The Strategic Health Authority for London Planning 2007/8: PCT Operating Plans SHA Board Meeting 28...

The Strategic Health Authority for London

Planning 2007/8:PCT Operating Plans

SHA Board Meeting

28 March 2007

Enclosure N

Appendix 1

LOX-GNH077-20060208-DMPM

2

Contents

Topic Slide

Executive Summary - 2

Description of risk ratings - 3

PCT risk ratings (proposed) - 4

Overview of risk ratings - 5

Next Steps - 6

Appendices

Details of governance ratings - 8-11

Details of quality and service - 12-14

performance ratings, including

health improvement ambition

Glossary of terms - 15


3

Executive summary

The Board is asked to

Sign off Operating Plans for 23 PCTs, subject to reconciliation with satisfactory and robust FIMS plans and to sign-off of the overall LDP by the DH

Agree risk ratings (also subject to agreement of the above)

Where plans are not agreed ensure that PCTs deliver robust and credible plans as a matter of urgency.

Agree that delegated authority is provided to the SHA Chair and CE to sign off the remainder of the plans

• The PCTs have submitted Operating Plans in response to the DH Operating Framework and the SHAs Planning Guidance.

• The PCTs are planning to achieve all the key targets in 2007/8 and most of the other LDP targets.

• In aggregate PCT plans are broadly breakeven (after debt repayment and topslice).

• However, 8 individual plans require further work / discussion are not yet in a position to be signed off.

The provisional risk ratings are set out in slides 4 & 5


4

Processes fail to sufficiently ensure good governance in key areas

Persistent or deliberate failure to address other areas of governance

Operating plans will be used to assess PCT risk rating in 3 areas

Quality and outcomes GovernanceFinance

5

4

3

Meeting all key national targets and 85% of other targets within green tolerance

Processes in place to ensure good governance or achievable action plans to address areas of concern

Consistent good performance

Reasonable surplus

Achieving balance

2 Risk of failing to achieve 1 or more key national targets

Risk of achieving below 85% of other targets within green tolerance

Concern in 1 or more areas where insufficient remedial action is being taken to ensure good governance when necessary

Small deficit Risk of not achieving balance

High risk of failing to meet several of the national priorities or below 75% of other targets within green tolerance

Significant deficit High risk of not achieving

balance

1


5

Recommended risk ratingsPCT Finance

Quality & Service Targets Governance

Status of plan

Monitoring regime

Surplus/ (deficit) £m, 2007/8

Barking and Dagenham PCT 4 Agreed Quarterly 6.0

Barnet PCT 2 Agreed Monthly 0

Bexley Care Trust 1 Not yet agreed Monthly Not yet agreed

Brent Teaching PCT 2 Agreed Monthly 0

Bromley PCT 3 Agreed Quarterly 0

Camden PCT 3 Agreed Quarterly 0

City and Hackney Teaching PCT

4 Agreed Quarterly 1.0

Croydon PCT 3 Agreed Quarterly 0

Ealing PCT 3 Agreed Quarterly 0

Enfield PCT 1 Not yet agreed Monthly Not yet agreed

Greenwich Teaching PCT 2 Agreed Monthly 0.1

Hammersmith and Fulham PCT

4 Agreed Quarterly 0

Haringey Teaching PCT 3 Agreed Quarterly 1.9

Harrow PCT 2 Agreed Monthly 0

Havering PCT 1 Not yet agreed Monthly Not yet agreed

Hillingdon PCT 1 Not yet agreed Monthly Not yet agreed

Hounslow PCT 1 Not yet agreed Monthly Not yet agreed

Islington PCT 2 Agreed Monthly 0

Kensington and Chelsea PCT 3 TBC Agreed Quarterly 0

Kingston PCT 1 Not yet agreed Monthly Not yet agreed

Lambeth PCT 3 Agreed Quarterly 0

Lewisham PCT 2 Agreed Monthly 0

Newham PCT 2 Agreed Monthly 0

Redbridge PCT 4 Agreed Quarterly 2.0

Richmond and Twickenham PCT

3 Agreed Quarterly 1.2

Southwark PCT 2 Agreed Monthly 0

Sutton and Merton PCT 1 Not yet agreed Monthly Not yet agreed

Tower Hamlets PCT 4 Agreed Quarterly 0

Waltham Forest PCT 2 Not yet agreed Monthly Not yet agreed

Wandsworth PCT 4 Agreed Quarterly 2.1

Westminster PCT 4 Agreed Quarterly 3.0


6

Overview of initial PCT ratings and implications for the monitoring regime

Implications for monitoring regimePCTs Finance Quality Governance

Ratings

Lo

w r

isk

Barking and Dagenham* City and Hackney Hammersmith & Fulham Redbridge Tower Hamlets Wandsworth Westminster

4

Med

ium

ris

k

Bromley Camden Croydon Ealing Haringey Kensington &

Chelsea Lambeth Richmond

2/3

Hig

he

r r

isk Bexley

Enfield Havering Hillingdon Hounslow Kingston Sutton and

Merton

1/2

Ideally the majority of PCTs would be in the ‘low risk’ category. It is anticipated that this will be the trend, but the timing is of course dependent on future performance.

NHS London will need to focus its support on the most challenged PCTs

At the start of ’07/8 around half the PCTs will be required to submit monthly monitoring reports (i.e. all ‘higher risk’ PCTs and the ‘medium risk’ PCTs rated a 2 on finance).

As soon as confidence in ’07/8 performance warrants it all the ‘medium risk’ PCTs will be switched to quarterly reporting.

The ‘low risk’ PCTs will move to six-monthly reporting during ’07/8, on a case by case basis.

Brent Lewisham Waltham Forest

Barnet Greenwich Harrow Islington Newham Southwark

* At SHA discretion Barking & Dagenham PCT moved to ‘low risk’ as its amber governance issue is on an LAA ‘stretch’ target.

N.B. These PCTs have ratings of 4 / green / green

N.B. These PCTs have ratings of 2/3 or amber or amber

N.B. These PCTs have ratings of 1/2 or red or red


7

The SHA is taking a number of steps to address emerging common themes

What this entails How it will help

Fitness for Purpose Development Plans

PCTs are producing Development Plans to respond to the issues identified in the diagnostic assessment

The Development Plans will address issues of capacity and capability to enable the PCTs to deliver their Operating Plans

Step

Programme work on 18 weeks

The 18 week waiting time target for referral to treatment will require some coordination at SHA level

The SHA will review plans, provide advice and coordinate the delivery of improved service pathways to achieve the waiting time targets

Programme work on health improvement

The SHA (inc. Regional Public Health and London Health Observatory) will review PCT action plans and support PCTs

Targeted support, e.g. on smoking or GUM access, will be focussed on the key interventions at the most challenged organisations

Benchmarking

The SHA will provide information and some analytical support to PCTs and Trusts to benchmark their performance

High quality benchmarking information will enable organisations to focus efforts on the areas likely to result in the greatest improvement


8

Appendices


9

Governance (top three) Clinical Governance - effective processes for

monitoring (in qualitative and quantitative terms) the experience of the full spectrum of patients and other users of services commissioned by the PCT

Clinical Governance - effectively monitoring and managing (a) the clinical and public health outcomes of its own provider arm, with clearly tracked, owned and understood metrics and a system of intervention; and (b) that its provider clinicians are appropriately qualified and trained;

Delivery and Financial Governance - information systems are suitable for fulfilling its financial and clinical needs and the information is used for performance management.

Governance ratings

Governance13%

55%

32%

n

n

n

Key themes

Red-rated PCTs;

• Bexley• Brent • Enfield• Havering• Hillingdon • Hounslow • Kingston • Lewisham • Sutton & Merton • Waltham Forest

GreenAmberRed

Bexley Care Trust

Havering PCT

Barking & Dagenham PCT

Croydon PCT

Sutton & Merton PCT

Enfield PCT

Redbridge PCT

Greenwich Teaching PCT

Lewisham PCT

Southwark PCT

Lambeth PCT

Kingston PCT

Richmond & Twickenham PCT

Wandsworth PCT

Haringey TPCT

Barnet PCT

Hillingdon PCT

Harrow PCT

Ealing PCT

Hounslow PCT

Camden PCTIslington

PCT

City & Hackney

TPCT

Tower Hamlets PCT

Waltham Forest PCT

Newham PCTWestminster

PCTHammersmith &

Fulham PCT

Kensington and Chelsea PCT

Brent PCT

Bromley PCT


10

Board processes Member interests Member qualifications Non-executive skills and training Compliance with legal duties† Compliance with NHS

good practice †

Strategy and planning Contracts and SLAs agreed

with providers Board satisfaction with operating

plan assumptions

Delivery Plans/processes to deliver

operating plan † Management capable of delivering

operating plan † Appropriate management and staff

recruited Management and staff training and

accountability Information systems suitability

Financial governance Effective accounting and reporting

arrangements † Risk management and internal audit

† Probity and propriety Information systems suitability

Clinical governance Monitoring and improvement of

healthcare † National core standards & targets

Wal

tham

Fo

rest

X

Cit

y &

Hac

kney

X

L

amb

eth

So

uth

war

k

Kin

gst

on

X

X

X

X

X

Source: Operating plan self certifications; Team analysis

Bar

kin

g &

D

agen

ham

En

fiel

d

X

X

X

X

Hav

erin

g

New

ham

X

X

Red

bri

dg

e

To

wer

Ham

lets

X

Bex

ley

X

Cro

ydo

n

Gre

enw

ich

Ric

hm

on

d

& T

wic

ken

ham

Su

tto

n &

Mer

ton

X

X

Wan

dsw

ort

h

Lew

ish

am

X

X

X

Bar

net

X

X

Har

ing

ey

Bro

mle

y

B

ren

t

X

Cam

den

Eal

ing

Ham

mer

smit

h

& F

ulh

am

Har

row

Hil

lin

gd

on

X

X

Ho

un

slo

w

X

X

X

X

X

Isli

ng

ton

K

ensi

ng

ton

&

Ch

else

a

Wes

tmin

ster

PCT governance risk ratings (1/2)

X

X

Yes Not

certified

No

but with

plan

Denotes highly weighted questions

† X X

X

X


11

Emergency planning Emergency governance † Emergency resources † Major Incident Plan † Emergency exercises, training

and testing †

Overall compliance Compliance with statutory

duties † Consideration of risks to

statutory duties † Review evidence of risk to

statutory duties †

Relationship management Engagement of local authority

and others Compliance with NHS London

and DH requirements Response to all regulators and

audits Relationship with providers Public patient involvement

Source: Operating plan self certifications; Team analysis

Overall risk rating(commissioner perspective)*

Clinical governance (continued) Monitoring experience of services

provided Monitoring experience of services

commissioned Provider arm performance and

staff Involvement of GP practices LAA target achievement

Ho

un

slo

w

Ken

sin

gto

n

& C

hel

sea

Ham

mer

smit

h

& F

ulh

am

Cam

den

Wes

tmin

ster

New

ham

X

X

To

wer

Ham

lets

X

X

X

Cit

y &

Hac

kney

X

So

uth

war

k

Cro

ydo

n

X

Kin

gst

on

X

X

X

Wan

dsw

ort

h

En

fiel

d

Bar

kin

g &

D

agen

ham

XB

ren

t

X

X

Har

row

Hil

lin

gd

on

X

X

X

Isli

ng

ton

X

X

X

Bar

net

Hav

erin

g

X

X

X

Red

bri

dg

e

X

X

Wal

tham

Fo

rest

X

X

Bex

ley

X

X

Bro

mle

y

Gre

enw

ich

Ric

hm

on

d

& T

wic

ken

ham

X

Su

tto

n &

Mer

ton

X

X

Eal

ing

Lew

ish

am

X

X

Har

ing

ey

X

X

Lam

bet

h

PCT governance risk ratings (2/2)

X

X

X

X

X

X

Yes Not

certified

No but

with

plan

Denotes highly weighted questions

† X X


12

Quality & Service Targets

A number of targets are subject to revision as part of the national LDP phase 3 process, and therefore the assessments are subject to amendment when the final LDP is signed-off by the DH in April / May.

All PCTs are intending to deliver the 18 week referrals to treatment milestones

All PCTs are intending to achieve the key targets, with he exception of 5 PCTs on the all age all cause mortality target

Quality and Service Targets risk ratings

nQuality & Service Targets

3%3%

94%

0%

n

n

Key themes

Red-rated PCTs;

None

Amber • Enfield

To be confirmed (following discussions with the DH on the sign-off of

one key target)• Kensington and Chelsea

GreenAmberRed

Bexley Care Trust

Havering PCT

Barking & Dagenham PCT

Croydon PCT

Sutton & Merton PCT

Enfield PCT

Redbridge PCT

Greenwich Teaching PCT

Lewisham PCT

Southwark PCT

Lambeth PCT

Kingston PCT

Richmond & Twickenham PCT

Wandsworth PCT

Haringey TPCT

Barnet PCT

Hillingdon PCT

Harrow PCT

Ealing PCT

Hounslow PCT

Camden PCTIslington

PCT

City & Hackney

TPCT

Tower Hamlets PCT

Waltham Forest PCT

Newham PCTWestminster

PCTHammersmith &

Fulham PCTKensington and

Chelsea PCT

Brent PCT

Bromley PCT


13

Quality and service target ratingsPCT Risk rating

% other national targets PCT plans to achieveNational key target breaches

Barking and Dagenham PCT – 100

Barnet PCT – 95

Brent Teaching PCT – 90

Bromley PCT - 95

Camden PCT - 90

City and Hackney Teaching PCT

- 95

Croydon PCT - 90

Ealing PCT - 86

Enfield PCT – 62

Greenwich Teaching PCT - 81

Hammersmith and Fulham PCT – 95

Haringey Teaching PCT

– 86

Harrow PCT – 95

Havering PCT – 90

Hillingdon PCT - 90

Hounslow PCT – 81

Islington PCT – 81

Kensington and Chelsea PCT

All age all cause mortality is subject to DH agreement 100

Kingston PCT 76

Lewisham PCT - 81

Redbridge PCT - 86

Richmond and Twickenham PCT – 76

Southwark PCT

- 86

Sutton and Merton PCT

– 86

Tower Hamlets PCT - 90

Waltham Forest PCT – 86

Wandsworth PCT – 90

Westminster PCT – 95

Lambeth PCT – 81

Newham PCT – 86

Bexley Care Trust

- 81


14

PCTs in a sustainable finance position and / or with significant growth have defined local priorities and action plans. NHS London will be monitoring delivery against these plans. There are three PCTs in this category:

Barking and Dagenham City and Hackney Tower Hamlets

Health Improvement Ambition

n

n

• PCTs in financial balance were also asked to review progress on TB and HIV in the London guidance of December 2006. There are six additional PCTs in this category which was made on the basis of M11 (forecast outturn):

• Hammersmith and Fulham• Kensington and Chelsea • Lambeth• Redbridge• Wandsworth• Westminster• Barking and Dagenham• City and Hackney• Tower Hamlets

LOCAL HEALTH PRIORITIES

LONDON PRIORITIES


15

Glossary of terms

Risk rating NHS London assesses the risks in each PCT’s Operating Plan and assigns a risk rating in three areas: financial performance, quality and outcomes and governance. NHS London will use the risk ratings to guide the intensity of its monitoring and signal to the PCT its degree of concern with the specific issues identified and evaluated in the Operating Plan review.

Finance rating The risk that the PCT will end the year in deficit (refer to slide 3 for meaning of the finance ratings and to the PCT Commissioning Regime for the methodology for calculating the ratings)

Governance rating

The risk posed by the PCT’s governance systems and processes (a summary of the results of the governance self certification questionnaires is set out in slides 8- 10, the methodology for calculating the ratings is set out in the PCT Commissioning Regime)

Quality rating The risk that the PCT and its commissioned services will not deliver national, London-wide and local quality and outcomes targets (the targets and the methodology for calculating the ratings are set out in the PCT Commissioning Regime)

Operating plan Sets out how the PCT plans to achieve the health outcome and financial goals for the year. In future years will be based on its Commissioning Strategy Plan. It includes targets, financial and activity schedules and action plans. Developed annually.

Monitoring regime

As part of the PCT Commissioning Regime, intervention is also underpinned by the Regime’s overall principles: (1) self-governance, (2) risk-based, proportionate approach, (3) trust, (4) transparency, (5) minimal information requirements and (6) developmental

CIPs Cost Improvement Programmes, initiatives developed each year by service providers to improve efficiency

DP Development Plan - describes the organisational capabilities needed to deliver the Commissioning Strategy Plan, the current capability gaps and how they will be filled, for 2007/8 this will be the Fitness for Purpose Development Plan

Contingency Resource retained to mitigate in-year financial pressures, DH guidance is that this should be 0.5% of turnover as an absolute minimum

FIMS Financial Information Management Systems, a system of financial plans and monthly reporting against them

London Planning Guidance

Guidance issued to PCTs and Trusts by NHS London each year to inform the planning process, including confirmation of the targets to be delivered in the following year and of the financial planning assumptions to be used by organisations in producing their annual and operating plans

Demand management

Action being take by PCTs to ensure that services respond most appropriately to need including being located in the most appropriate places to provide quality, personalised care. Strategic context is set by the Our Health, Our Care, Our Say White Paper

The Strategic Health Authority for London Planning 2007/8: PCT Operating Plans SHA Board Meeting 28...

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