Transcript Document

Finance and Funding in an
NHS Organisation
Emma Partridge – NHS Capital Manager
and
Louise Stead – NHS Contracts Manager
Agenda
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Background of NHS and HEFT
How the NHS is funded
Performance targets
Current issues within the NHS
Working for the NHS/Finance
Background of the NHS and
HEFT
Background of the NHS
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Britain pre-war
Labour Gov’t 1945
Launched in 1948 budget £437m
2011/12 budget of £106bn
Serves population of 61m people
Employs 1.7m people (4th largest employer in
the world)
Structure of the NHS
Foundation Trust Status
Means the freedom to make decisions
- Manage own budgets
- Manage operational services
- Tailored to meet needs of local population
- Regulated by Monitor
Structure
Parliament
Secretary of State for Health/DoH
10 Strategic Health Authorities (SHA)
NHS Trusts Hospitals,
Mental Health Services,
Ambulances, Learning
disability
Primary care Trusts
Monitor As
regulator
Care Quality
Commission
Foundation Trusts
Accountable to members
through governors
Background of HEFT
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Originated as a small fever hospital
Number of mergers took place
One of the largest Trusts in the UK
Based over 3 main sites and many satellite
units
• Gained Foundation Trust status in 2005
• 2nd largest employer in Birmingham
(over 11,000 employees)
Clinical Activity at HEFT
493 Acute Beds
14 Paediatric Beds
39 Maternity Beds
12 ITU / HDU
618 Acute Beds
39 Paediatric Beds
64 Maternity Beds
17 ITU / HDU
229 Acute Beds
3 ITU Beds
Also Birmingham Chest Clinic. We also have a number of smaller satellite units
so people can be treated as close to home as possible.
HEFT Activity Facts & Figures
(11/12)
Heartlands
Hospital
Solihull
Hospital
Good Hope
Hospital
HEFT
A&E Attendances
115,847
47,335
76,026
239,208
Emergency Inpatients
37,663
6,637
22,485
66,785
Elective Inpatients
8,275
4,213
4,273
16,761
Day Case Inpatients
27,303
15,948
28,603
71,854
Outpatient Attendances
354,844
218,741
260,091
833,676
6,963
409
3,791
11,163
Births
Also: Renal Dialysis, Cystic Fibrosis, HIV patients, GUM, Bone
Marrow Transplant, Blood Bank, Assessment
Areas………………
Financials 2011/12
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The Trust earned income of £607m
Savings targets of £23m for the year
Capital expenditure of £18.7m
Financial risk rating of 3
Governance Risk rating Amber-Red
How the NHS is funded
How NHS is funded
• Taxpayers money through tax/NI
contributions
• Amount received determined by economic
health of the country
• Charitable funds
• Private Healthcare
• Grants
• Research and development
Funding Process
• Initial funds are held by Primary Care Trusts
• PCTs are allocated funds from department of health
• Weighted capitation formula is used to determine
each PCTs target share and available resource
• A commissioning system is used to allocate funding
based on local needs of population
• Each PCT is required to show a breakeven position at
the end of the year
Payment for Services
• Payment by Results (Pbr) is the National Tariff
Implemented by the DoH
• The currency for this is Healthcare Resource Groups
(HRGs)
• Each HRG carries a price
• The HRG is determined by the diagnosis and
treatment of each patient
Flow of Clinical Activity at HEFT
Inpatient
Activity
(HISS)
O’patient
Activity
(UG)
A&E
Activity
(MSS)
Manual
Activity
(e.g. Crit
Care,
Sexual
health)
Support
Services
Data
(Pathology,
Radiology)
Clinical Coding / Data
Quality
Monthly Download = assign HRG / £
Charge
Commissioners
for Activity
Measure
Performance
Against Targets
Payment by Results (PBR)
• PBR Guidelines are issued by the Department of
Health (DoH) on an annual basis
• Content of guidelines
• National Tariff and Reference Costs
• Market forces factor
• Best Practice tariffs
• National Performance Targets
• CQuINs
Tariff Movements
Tariff Adjustment 12/13
3.00%
2.00%
1.00%
0.00%
-1.00%
-2.00%
-3.00%
-4.00%
-5.00%
Pay and price inflation
Total national efficiency
requirement *
Net price adjustment
PBR Exclusions
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Some procedures are excluded from PBR such as:
- High cost drugs and devices
- HIV
- Cystic Fibrosis
- Critical Care
- Neonatal Cot Days
- Chemotherapy
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The reason for these exclusions is the complex
nature of these treatments and difficulty in costing them
Contracts with the Commissioners
• Local Delivery Plans are held between the Commissioners eg
Primary Care Trusts, Care Trusts and Local Commissioning Boards
and the Providers (Us)
• Plans are generally based on outturn from the previous year
• These are broken down into following elements:
 Activity by Specialty and HRG
 Monetary Value of the above
 CQuIN - Commissioning for Quality & Innovation (currently
2.5% increase on the baseline budget)
 MFF – Market Forces Factor
 National and local targets (such as 18 weeks and CQUIN)
2012/13 LDPs
2012/13 Contract Value £m
72
28
63
5
Other West Midlands
Out of Area
B'ham & Solihull Cluster
Specialised
369
Community Services
PERFORMANCE
Regulate foundation trusts to ensure they comply with their terms of authorisation. These are
a set of detailed requirements covering how foundation trusts must operate – in summary
they include:
•the general requirement to operate effectively, efficiently and economically;
•requirements to meet healthcare targets and national standards; and
•the requirement to cooperate with other NHS organisations.
Targets for Monitor
•Cancer Waits
•A&E Waits (4 Hours)
•18 weeks (admitted / not admitted)
•Infection Control (MRSA and C-Diff)
Financial penalties in Contract
Nationally specified
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18 Week RTT – up to X% of elective
income could be lost
Rates of C Diff – up to X% of income
could be lost
4 Hour A&E wait – X% of A&E service
line income could be lost if performance
is below 95%
Cancer targets – X% of service line
income could be lost
Breach of same sex accommodation rule
– fine per breach.
Never Events (eg leaving a swab in a
patient) - we will not be eligible for
payment for the patients care.
Volume & ratio targets
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Non GP referrals
C- Sections
Ratio of new to follow up O/P
appointments
Well vs Unwell babies
Antenatal admissions/no delivery
A&E conversion %
Ratio of short stay to 08/09
Readmissions in 14 days
Elective & non elective XSBDs
Emergency bed days vs 08/09
Emergency admissions vs 08/09
Commissioning for Quality and Innovation (CQuIN)
• A number of targets around improving quality and innovation are set
between the PCTs and the providers.
• If targets are met the Trust could be set to receive an additional 2.5%
of funding on top of their baseline budgets.
• 2012/13 CQUIN Value is £12.2m
• Each target is weighted and so given its own value.
• If target is not met the Trust will forfeit the additional funding for that
particular target.
• Targets differ between acute and specialised services
contracts
Implications of not meeting quality targets
• Fined up to 2% of contract value
• Monitor and CQC requirements
• Public Perception/Patient Choice
• Primary Care and Partners Perception
• Coroners Court and Health and Safety
Executive
CURRENT ISSUES WITHIN THE
NHS/HEFT
£20 Billion savings by 2015
• Trusts are asked to make savings of 4% per annum
based on turnover
• £20 Billion savings means a 4% reduction in prices
the trust charge for activity.
NHS Reform
• White Paper released ‘equity and excellence:
Liberating the NHS’
• Set to improve efficiency, productivity and quality
• How??
- To put patients first
- To focus on outcomes
- To empower NHS staff
• How will this affect HEFT?
White Paper Structure
Trusts running into financial difficulty
• Historic debt
• Too few patients
• Bad activity mix
• Uncontrollable costs
• Affect on HEFT
NHS Global
• NHS on the international stage
• HEFT opportunities, CIP
Cabinet Re-shuffle
• September 4th 2012 Andrew Lansley, the
architect of the Coalition’s controversial
NHS reforms, replaced by Jeremy Hunt
• NHS/ HEFT - ?
HEFT Finance Team
Overview of Finance
Finance Director
Operational
Business Support
42
Group Business
Consultants
Trust Financial
Services
48
Finance
Operations
Performance
50
Procurement
36
Income and
Contracting
18
Finance Staff Development
Headcount
Qualified
CIMA
ACCA
ICAEW
CIPFA
AAT
ACC
Couching
Supervisory
Procurement - CIP's
Studying
CIMA
ACCA
CIPFA
AAT
ACC
Leadership
Masters
Procurement - CIP's
Unqualified
TFS (inc Income)
66
12
4
3
2
Procurement Performance
36
50
7
15
OBS
42
15
4
6
3
3
12
1
2
11
3
2
7
0
6
43
29
2
5
0
0
0
0
3
1
1
19
8
9
2
30
8
Total
194
49
8
9
2
3
3
12
3
2
7
35
11
11
2
6
3
1
1
110
25.3%
18.0%
56.7%
Staffing grading in the NHS NHS
Doctors
Consultant contract
The rest
Agenda for change contract
Incremental pay annually, maximum level
AAT
CCAB
(depending on
ability &
experience)
Band
Type of role
Salary
max (£)
3
Admin support, health care assistant
18,157
4
Personal assistant, junior nurse
21,318
5
Credit manager, most nurses
26,839
6
Starting CCAB trainee, senior nurse
33,436
7
Part qual CCAB trainee, ward manager
(sister)
39,273
8
Senior staff – 4 separate bands a, b, c.d
CCAB qualified can be 8a
80,000
QUESTIONS?
• www.heartofengland.nhs.uk
• www.nhs.uk/NHSEngland/thenhs/nhshisto
ry/Pages/NHShistory1948.aspx
• www.dh.gov.uk/en/Publicationsandstatistic
s/Publications/PublicationsPolicyAndGuida
nce/DH_117353