Why is financial stability important to the ICS?
As spenders of public money, all our ICS partners have a duty to taxpayers and the Treasury to use the funding available as efficiently and effectively as possible, maximising the improvement in health and care which can be gained from each pound spent. Public Sector organisations, including the NHS, have a statutory duty to break-even and are held to account for failure to deliver that target. In recent years the NHS has managed to operate within its allocated budget at a national level. However, most provider organisations and many commissioners have failed to balance their books, with the resultant shortfalls being offset by nationally held reserves, deferral of investments, and the use of various national support funding schemes. In summary the NHS system needs to move towards sustainable financial balance as any deficits built up will need to be repaid, which in itself is a brake on health investment and a reduction in future health outcomes. To help restore financial balance in this period of organisational deficits, NHS England and Improvement has set ’financial control totals’: maximum amounts by which organisations may overspend.
What difference does the ICS make?
In 2019/20 for the first time, the NHS partners in the ICS System were accountable for the delivery of a NHS system financial control total, which aggregates the control totals of individual NHS organisations set by Regulators. Over time, it is planned that the proportion of support funding that will be reliant on delivery of the whole system control total will increase, although the rate of that increase has not yet been specified.
|NHS Ipswich and East Suffolk CCG
|NHS North East Essex CCG
|NHS West Suffolk CCG
|East Suffolk and North Essex NHS FT
|West Suffolk NHS FT
In addition, East of England Ambulance Service Trust which covers six ICS/STP footprints is wholly reflected in the Suffolk and North East Essex ICS financial plans, but does not count for the purposes of system financial control management. The tables and charts that follow reflect the five core organisations noted above.
Five Financial Tests
Scheme 1: Agency standardisation: system-wide agreement and implementation
Scheme 2: Effective use of estates and support services
Scheme 3: Effective use of estates and support services
Scheme 4: Developing the model for urgent and emergency care
|Improving clinical productivity and releasing more time for patient care
|Expansion of Consultant Connect scheme (new locations and specialties). Suffolk and North East Essex Implementation project for Local Health Care Records (Regional lead), and WiFi expansion (including GovRoam). Ambulance Electronic Patient Record being procured. Recruitment of new staff categories, to improve skills utilisation, and address shortages.
|Maximising the buying power of the NHS, including Purchase Price Index and Benchmarking Tool, Getting It Right First Time clincally led procurement work and Support Supply Chain Coordination Limited
|Key providers engaged with supply chain programme including standards of procurement accreditation Getting It Right First Time programme board in place. Product standardisation to deliver merger efficiencies.
|Supporting the development of pathology networks and diagnostic imaging networks.
|IT developments to pool diagnostic capacity and prevent duplication. Implementation of clinical decision support tools to reduce unnecessary referrals (target 3% reduction and 10% improved referrals).
|Supporting pharmacy staff to take on increased patient facing clinical roles and, through the Medicines Value Programme, help the NHS deliver better value from the £16 billion annual spend on medicines
|Pharmacy network development to enhance pharmacy in the community/neighbourhood services. Pharmacy support to primary care teams. Healthy living programmes. Medicines Optimised programmes (care homes). Clinical pharmacy, and social prescribing support to Primary Care Networks. Application for pilot status for PrescQIPP to identify system medicines management savings
|Deliver an additional £700m savings in administration costs by 2023/24.
|CCG management reconfiguration to complete by December 2019, to deliver 20% initial reduction East Suffolk and North Essex NHS Foundation Trust acute service reconfiguration to deliver a streamlined management structure.
|Make better use of capital investment and its existing assets to drive transformation.
|East Suffolk and North Essex NHS Foundation Trust acute reconfiguration, and West Suffolk NHS Foundation Trust Emergency Departments and Clacton Hospital cases to develop from existing estate, to improve utilisation, and drive efficiency agenda (West Suffolk NHS Foundation Trust admissions avoidance, and specialisation). GP surgery relocations to utilise existing sites (Oakfield, Kennedy Way) East of England Ambulance Service NHS Trust to rationalise estate to create Make Ready hubs, and to enhance Control room capacity, efficiency and resilience.
|Implement the national Evidence Based Interventions programme to reduce harm and free up resources
|Cancer plans (early diagnosis and personalised care programmes), to ensure appropriate and timely testing, improving outcomes and improving efficiency. Development of early intervention and crisis mental health services. Diabetes prevention and structured education. Implementation of maternity continuity of care projects.
|Implement the National Patient Safety Strategy which will improve patient safety and prevent harm thus reduce costs
|Roll out of Suffolk and North East Essex national pilot for Serious Incident investigation framework (expected to deliver improved patient outcomes rather than savings).
|Reducing variation across the health system improving operational and financial performance
|Full assessment of clinical directorates against NHS Efficiency Map. AI and digitisation assessment process in place; plans implemented to appropriate timescales. Alliance transformation programme to identify appropriate changes to care pathways and care settings using Rightcare, Getting It Right First Time and Model Hospital. Rightcare savings in urgent and emergency care opportunity estimated at £10.6m and elective care (GP referrals, other referrals, elective admissions and occupied bed days) estimated £13.9m
In summary we have made the following cross system commitments to achieving system efficiency over the next five years:
- To develop an ICS wide policy for the use of agency and to seek a regional wide approach.
- To explore additional steps partner organisations can take to reduce sickness absence, provide more flexible working for our staff, and to develop a‘workforce passport’.
- To review opportunities for estates rationalisation with a particular immediate focus upon North East Essex where there are opportunities to achieve savings now.
- To move towards seven day working in community services across the ICS through a review in each Alliance of the relative merits of this and todevelop a costed plan.
- To work more closely together across the three Alliances on the Ageing Well Programme to develop a more consistent model across the ICS foradmissions avoidance and discharge support
- To develop an ICS wide outpatient programme which reviews and implements changes to enable a 33% reduction in face-to-face follow upappointments and, more widely, a reduction in demand.
- To renew discussions between partners to consolidate support services
New integrated contracting options
The NHS Long Term Plan notes that a new Integrated Care Provider (ICP) contract will be made available for use from 2019, following public and provider consultation. It allows for the first time the contractual integration of primary medical services with other services, and creates greater flexibility to achieve full integration of care.
Better Care Fund
The Better Care Fund and ‘Improved’ Better Care Fund is a joint budget between health and social care. The key features of the funds within Suffolk and North East Essex are the protection of adult social care, reablement services and out of hospital services. The combination of health and social care funding into a joint budget has enhanced the ability of commissioners to come together to improve efficiency and patient experience. For example, Emergency Vehicles have been commissioned which bring occupational therapy and paramedic care together. Joined up hospital discharge and reablement funding has enabled social care and health to jointly design services to improve efficiency and support our patients. The Better Care Fund continues to be a key feature of system integration and will develop further to include additional services over the planning round.
How will we know that we’re making a difference?
- Non-elective admissions will reduce – number of specific acute hospital admission rates
- Delayed Transfers of Care from hospital will reduce – rates per 100,000 adult population
- Better Care Fund plans are delivered successfully
- Provision of social services maintained – Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement or rehabilitation services, Long-term support needs of older people (aged 65 and over) met by admission to residential and nursing care homes, per 100,000 population.
Last Updated on 16 January 2024