Finance
Local Financial Context
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NHS Yorkshire and the Humber has successfully delivered its overall financial strategy since its inception in 2006. The financial strategy for 2009/10 and beyond is built on these firm foundations laid in the delivery of a planned surplus and the knowledge that no single PCT expects to overspend its budget. The financial strategy is to invest the current surplus of approximately 3% over the next 2 or 3 years leaving a reasonable level of contingency with which to manage any financial risk. The additional investment made through reducing the surplus, along with growth in annual funding, is expected to deliver significant health benefits for patients across the health economy.
Future Resource Implications
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The DH has given a commitment to the level of funding to be expected over the next 2 years. For NHS Y&H the average growth for the next two years is 5.7% and 5.6% respectively, ranging from a maximum 7.8% to a minimum 5.3% in 2009/10 and 6.9% to 5.2% in 2010/11. This equates to an increase in funds of £441m in 2009/10 and £459m in 2010/11. This represents a significant amount of new money that needs to be spent wisely in a planned way to maximise the benefits for patients.
We are not able to predict what will happen to the financial position of the NHS beyond 2010/11. The wider economic climate is likely to impact on the NHS as it will other public finances. With this in mind it is imperative that the funding available over the next 2 years is used to deliver our strategic priorities set out in this document and improve the health of our local populations.
PCT Financial Plans
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Every PCT has submitted a financial plan that aligned with its overall strategy at the end of October 2008. These medium term financial plans will be refreshed at the end of March 2009 in order to reflect the recently published financial allocations and Operating Framework.
It is expected that PCTs will have further developed their investment plans to ensure delivery of their local strategy, which will have been informed by Healthy Ambitions. The SHA will provide an overall analysis of these revised plans and demonstrate their alignment with Healthy Ambitions. It is expected this comparative analysis across each PCT will show how much funding is being invested across each Healthy Ambitions pathway. The methodology for this work is currently being explored with PCTs.
National Tariff
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2009/10 will see the introduction of a new national tariff (HRG V4) along with the introduction of a new suite of rules and levers to foster innovation and improvement. HRGv4 is a new currency designed so that pricing can support the delivery of services independent of their setting. Other developments include the unbundling of diagnostic imaging from the inpatient tariff, the provision of non mandatory tariffs for the acute phase of rehabilitation and the introduction of planned same day tariffs for day case patients to incentivise the shift of activity to less acute settings.
DH recognise the need for innovation and improvement. The PbR 2009/10 draft guidance states ‘PbR is meant to be a tool not a strait-jacket. Having a national price for defined units of care is useful for both commissioners and providers’. ‘However we recognise that a national pricing structure can never reflect the reality of the most innovative care occurring locally. Therefore, in line with the principle of subsidiarity, there needs to be the opportunity for local discretion, so that PbR is not seen as a barrier to providing the best care for patients. Within PbR, the application of such local discretion to national currencies and/or prices is referred to as flexibility’.
It is vital that these flexibilities are used to promote health improvement. The SHA currently provides PbR support to all Trusts and PCTs and this expertise can be called upon to work through when it would be appropriate to use these flexibilities to enhance patient care.
The tariff and quality
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We have developed the Quality Assurance and Improvement Scheme. The scheme covers the eight clinical pathways set out in Healthy Ambitions and covers the three quality domains of patient safety, effectiveness of care and patient experience.
The scheme is divided into two parts. The core (Part 1) scheme covers 24 quality indicators across acute, ambulance, mental health and community care services (CQUINS). PCTs also have flexibility to develop local schemes (Part 2) to support delivery of their key objectives set out in their strategic plan.
The scheme will begin in the financial year 2009-10, during which time additional indicators will be developed implementation in 2010-11.
The impact of this innovative approach will be monitored during the year to determine if these incentives achieve the objective of improving quality as defined by the measures themselves.
Within primary care, the national Quality and Outcomes Framework for GPs, rewards quality.
Personal health budgets
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The Long Term Conditions pathway recommended that we look at the scope to enable individual patients to have a personal health budget to put them more in control of their care. The Department of Health’s High Quality
Care for All gave a commitment that piloted schemes would be introduced and the legal framework amended to enable NHS resources to be given directly to patients to direct their own care. The Department of Health has invited PCTs to bid to pilot personal health budgets for three years starting in summer 2009. Areas suggested for piloting are: NHS continuing healthcare, mental health services, learning disability services, maternity services, end of life care and some long term conditions.
PCTs participating in the pilots would receive support for project costs but the budgets themselves would be funded from existing allocations. It will be important that the learning from the pilots is informed by, and in turn contributes to, work within local government to introduce personalised budgets for all clients of adult social services. A seperate DCSF/DH pilot programme under the Aiming High for Disabled Children Programme invites local authorities and PCTs to pilot individual budgets for disabled children.
NHS Yorkshire and the Humber sees the opportunity to pilot personal health budgets as an important element of taking forward work to increase the quality of care through the involvement of people in managing their own care. Links will be made with long term conditions pathway delivery arrangements and with local government colleagues dealing with personalization developments to help share learning and best practice.