPP Benefit Roll Forward 1.5 Submitted Position NB To move from the exit position from 15/16 and achieve business rules requires the following; Movement from Exit to Required Surplus ( 3.1m Def to 2.5m surplus) 5.6 Re-establish Contingency 1.4 Establish 1% NR Fund 2.8 MH Parity Of Esteem

18 Mitigations/ concessions Mitigations m QIPP (2%) c5.6 Contract reserve (2%) 2.6 Prescribing reserve (2.4%) 0.8 Contingency (0.5%) 1.4 Concessions(assumed in Plan - not agreed by NHSE) m Utilisation of 1% headroom 2.8 Reduction in required surplus 2.1

19 Capital pipeline outline bids Business as usual capital schemes submitted CCG: 4 schemes submitted totalling 629k (ARC intermediate care; MSK service redesign; Extensive care; Learning disabilities) GPIT: 2 schemes totalling 153k GP practice improvement schemes: 2 schemes totalling c 300k (via NHSE) (Arnold Medical Centre and St Pauls Medical Centre) PCIF submissions - delayed until April Pre-commitments totalling 1,125k (Layton; Clevelys Group & Crescent; Abbeydale) Pipeline totalling 5,400k (Adelaide Street; South King Street)

20 Next Steps At the meeting with NHS England on 18th February, financial plans noted to be based on a virtual do nothing scenario Financial plan was not accepted by NHS England; next re-submission is required on 2nd March The requirement is to firm up savings plans in order to confirm or change the estimates for meeting the business rules PMO arrangements for the savings plan to be described and implemented Commissioners must define the contractual relationship with BTH to ensure the rules of engagement are clear to enable controls on activity and coding issues to be effective NHS England has indicated it is more important for the CCG to get the contract right than sign by a certain date and arbitration could be used as a means of achieving the deadlines if required Overall, the expectation is that the CCG must have plans that aim to meet the business rules, or show that there is an improvement trajectory to achieve it during 2016/17 (noting that growth in 2017/18 will only be 2%)

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