Www.england.nhs.uk Planning & Commissioning in Surrey and Sussex Workforce challenges Adam Wickings 9 th July 2014.

www.england.nhs.uk

Planning & Commissioning in Surrey and Sussex

Workforce challenges

Adam Wickings

9th July 2014

www.england.nhs.uk 2

• Hello: My roles

• Overview: Commissioning and Planning in Surrey & Sussex• Call to Action - the national challenge

• Two “Units of Planning” and what they’ve planned• Primary Care & “Out of Hospital” Strategy• “Enablers”: Ring-fenced pots of money

• Better Care Funds• Urgent Care and RTT “resilience” funds

• Change in the Air - co-commissioning, specialised commissioning

• Big themes with workforce implications

From A to B


Surrey & Sussex


Commissioning & Planning responsibilities in Surrey & Sussex

Commissioning organisations in Surrey and Sussex are :• 12 CCGs (5 in Surrey, 7 in Sussex)• NHSE Area Team commissions:

• Primary Care• Specialised services• Prison services• Armed Forces

• 4 Local Authorities (East Sussex, West Sussex, Surrey and Brighton)

Provider landscape is as follows:-• 6 Acute Trusts• 2 Healthcare (Acute & Community)• 3 Community Trusts

• 354 GP Practices• 2 Mental health Trusts








2 Year “Operational Plans”

2 x 5 yr Strategies


Surrey & Sussex UoPs

2 “Units of Planning”2 NHS 5 Year Strategies








4 x Health & Wellbeing Strategies


Surrey & Sussex HWBs

4 Health & Wellbeing Boards4 Health & Wellbeing Strategies

Better C

are Funds

www.england.nhs.uk

The Need for Change


The NHS faces a range of whopping challenges

• We have limited financial resources, no longer growing• An ageing population and growing LTC, and so• A greater and growing demand on services• Workforce that in key areas is not growing at even a similar rate

A ‘Call to Action’ tells us that if we are to preserve key values of the NHS, it must change to survive. More of the same won’t do it. It means transforming services, to put patients at the centre and to better meet the health needs of the future.

• Improving efficiency (£20bn) • Lowering financial costs • Providing more care outside of hospitals:-

INTEGRATION, FEDERATION,… polysystem? TRANSFORMATION SELF MANAGEMENT

National Context - A ‘Call to Action’


How does providing care “out of hospital” not save money?

• Staff in the community are not cheaper than hospital staff (and they have to travel)• Buildings in the community are not cheaper than hospitals (they’re more expensive)• Episodes of care, e.g. appointments, are not cheaper than hospital OP appts - moving

appointments from hospitals to clinics, health-centres or surgeries is not cheaper• The point of a hospital is to lump staff and services together to make them efficient and cheap

How can providing care “out of hospital” save money?

• Fewer, more-expensive episodes are much cheaper overall• People pay for their own homes• 30% of a GP Practice list use 80% of the appointments• They’re the same patients having hospital appointments and admissions etc.• Money is saved when we reduce the fixed assets: hospital buildings

The Money - A ‘Call to Action’


Surrey and Sussex need to provide a better landscape of health and social care services for our communities and must be committed to:-

• Increasing the Potential years of life lost from causes considered amenable to Healthcare

• Improve the quality of life for people with Long term conditions• Increase the proportion of older people living at home• Decrease the number of people having a negative experience of care outside

Hospital, in primary care and in the community• Decrease the number of people having a negative experience of hospital care• Making a significant progress towards eliminating avoidable deaths in our

hospitals

Why Do we Need to Change here?

www.england.nhs.uk

How Do we Do This?


Surrey Strategic Plan• Out of hospital (primary care, Better

Care Fund, urgent care• Acute Hospital Urgent and

Emergency Care• Stroke• Complex Invasive Cardiology• Elective productivity• Mental Health• Cancer• Burns• Plastic

Main Workstreams in Surrey & Sussex

Sussex Strategic Plan• Out of hospital (primary care, Better

Care Fund, urgent care• Maternity and paediatrics• Acute Hospital Urgent and

Emergency Care• Stroke• Complex Invasive Cardiology• Elective productivity• Renal• Cancer• Burns/Plastic• Provider Landscape

Enabling Workstreams Workforce Commissioning developments and levers Others, e.g. BI, IT, premises










www.england.nhs.uk

Wider area transformation strategy - Call to Action

Primary Care Strategy

What’s a Primary Care Strategy?

16


How can commissioners deliver this change?

PLAN

Provider changes – integration?, federation?, reorganisation?, workforce?

Incentives, contracts, new commissioning

Strategy, aims, values, commissioning intentions, messages


Elements of CCG PC StrategiesFederations?integration

New commissioning

Enablers: estates, IT etc

New care pathways

Workforce, Extended roles & patient self-care


• Prime Provider models

• “Outcome based commissioning”

• Commissioning from “federations”

• New procurement approaches

• Less commissioner specification

• More co-design

“New commissioning”



















www.england.nhs.uk

“Enablers” – ring-fenced & discretionary funds

www.england.nhs.uk

• £18 M Surrey 14-15 BCF £47 M Sussex 14-15 BCFs• £65 M Surrey 15-16 BCF £120 M Surrey 15-16 BCFs

• Not new money: CCG allocations ring-fenced for use as agreed with HWBs, technically non-recurrent

• Not a “bung” for Local Authorities: NHS money for use on integration, transformation, out-of-hospital

• 14-15 plans a plethora of “schemes” and “initiatives”

Other Funds in CCGs Control• Local Contracts (Local Enhanced Services)

• DES contracts

Better Care Funds (& others)

www.england.nhs.uk

£17 Million resilience funds (winter)

£xyz Million RTT funding

• “New” money: non-recurrent allocations (via CCGs, not straight to Trusts) for delivery of constitution standards (4 hrs in A&E, 18 wks RTT)

• Non-recurrent and short timescales, short notice so very difficult to use well

• 14-15 plans a plethora of “schemes” and “initiatives”

Resilience Non-Recurrent Funds

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Changes in the air?

Co-commissioning & beyond

25


• Moving control from NHSE (back) to CCGs

• Expressions of Interest so far

• Can be about budgets or just co-design

• A journey: back to unified budgets?

• A unified budget allows investment (investment in

primary & community care)

Primary Care “co-commissioning”


• Moving control from NHSE (back) to CCGs

• Re-designation - what is designated as specialised

• Population commissioning - away from contracts

• A journey: back to unified budgets?

• A unified budget allows investment (investment in primary &

community care) or disinvestment…

Specialised Commissioning


Key Themes for workforce planners?

• Redesign, initiatives, federations… • Get involved with planners

• Integration and federation have to be instead of increases in workforce• We can move nurses and doctors from place to place but we can’t

often get more• Reduce episodes and reduce hand-overs• Lots of new schemes and initiatives can’t be delivered if they all

mean more nurses or doctors• What workforce can we recruit successfully?

• Pharmacy?• Physician assistants?

• Who should do innovation and workforce planning?• Commissioners?• Providers?

“Every child deserves to be given the very best start in life, and healthcare staff working with children and young people must have the right knowledge and skills to meet their specific needs and ensure that children receive joined up health and care across both hospitals and the community” . (CMO 2013)

Nursing Medical

How do we get the right balance?

Make a

plan- Training & governanc

e wider children’s

workforce e.g. PA’s and

school

staff- perso

nal healt

h budgets and the DfE

statutory

guidance

which

takes effect from 1st

Sept 14

Sort- Coding and Counting of Staff on

ESR is required to

have robus

t Health and Social Care Informatio

n Centr

e Data

HEE Mandate P11-13

Other issues Health Visitin

g – Role of minor Illness School Nursing role

in Long term

Conditions

Health

SCN WORKS JOINTLY WITH HEE CYP PROGRAMME BOARD

DEPARTMENT OF HEALTH COMMUNITY NURSING STRATEGY The SCN are engaged in scoping of CYP community nursing

HEE Mandate https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/306967/HEE_mandate_2014-15.pdf?utm_medium=email&utm_source=The+King%27s+Fund+newsletters&utm_campaign=4043517_HMP+2014-05-02&dm_i=21A8,2ENZX,FLWRM1,8RQGI,1

How do we work

with Social Care

Education to join up our

workforce strategies

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/306967/HEE_mandate_2014-15.pdf?utm_medium=email&utm_source=The+King's+Fund+newsletters&utm_campaign=4043517_HMP+2014-05-02&dm_i=21A8,2ENZX,FLWRM1,8RQGI,1





https://www.google.co.uk/url?url=https://sites.google.com/a/jeffcoschools.us/che-book-blog/the-hunger-games-book-movie&rct=j&frm=1&q=&esrc=s&sa=U&ei=aoW6U8ScHKeM7Qac2oHgCQ&ved=0CCIQ9QEwBg&usg=AFQjCNGeXKKnb74p_W7qW9J1LpYGEBZCqA

www.england.nhs.uk

Any Questions?

9th July 2014

Www.england.nhs.uk Planning & Commissioning in Surrey and Sussex Workforce challenges Adam Wickings 9 th July 2014.

Documents

surrey sussex hwbs

surrey sussex uops

west sussex

planning commissioning

community trusts

acute trusts

local authorities east

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