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«THE FORWARD VIEW INTO ACTION: PLANNING FOR 2015/16 December 2014 CONTENTS 1. Our approach to partnership and planning for 2015/16 2. Creating a new ...»

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December 2014


1. Our approach to partnership and planning for 2015/16

2. Creating a new relationship with patients and communities

3. Co-creating new models of care

4. Priorities for operational delivery in 2015/16

5. Enabling change

6. Driving efficiency

7. Submission and assurance of 2015/16 plans

2 NHS England Publications Gateway Number: 02768

1. Our approach to partnership and planning for 2015/16

1.1 This document describes the approach for national and local organisations to make a start in 2015/16 towards fulfilling the vision set out in the NHS Five Year Forward View, whilst at the same time delivering the high quality, timely care that the people of England expect today.

1.2 The NHS continues to provide a high standard of care for our country’s growing population and ageing population - but demand is rising and services are under pressure. The NHS has received an increased financial settlement next year, which will help in managing current pressures and kick start the new ways of providing care as signalled in the Forward View. However, the challenge for NHS staff and leaders of delivering high quality care within the available resources is as great as it has ever been.

Planning together with confidence

1.3 There are grounds for optimism because as the positive reaction to the Forward View revealed, there is a powerful consensus amongst patient groups, clinicians, local communities, frontline NHS leaders and national organisations about how to sustain and improve the NHS over the next five years – and a shared desire to lead and support change.

1.4 The future financial gap is challenging but not intrinsically insurmountable, both for 2015/16 and beyond. For 2015/16, the revised Mandate allocated an extra £1.83bn to NHS England, to which NHS England will reallocate a further £150m of its own resources, bringing the total of new money for front line services to £1.98bn. This includes making recurrent money for winter pressures that the NHS has received from time-to-time midway through recent years. Although the financial position will continue to be very challenging in many local health economies, there is now a clear basis on which to commence local planning.

1.5 The pace and scale of transformation over the next five years will partly depend on the scale of additional investment in, and uptake of, new care models. We will take our first tangible steps in 2015/16, through a £200m investment fund in new care models, and a further £250m investment in primary care.

1.6 Local leaders are already thinking about how to apply the Forward View. It is increasingly understood that tackling the causes of ill-health, empowering patients, and engaging communities are all essential components of creating a sustainable NHS. In some parts of the country, clinical commissioning is beginning to drive changes, while in others innovative provider organisations are taking the lead. And providers and commissioners alike are working together on how to dissolve the artificial barriers between prevention and treatment, physical health and mental health, and the historical silos of primary, community, social care and acute care— and the professionals who work across them.

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A differentiated national approach

1.8 Over the next year we will co-design a programme of support with a small number of selected areas and organisations that have already made good progress and which are on the cusp of being able to introduce the new care models set out in the Forward View. Our goal is to make rapid progress in developing new models of promoting health and wellbeing and providing care that can then be replicated much more easily in future years. Achieving this goal involves structured partnership rather than a top-down, compliance-based approach. So we are today extending an open invitation to local and national partner organisations to put themselves forward by the end of January 2015 to work alongside us in creating and implementing these new prototypes.

1.9 A minority of local health economies have for some years been in significant difficulty, and have struggled to develop and implement credible plans to recover their position. For these systems NHS England, Monitor and the NHS Trust Development Authority (TDA) will in 2015/16 become more jointly engaged, acting in concert. We will design and apply a new “success regime” intended to help create the conditions for success in the most challenged health economies.

1.10 For the majority of geographies and organisations, i.e. neither the first cohort of the leading edge organisations, nor the most challenged systems, we will make it easier for local areas to implement change. We also recognise that some of the vanguard sites for new care models may be part of local systems facing significant difficulties.

Achieving core standards 1.11 Planning for tomorrow and delivering for today go hand-in-hand. Next year will not see a relaxation in NHS Constitution standards for providing timely care for patients, or in the requirement set by taxpayers and Parliament that the NHS lives within its means. Given the current pressures that many local health systems are experiencing, we do not underestimate the scale of this challenge. So the 2015/16 planning round will be characterised by building strong partnerships for future transformation, and at the same time an intense focus on achieving performance standards backed by clear, transparent and consistent incentives to do so.

4 Maximising the value of local planning 1.12 For this planning round we are asking NHS organisations to refresh their operational plans for 2015/16 only, based on the common planning assumptions for NHS commissioners and providers agreed by NHS England, Monitor and the TDA and on their local joint health and wellbeing strategies. There are few new national requirements for planning. The Mandate from the government to the NHS is broadly stable, apart from the introduction of new and important access standards for mental health. These form part of our wider ambition to achieve a genuine parity of esteem between mental and physical health by 2020. To support that ambition, we expect each CCG’s spending on mental health services in 2015/16 to increase in real terms, and grow by at least as much as each CCG’s allocation increase.

1.13 Learning from the experiences of 2014/15, it is clear that the NHS now needs to ensure the fundamentals are in place of accurate activity and financial planning, to ensure delivery of NHS Constitution standards, other key outcome and performance measures, and financial balance. We therefore expect aligned, realistic activity and financial assumptions between NHS commissioners and providers, right across the country. We expect providers and commissioners to work with Local Education and Training Boards (LETBs) to ensure that they can secure the right staff to meet future service needs and their workforce plans are affordable and reflect local strategies for transformation.

1.14 Rather than imposing a new top-down planning process for transformation we strongly encourage local areas to develop and progress their emerging vision for the future of health and care for their local populations, on the same “units of planning” basis as 2014/15.

1.15 We have set out in separate annexes the specific planning requirements for commissioners (in the case of NHS England), NHS Trusts (in the case of the TDA) and NHS Foundation Trusts (in the case of Monitor). These are supported by our respective sets of technical guidance, planning templates and planning resources.

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2.2 First, Clinical Commissioning Groups (CCGs) should work with local government partners to set and share in 2015/16 quantifiable levels of ambition to reduce local health and healthcare inequalities and improve outcomes for health and wellbeing.

These should be supported by agreed actions to achieve these, such as specifying behavioural interventions for patients and staff, in line with NICE guidance, with respect to smoking, alcohol and obesity, with appropriate metrics for monitoring progress.

2.3 Second, we reiterate our support for comprehensive, hard-hitting, and broad-based national action on prevention. With the Local Government Association (LGA), we will develop and publish proposals for actions that local areas could take to go further and faster in tackling health risks from alcohol, fast food, tobacco and other issues.

2.4 Third, we will take action to become the first country to implement at scale a national evidence-based diabetes prevention programme, based on proven UK and international models, and linked where appropriate to the NHS Health Check. We are today inviting those local areas that have made greatest strides in developing preventative diabetes programmes to register their interest at england.fiveyearview@nhs.net by the end of January 2015 in joining with us as partners to co-design a new national programme led by Public Health England, NHS England and Diabetes UK. By March 2015 we will publish our agreed approach, and a nationwide implementation plan from 2016/17 onwards. A national Prevention Board, chaired by PHE and bringing together NHS, local government and other stakeholders will oversee delivery of these commitments.

2.5 Fourth, by autumn 2015 we will have developed proposals for improving NHS services for helping individuals stay in work, or return to employment, while saving downstream costs at the Department for Work and Pensions.

2.6 Fifth, in the same timeframe, we will have examined and published our findings on the potential to extend incentives for employers in England who provide effective NICE recommended workplace health programmes for employees.

2.7 And sixth, all NHS employers should take significant additional actions in 2015/16 to improve the physical and mental health and wellbeing of their staff - for example by providing support to help them keep to a healthy weight, active travel schemes and ensuring NICE guidance on promoting healthy workplaces is implemented. To reinforce local action, by March 2015 we will have established and launched a new broad-based task force charged with achieving a healthier NHS workforce. To support early progress, the 2015/16 NHS standard contract now requires providers to develop and maintain a food and drink strategy in accordance with the Hospital Food Standards Report (available here).

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2.9 To give patients more direct control, we expect CCGs to lead a major expansion in 2015/16 in the offer and delivery of personal health budgets to people, where evidence indicates they could benefit. As part of this, by April 2016, we expect that personal health budgets or integrated personal budgets across health and social care should be an option for people with learning disabilities, in line with the Sir Stephen Bubb’s review (available here).

To improve the lives of children with special educational needs, CCGs will need to continue to work alongside local authorities and schools on the implementation of integrated education, health and care plans, and the offer of personal budgets. CCGs should engage widely and fully with their local communities and patients, including with their local Healthwatch, and include clear goals on expanding personal health budgets within their published local Joint Health and Wellbeing Strategy.

2.10 2015/16 will see the first steps towards integrated personalised commissioning (IPC) in national demonstrator sites. For the first time, IPC brings together health and social care budgets for individuals and enables them to exercise more clout over how their own care and support is provided. As well as care planning and voluntary sector advocacy and support, IPC will provide an integrated ‘year of care’ budget that will be managed by people themselves, supported, where required, by councils, the NHS or a voluntary sector organisation.

2.11 The Forward View promised to make good the NHS’s longstanding promise to give patients choice over where and how they receive care, in line with their legal rights set out in the NHS Constitution and the statutory duties of NHS England and CCGs to promote choice. Commissioners and providers should work together and with patient groups to understand current delivery, and make significant further strides to honour patients’ entitlements to choose.

2.12 A particular priority for choice next year will be mental health. We expect CCGs to work with GPs and providers to ensure that patients are aware of their rights and are offered choice in mental health services, and are able to make well-informed, meaningful choices at appropriate points along the pathway.

2.13 We will work with the Royal College of Midwives and others to develop plans so that, from 2016/17, tariff-based NHS funding will support the choices women make rather than constrain them and, as a result, make it easier for groups of midwives to set up their own NHS-funded midwifery services. For 2015/16 commissioners should review the choices that are locally available for women accessing maternity services and, working together with service users and the public, consider what more can be done to offer meaningful choice. This may include choice of how to access maternity care, the type of care women receive, where they give birth (taking account of recent NICE recommendations) and where they receive their antenatal and postnatal care.

7 Engaging communities 2.14 In 2015/16 we will focus on actions to improve the way that the NHS engages with communities and citizens, including with local Healthwatch, involving them in decisions about the future of health and care services. It is essential that CCGs focus on how they will meet their statutory duties on public and patient involvement in their commissioning decisions. In support of this we are continuing to further develop the NHS Citizen approach (www.nhscitizen.org.uk). Commissioners should also consult the voluntary and community sector at local or national level for more strategic advice on this. We will also progress four further specific actions.

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