HEE Business Plan 2015/16

Transcription

1 HEE Business Plan 2015/16 March 2015

2 Contents Foreword Section 1: Our purpose Section 2: Our priorities Section 3: Delivering our Business Plan Section 4: Our resources and efficiency challenges Annex A: Our top Priorities and related Work Programmes Annex B: Our 2015/16 Work Programmes Annex C: Education and Training Commissions 2015/16 Annex D: Key Risks Annex E: Glossary 2

3 Foreword Health Education England (HEE) exists for one reason alone: to help improve the quality of care by ensuring our workforce has the right numbers, skills, values and behaviours to meet the needs of patients. On 1 st April 2015 Health Education England becomes a Non-Departmental Public Body as a result of the 2014 Care Act which puts HEE on a firm footing as the organisation responsible for educating and training the health workforce in England now and in the future. This change of status is a vote of confidence in the work of HEE since its creation as a Special Health Authority on 1 st April This, our third annual business plan and our first as an NDPB, builds on HEE s achievements in its two years as a SpHA; an organisation that sets out what it is going to do, then delivers on what it says. We said we would train 100,000 NHS staff in 2013/14 and a further 250,000 in 2014/15 in dementia awareness. We did that. We said we would support the needs of the service in managing the problems in emergency care by working closely with the Royal College of Emergency Medicine. We did that. We said we would increase the nurse training places. We did that and will do it again. We said we would provide a focus like never before on the NHS healthcare support workforce. We did that through Talent for Care, and we will continue to do it. We said we would deliver pre-degree nursing experience pilots. We did that and now hundreds of prospective nurses, and the patients they care for, are benefiting and will do so every year from now on. These are just some examples of HEE delivering and in 2015/16 we will go further in ensuring the NHS has the right workforce with the right skills, behaviours and values in the right place at the right time, first time. In 2014/15 HEE published its 15 Year Strategic Framework which set out our long term vision for the development of our workforce. Building on that work HEE has been a key partner in the creation of the NHS Five Year Forward View which sets out the changes the service needs to make to meet the needs of patients and the public for quality care on a sustainable basis in the future. This Business Plan sets out how we will continue to work with partners, locally and nationally, to ensure the workforce changes needed to support better services are put in place. This includes improving the development and capability of the healthcare support workforce; ensuring we educate and train the nursing profession so it is fit for the future; delivering a workforce to help improve primary care; increasing the focus on mental health and its workforce and supporting the changes 3

4 required to deliver the Bubb Review recommendations into care for those with learning disabilities. The business plan is based on the priorities of the service. It delivers better care now, through the return to practice campaign for nurses and staff training in dementia, and prepares for the future by helping make the NHS a world leader in genomics and continuing our work on the Future Patient education and training programmes for carers. HEE cannot and does not deliver alone. We are proud to work with the providers of NHS services and other organisations such as commissioners, local authorities and Higher Education providers who make up our LETBs. And we are proud of our role on the national stage working with the other Health Arms-Length Bodies and the Department of Health to ensure the workforce, which the NHS spends the vast majority of its budget on, is at the centre of creating a better future. This is our Business Plan for 2015/16. With our partners we will continue to deliver for our patients, our staff, our trainees and our students. Professor Ian Cumming OBE Sir Keith Pearson JP DL 4

5 Section 1: Our purpose 1.1 What we do Our job at HEE is to ensure that when a patient turns to the NHS for help, there is a trained person with the right skills and behaviours ready to meet their needs. Two simple actions are required to ensure that the right staff are available to patients when they need them: 1. Enough jobs must be created and funded to deliver the care required by the people of England 2. Enough staff with the rights skills and behaviours must be available to fill the jobs created. Provider and commissioners are responsible for the first action. HEE is then primarily responsible for the second, using our training and education commissions to ensure balance between supply and employer demand. Sometimes demand is best met by developing the skills of existing staff, which is why HEE is committed to developing the existing workforce as well as creating the future workforce. To this end, each year we invest approximately 5 billion pounds of public money. Overall, we are commissioning more education and training than ever before, with over 50,000 doctors in training and over 37,000 new training opportunities for nurses, scientists, and therapists. These commissions for under graduate and post graduate programmes make up the majority of our investment and ensure a supply of medical and non-medical healthcare workforce. We need to be assured our investments in education and training are getting the very best value for money for tax payers (especially so in this challenging financial environment), improving quality for current and future patients, and ensuring high level satisfaction rates from our trainees and students. Our budget setting principles of equity, stability, transparency, and flexibility, with an overarching principle of quality, guide our decision making, ensuring the five billion we spend on education programmes are meeting the outcomes we are aiming to achieve. 1.2 What we do and why HEE is not the only body concerned with the education and training of healthcare staff. The regulators have an important part to play, as do providers who are ultimately responsible for employing, maintaining and developing their staff and the quality of care they provide. HEE serves the wider healthcare system (including private and third sector providers) but has no remit over social care. HEE has four levers that we use to achieve our shared purpose of improving the quality of patient care: 5

6 These are supported by our corporate enablers that that help support the delivery of HEE s key objectives including: Strategy, Performance and development, HR and OD, Corporate Finance, Estates, Internal and external communication and Corporate services 6

7 Section 2: Our priorities A Business Plan represents a formal statement of a set of business goals or ambitions for a defined period of time. Its purpose is to provide a road map for the future; identifying priorities and allocating resources to give us the best chance of getting there. In order to determine our business goals for the next year, we have assessed our Business Plan against four key tests: Does our Business Plan align with and help deliver our fifteen-year strategy and Five Year Forward View Does it support the delivery of our statutory directions and Mandate requirements? Do we have the capacity and resources to deliver our business goals? Are we clear what our top priorities are? Each of these questions is addressed in more detail below. Strategy & Planning into action 7

8 2.1 Aligning our business goals with our fifteen year strategic framework and the Forward View Into Action In June last year we published our Strategic Framework (Framework 15 / F-15), with a minor update in October (see Framework-15) It can take over a decade to train a medical consultant or senior nurse. Those who get the student places we have commissioned in 2014 will still be working as healthcare professionals until Therefore, every time we make an investment in a training place, we are making an expensive set of assumptions about future healthcare needs and how best to meet them. If our assumptions and investments are very wrong, then this could contribute to: an under-supply in some areas of the workforce, with negative consequences for the care we are able to offer patients and their families, or an over-supply, resulting in a highly-skilled unemployed workforce and a wasted opportunity to invest public money elsewhere in the NHS, or the wrong set of skills in the wrong place, locking the service into particular models of delivery that may not be appropriate for the needs of future patients. We recognise that the workforce is integral to the way that healthcare is provided both now and in the future, so we have chosen to set out in one place our planning assumptions, so that others can let us know if they think we have got it wrong and work with us to address longer term challenges and achieve shared goals. 8

9 Better patient care will only be delivered by co-operation and partnership across the system, because workforce strategy is intimately connected with decisions about service configuration, models of care, quality and cost. By sharing our current thinking, we will promote not just more discussion and debate about strategy, but better decisions and thereby better patient care. Our strategic framework: Provides the conceptual framework for how HEE approaches problems and identifies solutions, ensuring our focus remains on the patient. Guides the decisions we make in the short term, such as the annual workforce planning process and the priorities in our Business Plan. Informs our longer-term work programme, including taking forward The Shape of Training Review and piloting life-cycle workforce planning for children and young people. Enables our board and the public to assess our actions against our expressed strategic ambitions, and to challenge us if we veer off course. Provides the basis for more detailed conversations with our partners and stakeholders about the challenges and opportunities ahead. HEE made six strategic assumptions that underpin Framework 15: These assumptions led us to develop our strategic framework based on three key pillars: 9

10 These are represented in the following diagram: The Forward View into Action describes the approach for national and local organisations to start fulfilling the vision set out in the Five Year Forward View (5YFV), whilst continuing to deliver the high quality timely care that the people of England expect today. We have worked closely with the other five ALBs (NHSE, TDA, Monitor, CQC and PHE) to produce aligned planning guidance for the system to ensure that we have common planning assumptions and processes to deliver our shared vision. 10

11 The Forward View into Action makes clear that: We will work together to accelerate the design of new models of care, with a structured programme of support. The workforce will be central to the development of the new models of care: the provision of health and care is delivered by people not buildings. We expect providers and commissioners to engage with their Local Education and Training Boards (LETBs) to work together to identify their current and future workforce needs. For those economies that wish to put themselves forward to co-create the new care models, we expect to see plans to develop the existing and future workforce plans to develop these models. In challenged health care economies, a plan to deliver workforce needs will also be a key ingredient of success. Planning assumptions must be shared between commissions, providers, LETBs and other partners to ensure alignment, with LETBs triangulating their plans with local commissioners and providers before submitting them to HEE. We will establish a Workforce Advisory Board, chaired by HEE and with membership across the system to support delivery of a health and care workforce with the skills, values and behaviours to deliver the new models of care. HEE continues to work with our partners on programmes that will help us to deliver our shared purpose at scale and pace. LETBs have been engaged with partners in discussing the workforce needs of the Five Year Forward View. These discussions have served to inform local plans as required by The Forward View into Action, but also helped to shape the priorities for the Workforce Advisory Board and for this 15/16 Business Plan and workforce planning guidance by identifying priority areas for investment and action to deliver the workforce transformation required by the 5YFV. This Business Plan sets out at a high level the key priorities that Health Education England will deliver to support other organisations to deliver the commitments for tomorrow and today. This will be supported by the new Workforce Advisory Board, chaired by HEE with senior membership from across the system, to develop a health and care workforce with the skills to support the implementation of new models of care. The Workforce Advisory Board (WAB) will initially focus on four areas: additional actions to retain existing staff and attract returners in roles experiencing shortages such as Emergency Medicine, nursing and GPs; provide support to challenged economies where workforce shortages are impeding improvement; identify the flexibilities that will need to be developed in order to deliver new care models as well as opportunities to reskill the existing workforce; identify new roles that may need to be commissioned to deliver on the aspirations of the Forward View. 11

12 2.2 Do our business priorities for 15/16 help us to deliver our Mandate? HEE was given a Mandate by the Secretary of State for Health in May 2013 and this has since been the subject of a refresh for 2014/15 and 2015/16. The latest version published on 5 th March. The process of refreshing the mandate happened in parallel to the creation of our Business Plan, and we have mapped each deliverable, identifying timelines and milestones and lead Directors. Following this exercise, we are confident that we have captured each of the mandate requirements within our business functions and respective directorates. The priority commitments highlighted in section 2.4 below address the main themes of the 2015/16 mandate. However HEE s work programmes (Annex B) ensure that all requirements of the Mandate will be appropriately addressed. 2.3 Do we have the resources and capacity and capability to deliver our business goals whilst making our efficiency savings? HEE is working hard to ensure that it truly acts as one HEE. Staff have already started to work in different ways and are identifying peers across LETB areas, making connections and sharing work. An example of one HEE already beginning to work includes the new intranet across the whole of HEE enabling greater sharing. There are a range of changes for each national directorate and for each of the four national geographies (the North, Midlands & East, London & the South East and the South). Each structure has been costed to ensure it meets running cost requirements and makes provisions for the delivery of our responsibilities by staff in the right place at the right time with the right skills and experience whether that be nationally, locally or nationwide. Whilst we are seeking greater alignment and focus as one HEE, there will be differences in approach locally which is to be encouraged if linked to a greater focus on sharing, learning and adopting across the organisation. Each LETB area will take taking lead roles, working across the geography, and building on lead commissioning arrangements and managing shared programmes. There is a new pan-hee network of Research and Innovation Leads that will enable the better connection of expertise and further coherence in the delivery of the Research and Innovation Strategy. We are a very information dependent organisation. Everything we do in planning, delivery and monitoring has information at the heart so we are working on how we can better collect, collate and use information and data in the new structures. Assurance is best provided locally so we are aligning information and data assurance with the LETB leadership and developing a resource for Business Information Systems that aligns the local and national. The purpose of this is to streamline and simplify local systems, processes and practices in each LETB, creating the consistency that is vital to effective information systems. 12

13 In the core enabling functions of Communications, Human Resources and Governance within the People and Communications Directorate it became clear that resources across the country needed to evolve to reflect the need for each local area to have equal access to staff, skills and broader resources but also greater understanding of what needed to be done where. Risk and business continuity will remain core to the governance strand within People and Communications. The vital importance of information technology in making one HEE work is understood and action is being taken to address these issues. The Finance structures provide for the distributed support to budget managers from designated financial managers. For financial systems work we have developed a core central team working with designated individuals in geography teams to drive greater consistency (a common spine ) and system improvement. There is a requirement for greater resource for workforce analytics. Therefore it was agreed to increase the resource in the workforce planning functions of the Planning and Strategy Directorate and we are working to ensure the best use of our available skills, experience and resources in this area Are we clear what our top priorities are? The extent of our statutory duties and the scale of our ambition, requires HEE to be very clear about what our core priorities are so that our resources at both local and national level are allocated appropriately. Our top priorities are divided into two categories: (1) Priority commitments: HEE is committed to delivering our entire mandate, but below we have pulled out those deliverables where we expect to come under greater public scrutiny or where a specific numeric measure has been applied. The table below details priorities in respect of; The Primary and Community care workforce Mental Health, Learning Disabilities, and Dementia Birth, Children and Young People Public Health and Prevention In addition HEE will continue to increase its focus on supporting partners to address areas of current workforce shortage, including; Emergency and Urgent care including paramedics Nursing Specific Geographic Shortages 13

14 (2) Transformational changes: These are the actions or programmes of work that may not deliver in-year results, but represent a fundamental change in the nature of the health workforce, that will take HEE closer towards achieving our fifteen year strategic ambitions The table below describes how HEE, in line with our 15 year strategic framework is seeking to actively shape an increasingly flexible workforce including; Patients, the public, and carers as part of the health workforce Flexible training and careers for doctors Flexible training and careers for registered nurses and care assistants and the wider support workforce A workforce representative of the communities it serves A workforce planned with the needs of patients as it primary driver not profession or service HEE is also seeking to ensure the workforce is able to responds to the key drivers of the future patient and in particular developments in technology; Developing a workforce capable of maximising the impact in care of developments in Genome mapping A workforce aligned to the strategy of the National Information Board, The two groups of priorities are not mutually exclusive, for instance the mandate priorities on integrated care include elements with more immediate deliverables and impact, as well as indicating the need for the transformation of future care models and the workforce that delivers them. We also need to be clear that these work streams represent the key workforce input to implementation of new care models and the radical ambition set out in the five year forward view. As implementation of the Five Year Forward View programme develops, and not least through the work of the Workforce Advisory Board, HEE will be able to become more explicit about how this work directly enables delivery of the NHS of the future. In addition to these high level priorities we need to recognise that a significant proportion of HEE s activity can be typified as being core operational business. In particular the commissioning of, and contracting for, at least 129 programmes of structured education. This activity, including nationwide Post Graduate medical recruitment, represents the majority of both our financial and human resource, and it is therefore important to our staff that their contribution to our mission is explicitly recognised within this plan. HEE will also be undertaking a number of enabler / process improvements, designed to ensure that delivery of both our top priorities and core operational business can be undertaken with the highest degree of efficiency and impact. These include: 14

15 HEE beginning in its role as a Non-Departmental Public Body (NDPB) and implementing changes following the Beyond Transition (BT) review Establishing the Workforce Advisory Board (WAB) to develop a healthcare workforce with the skills to support the implementation of new models of care Refining our process for a medium term Financial Strategy with a longer term perspective that links current investment decisions to the Strategic Framework 15, HEE s mandate and Five Year Forward View Improved workforce data from all sectors, and the streamlining and standardisation of workforce planning processes and products An extensive programme of work with DEQ exploring education commissioning for patient safety and quality. An extensive programme of informatics delivery in support of one HEE operations. 2.5 Flexibility for Emergent Five Year Forward View and New Government Priorities The HEE Business Plan 2015/16 enables the organisation to progress with pace and intent to ensure the current and future needs of people are met. However, we do need to recognise that the implementation of the Five Year Forward View is in its early stages and that the general election on May 7 th will result in a new government of whatever political complexion that may have its own views on the relative priorities for the NHS. Our assessment is that the priority areas identified in this plan are all likely to form part of any emergent priorities and that any re-planning will mainly be a matter of scale and emphasis rather than any fundamental change. 15

16 No. PRIORITY COMMITMENTS(what) PURPOSE (why) Indicative dates PC1 Identify the need for and act to deliver a multi-professional primary and community care workforce (including dentistry) able to meet the needs of current and future service requirements - 3,250 doctors completing Foundation training enter GP training programmes by Implementation of the 10-point GP Plan - Progress recommendations of the Primary Care Commission Resolving the workforce challenges in the provision of out of hospital care is pivotal for both current service delivery, across the system and as the critical component of new integrated care models. Failure to address these challenges presents significant risks to both the successful implementation of the Five Year Forward View and delivery of high quality services to current patients PC2 Implement actions to support end of life care from One Chance to get it Right To support patients at all times in their lives, including supporting their choice of where to die. March 2016 June 2015 PC3 PC4 Ensure a greater focus on mental health workforce, including - support delivery of the IAPT workforce to meet access and recovery targets. - increase number of psychiatrists, - focus on perinatal mental health, - Early intervention and, liaison psychiatry services Dementia Working to ensure that the tools and training opportunities are available to all staff by the end of As service commissioning responds to the need to ensure parity of esteem between physical and mental health, HEE needs to ensure the mental health workforce is able to grow and develop to meet new service demand and requirements To improve the experience of people with dementia when they are in NHS and care settings by increasing staff awareness December 2015 March 2016 PC5 Support for NHSE on Bubb report: Winterbourne View Time for Change Developing the Learning Disabilities workforce to deliver new care models in new settings PC6 Deliver the increased midwifery commissions planned for by HEE in 2015/16 and working through our annual planning process assess the demand required to ensure sufficient midwives and other maternity staff are available to provide personalised care and ensure sufficient staff are trained to meet this demand. PC7 Commission sufficient Health Visitor (HV) training places to ensure a sustainable workforce to reflect Local Authority (LA) commissioning of HV services PC8 Work with PHE, NHS England, DH and other system leaders to deliver the action plan for public health To ensure the Learning Disabilities workforce is of the right size with appropriate development and values to deliver the quality care this vulnerable group deserves To ensure there are sufficient midwives to provide every woman with personalised one to one care Good, well-resourced health visiting services help ensure that children have the critical positive start to life To support the prevention and public health agenda across the healthcare system July 2015 September 2015 October 2015 March 2016 PC9 To address the current supply of staff in current shortage areas, including; - Nursing: increasing commissions, Return To Practice initiatives - Urgent and Emergency Care - Emergency Cabinet, Paramedics, new roles for physician associates and pharmacists within EC To meet the expressed need of employers/patients and to address the significant financial burden of excess agency usage. September 2015 PC10 Reduce avoidable attrition from training programmes by a third Maximise future supply and return from the investment we make March 2016 PC11 Supporting veterans health To target support on veterans with complex needs December

17 No. TRANSFORMATIONAL CHANGES (what) PURPOSE (why) Indicative dates TF1 TF2 TF3 TF4 Lead work on the Future Patient, to pilot and evaluate approaches for education and training programmes for people & carers in areas of self-care, self-management, and prevention Take the lead in England to develop a detailed feasibility assessment of proposals within the Shape of Training review, including proposals to move the point of registration. Following consultation take forward agreed proposals within the Shape of Caring review, including increasing flexibility across training pathways, an increased focus on care assistant roles, and the need to ensure nurses are supported in their development over the whole of their careers Play a leadership role in continuing to implement the relevant recommendations of the Cavendish Review Framework 15 and Five Year Forward View both highlight the critical role that the public need and want to take in management of their own health. To educate and train doctors who are able to provide general care in broad specialty areas across a range of different settings, and to ensure sustainable and flexible careers to meet the changing needs of the pubic To deliver patient focussed education and training for registered nurses and care assistants linked to appropriate careers structures. The potential for the delivery of more practice, district, and community nurses, to support integrated service provision across health and social care. Improving the capability of the care assistant workforce in support of integrated care models and flexible care teams. October 2015 September 2015 July 2015 March 2016 TF5 TF6 TF7 TF8 TF9 Implement the Talent for Care strategic framework and the take up of the employer partnership pledge Implement the widening participation strategy, including developing evidence about effective approaches to widening participation through research and evaluation. Continuing to develop and implement the approach to demand led/ service based workforce planning by piloting a life cycle approach starting with children and young people Lead on the workforce implications of, and develop a training strategy for genomics and Bio-informatics Supporting the National Information Board (NIB) strategy for the health and care workforce to embrace information/data/technology Drive the development of the healthcare support workforce and provide opportunities for effective career progression and maximisation of individuals capabilities and potential To ensure diversity of the workforce to represent the communities it serves, raise aspirations and support flexible methods for entering training So that we can embed a method for planning the future workforce based upon the needs of future patients, so that care is more person centred To actively develop the current workforce to equip them with the skills to utilise in the near term, developments in genetics within the management of populations and their health conditions. To ensure the workforce is willing and able to embrace innovation and takes full advantage of new technology and the use of information to enhance patient care. November 2015 December 2015 March 2016 March 2016 April

18 3. Delivering our Business Plan 3.1 Our 2015/16 Work Programme The top priorities outlined above are a summary of a number of specific work streams allocated to HEE directorates who in turn will work coherently with equivalent LETB colleagues to ensure consistent and comprehensive delivery. Other work streams represent the fuller mandate deliverables, core operational work, and our system and process improvement goals for the year. Annex A describes which individual work programmes contribute to which priority areas Annex B sets out these key work programmes for 15/16, and includes: Core business activities required to deliver our key objectives and business goals Strategic priorities to ensure that we deliver our fifteen year ambition Mandate deliverables and statutory requirements Enabler activities such as HR and Finance that will deliver our efficiency savings through new operating model and ways of working 18

19 3.2 Delivering through our staff We will measure how well we are doing in meeting the deliverables in this business plan by using a robust programme management system and integrated performance framework. The framework details all our activities as described in this business plan and we will monitor our progress to provide assurance to our board we are meeting our objectives. We will ensure all our activities are aligned to achieving the vision of HEE by using the process shown in the diagram below. By taking this approach we can be assured all our staff have individual objectives contributing to achieving our vision for patients: Strategic Framework Business Plan 2015/16 Patient needs Framework 15 Strategic Priorities Business Priorities Delivery Framework (AspireView system) 2015/16 Performance Appraisal Process 2015/16 GD/LD and Directorate Objectives and Deliverables Team Objectives and Deliverables Individual Objectives and Deliverables 19

20 3.3 Delivering with our partners There is increasing recognition of the importance of our workforce; the Five Year Forward View makes it clear that the new models of care simply won t become a reality without the people to deliver them. We now need to work with our partners through the Workforce Advisory Board to encourage: Employers to provide robust workforce forecasts to LETBs. These form the basic building blocks of our national plan, so the higher quality they are the better the overall plan. Every CEO needs to be engaged in this process, ensuring alignment with commissioning and provision plans and plans to implement the new care models, with workforce forecasts signed off by their medical and nursing director Employers and commissioners to create jobs in the right settings so that the staff we train are able to realise and deliver the policy intent of Five Year Forward View, rather than perpetuate an imbalance between community and acute sectors Employer and professional bodies to work with HEE and our LETBs on data sharing so that patients receive care from staff employed by a range of different sectors and bodies: the NHS, social care, the independent and charitable sectors. Currently, we only have access to data on staff employed in the NHS, which means we have an incomplete picture of supply Greater employer focus on retaining and investing in their current staff. It is our responsibility to commission education and training places to secure the supply of the future workforce, but it is becoming apparent that in some areas, requests for more commissions are due to a leaky bucket effect, whereby employers are failing to retain and develop their skilled staff. Commissioning more trainees is the most time consuming and expensive way to address shortages in supply. Attracting people back to the profession is more cost-effective, but the most effective approach of all would be to retain and develop their employees. We will work with NHS Employers and other partners to develop a more strategic and cost-effective approach to staff retention Patient groups, Royal Colleges and other stakeholders to work with us on reshaping the workforce. We know that more of the same simply won t deliver the transformed services that patients need. As set out in our Framework 15, we need a more flexible, adaptable workforce, able to work across professional boundaries and settings, so that they can provide high quality care wherever and whenever the patient needs help. This will require the creation and/or expansion of new roles, and active decommissioning of others, if we are to develop a workforce planning process shaped by patients needs rather than supply Continued support for a shared vision and aligned planning and action. The most important development this year has been the development of a shared NHS view of the future. The Five Year Forward View provides a clear service vision, and it is now our responsibility to develop an appropriate workforce to make that vision a reality. 20

21 Section 4: Our resources and efficiency challenges Ensuring that we deliver quality education and training from initial supply to further development of the workforce within the financial resources provided to us is of utmost importance. HEE is responsible for 5 billion of NHS funding in order to deliver its objectives and we recognise that ensuring it is spent effectively and efficiently is essential. The following assessment is of income and expenditure anticipated for our business as usual activities and to deliver the mandate. In addition to this HEE will receive additional non-recurrent funding to support work on genomics in line with the recently approved business case. Income HEE receives most of its funding directly from the Department of Health, with other substantial funding from a few key sources as shown in the table below. We received an indicative allocation in December This indicated a 30 million reduction in our programme allocation and a 5.1m reduction in administration allocation. Whilst we were anticipating a reduction in our administration allocation, and this is being dealt with through the Beyond Transition change programme, the reduction in programme expenditure was unexpected. This has resulted in some late stage revisions to the Investment Plans. However, HEE remains committed to delivery of the Workforce Plan and Mandate within the resources available. 21

22 Budget Budget Change million million million % Change DH Grant in Aid DH Programme - Recurrent 4, , % DH Admin - non-ring-fenced % DH Admin - ring-fenced DEL % Subtotal Recurrent funding 4, , % DH Programme - Non-recurrent* % Subtotal Grant in Aid 4, , % Contributions to programmes Devolved administrations % Clinical excellence % International Office ** Subtotal Contributions % Other income NIHR % Leadership academy % Subtotal Other % Total Income 5, , % * Genomics Programme approved business case ** Subject to contract being agreed and trainee recruitment in line with business case NIHR and Leadership Academy are categorised as other income as this activity does not relate to our main programmes. In both cases the income is available for specific purposes and expenditure budgets are matched with the level of income. The Leadership Academy is considering a substantial reduction in funding to local leadership teams which are commissioned and/or managed by HEE. Last year s values have been used whilst we await confirmation of final values and expenditure budgets will be reset as necessary when income is known. There still remains some uncertainty regarding the size and timing of income relating to international students. Expenditure Detailed spending plans have been put together from local level to ensure that budgets provide for the implementation of the Workforce Plan agreed by the Board in December. (see: ). The budget has been revised and expanded from that approved by the Board last March to reflect reclassification of expenditure to more appropriate headings and allow better comparison between years. 22

23 The following table shows the main categories of expenditure: Revised Budget Budget Change million million million % Change Programme Expenditure Future workforce - post graduate M&D 1, , % - undergraduate medical and dental % - non medical 1, , % - other % Subtotal future workforce 4, , % Workforce development % Education support % National activities % Transformation fund % Genomics project % Subtotal Programme Expenditure 4, , % Admin Expenditure % Other Expenditure % Total Expenditure 5, , % Future workforce is the largest category of expenditure and covers funding of clinical placements for both medical and non-medical undergraduate students and postgraduate medical and non-medical trainees. There are also some post-graduate 2nd registration courses covered by future workforce. The expenditure for future workforce is closely linked with activity levels. Once student places are commissioned expenditure is committed for the subsequent period until professional qualification is achieved. Therefore, there is a lead in time for changing expenditure patterns that can be anything up to 7 years. It was also noted that there were various stakeholders such as Royal Colleges who influence training numbers. The majority of the expenditure is subject to either benchmark prices for higher education institutes or transitional tariffs that are being introduced (with a transition path to smooth large changes in income) for placements with providers. Some clinical roles and professionals such as training in primary care, pharmacy and healthcare scientists are outside the scope of tariffs. 23

24 Budgets for undergraduate medical reflect the tariff reduction for undergraduate placement fees paid to placement providers. DH undertook to reduce this tariff as part of our allocation settlement, which makes it possible for our workforce plan to be affordable. The budgets also assumes a second year of zero uplift to the Benchmark Prices paid to HEIs in relation to undergraduate course fees for nursing and allied health profession courses. However, the effect of the increase in commissions for these professional groups in the workforce plan results in an aggregate increase in the budget. The budget for Workforce Development has been held at the budgeted level of 205m. This is an important resource to support the improvement, and changes to the skill base of the existing NHS Workforce which are essential to the transformational changes needed to deliver the recently published vision for the future in the Five Year Forward View. In we set a Transformation Fund at 30m to provide for contingency and to support delivery of the Mandate. The budget for separates this into two items a contingency fund to cover residual inflationary effects and other minor variations on programme budgets of 9m and a central Transformation Fund of 15m to supplement locally held budgets. Our restructuring programme Beyond Transition, reduced our admin costs by c20% to provide for the anticipated allocation reductions over the three years to and to cover the impact of inflation. We have a small degree of nonrecurrent flexibility in that will cover slippage on estate changes and infrastructure improvement, particularly to enhance productivity through better use of technology. 24

25 Projection of Statement of Financial Position as at March 2016: Estimated Mar-15 Projected Mar-16 million million Non Current Assets Property Plant and Equipment Trade and Other Receivables Land and Buildings Total Non Current Assets Current Assets Trade and Other Receivables Other Current Assets Cash and Cash Equivalents Total Current Assets Total Assets Current Liabilities Trade and Other Payables Provisions Other Current Liabilities Net Current Assets/Liabilities Total Assets less Liabilities Taxpayers Equity General Fund Reserves Total Taxpayers Equity Capital Expenditure It is anticipated that there will be minimal capital requirement for HEE and LETBs. Approximately 3 million is required for IM&T improvements, due to slippage of expenditure plans from These are initial estimates; options are still being considered which could impact on the exact amount required. 25

26 Procurement Landscape Health Education England has expected expenditure of nearly 5 billion. The majority of expenditure is committed through costs of staff in training e.g. salary costs of junior doctors, facilities and supervision. This supervision is usually from qualified NHS staff and using NHS premises. For both undergraduate and postgraduate levels training is provided in University and Further Education settings. The vast majority of the procurement HEE will manage over the next few years will relate to these existing education and infrastructure activities. A number of contracts have been mandated by DH through their efficiency review. These contracts have either been implemented or have a time line to be implemented. The contracts database has identified a number of key areas that need reviewing, here collaboration will give efficiency benefits; these include IT, Agency Staff and procurement provision. Procurement governance The Finance function within HEE has the lead responsibility for procurement and maintenance of all appropriate contractual records. The Director of Finance will therefore ensure the HEE Board has oversight of all relevant procurement decisions. A scheme of delegation and procurement manual has been issued to LETBs and will be reviewed and updated regularly to ensure guidance is current and best practice. HEE are developing a new national standard framework contract for use from 1st April 2014 for business with further and higher education providers, and a new learning and development agreement (LDA) for NHS and associated placement providers. The new national standard framework contract with higher educational institutions and LDA agreements with NHS trusts, represent the organisations core contracting activity. These education and training contracts will be the main focus of the Procurement and Contracts function based on their strategic importance to HEE. Appropriate resource will be designated to these strategic contracts, to ensure contracted performance levels and outcomes are delivered and maximum value achieved. A robust contract management framework will be developed and embedded within the organisation to ensure our commercial relationships are managed and developed to extract maximum value for money. HEE will ensure organisational compliance with EU and UK procurement regulations and will evaluate and implement any necessary changes to processes and policy resulting from the changes to EU directives due for implementation in 2015 and Procurement and contract management guidance is available to all colleagues within HEE which provides rules and processes to be followed in line with both the organisation s standing financial instructions and EU procurement rules. The guidance is also updated to incorporate current governmental policy and Cabinet Office controls in a number of business activities. 26

27 The procurement committee will oversee organisational compliance to overarching procurement strategy and policy and will where necessary make recommendations to the board on any identified, strategic procurement decisions. Procurement Service Procurement is provided through inherited arrangements with three Procurement Partners for 2015/16. They are: South of England Procurement Leicestershire and Rutland Procurement Partnership Leeds and York NHS Foundation Partnership Trust. HEE has reviewed the procurement service and will be working to commission a revised service during 2015/16 to ensure alignment with central government direction relating to the efficiency challenges which will be met in part, through the adoption of the Crown Commercial Service. HEE will be looking to rationalise the procurement service to ensure a common approach to procurement delivery and efficiency and will be evaluating options based on value for money and the expertise required to deliver future projects which have been identified through the HEE procurement pipeline. Procurement Strategy and policy HEE are committed to ensuring that procurement development and delivery aligns with the National standards of procurement and will be building its strategy on the NHS standards of procurement including plans relating to Leadership, People Partnerships and process. HEE will also incorporate any recommendations or policy resulting from the Better Procurement, Better Value, Better Care review. HEE will be supporting SMEs through greater transparency of contract opportunities and the promotion of contracts finder for tenders and contracts. HEE guidelines have been drafted on providing procuring officers a toolkit on practical steps that can be incorporated into tender processes. The guidance has been circulated throughout the organisation and tests will be carried out at regular intervals to ensure guidance is being incorporated into delivery. Linked to support of small medium enterprises HEE will be ensuring that all contracting opportunities will be made available through contracts finder as mandated by the cabinet office. We will also be publishing all spend of a value of over 25k on our website. LEAN Sourcing principles have been evaluated and will be incorporated into procurement manuals and guidance documents. HEE have identified procurement activity through projects that HEE and its LETBs will be delivering over the next months. Pipeline information will be provided to DH and the supply market through the use of Contracts Finder. Contracts finder will ensure openness and transparency of opportunities to all potential suppliers. 27

28 Estates Efficiencies Health Education England currently occupies a varied number of properties throughout England which are provided by the DH, NHS Property Services, a number of Universities and other NHS Organisations. The occupation agreements for these premises fall under four main headings full lease, under lease, Memorandum of Occupation and Licence and are in the main dependent upon the arrangements previously put in place by the Strategic Health Authorities. The core objectives for 2015/16 will be to: Ensure the management of our estate delivers efficiencies against the developed KPI s Ensure our estate rationalisation plans contribute to HEE s financial saving targets That the efficiency plans and rationalisation plans are in harmony to the service delivery requirements of our LETB s and national offices, whilst maintaining a fit for purpose estate Working in collaboration with our sponsors and stakeholders we will seek to ensure that we deliver the following. Estates Strategy Using the approved estates strategy action plans we will be able to provide a clear statement to our sponsors, staff and stakeholders as to how Health Education England plans to optimise estate management and support the efficient management of facilities through the next 5 years. It will detail an alignment of the Health Education England estates strategies and policies with government and sponsors guidelines. It will underline our commitment to sustainable development throughout the estate helping to reduce our environmental impact. We will be able to introduce clear controls and targets (KPI s) with particular interest in working towards the achievement of the workplace standard of flexible working and an 8m2/FTE average for the occupied office estate by the end of 2016 and then seeking to reduce this in line with targets when and where appropriate. Regular review of the estate policies and procedures will ensure that challenges are being met and performance is in line with providing an effective, efficient and value for money estate. Estates Data Information gathered from a number of sources in 2014/15, as part of our review now provides HEE with a clear understanding of the condition and management of the current estate and how it currently impacts upon the health and wellbeing of staff and the wider environmental impact through sustainable development. This base level data will now be utilised to develop and embed a set of workable key performance indicators, which will be a focus on which efficiencies and improvements can be measured. 28