Haringey tPCT Investment Plan

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Haringey tPCTInvestment Plan

• Board meeting
• 23rd July 2008

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Contents

• Summary
• Review of investment plan
• Objectives
• Investment strategy
• National and local priorities
• Prioritisation
• The visible difference
• Enablers
• Financial profile
• Financial flexibility and other funding issues
• Next steps
• Appendix Investment plan by area - performance
  targets and planned spend
• Introduction

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Section A Summary

• The objectives of this review were to articulate
  the investment strategy be specific about the
  impact on key targets review prioritisation in
  the light of the need for financial flexibility
  consider the robustness of individual projects
  and the tPCTs capacity to implement them
• This investment plan deals with incremental
  investment, above that already agreed as part of
  SLA negotiations. The investment strategy is
  consistent with the tPCTs current Commissioning
  Strategy Plan
• Planned investment has been mapped against
  expected performance on key targets and some
  additional requirements identified to improve
  performance in the current year. Despite planned
  investment, certain targets remain challenging
• Individual projects have been reviewed for
  outputs, outcomes and for expected financial
  phasing. One consequence has been a more
  pragmatic view of lead times
• Prioritisation has built on the earlier work of
  the Priorities Panel. In addition, some
  additional projects and cost pressures have been
  identified, as well as the need for certain
  additional enablers - capacity, skills and
  preparatory projects
• In addition to 12m SLA investment already agreed
  for growth in 08/09, the investment plan now
  proposes 6m cash spend in 08/09, 14m spend in
  09/10, and 14m recurrently thereafter. This
  enables the tPCT to meet the key priorities
  identified and retains flexibility for future
  cost pressures and emerging priorities.
• Significant financial flexibility has been built
  in. A number of projects have been deferred to
  09/10 (for both practical and financial reasons).
  In addition, whilst indicative allocations of
  resources have been made to certain key strategic
  priorities, flexibility in how these resources
  are committed remains

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Section B Review of investment plan
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Objectives

• The objectives established as a follow up to the
  Board review of investment strategy include
• Flesh out the strategy, in particular
• Articulate the linkage between the PCTs
  overarching strategy and the projects being
  proposed
• Identify relevant available outcome measures
• Be specific about the impact on key targets
• Prioritisation
• Review prioritisation in the light of the need
  for financial flexibility
• Identify any missing projects
• Make sure individual project proposals are as
  robust as possible
• The financial impact in the current year
• The level of uncertainty in financial estimates
• Expected outputs and outcomes
• Impact on targets
• Enablers
• Identify and plan to fill capacity or skills gaps

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Investment strategy
The investment strategy is consistent with the
TPCTs current Commissioning Strategy Plan. This
is incremental investment, above that already
agreed as part of SLA negotiations with the main
providers
Strategic Goals
Investment strategy

• Continuing investment in additional capacity, to
  meet growth in demand and waiting time targets
• Implementation of the infrastructure to support
  the primary care strategy (extended opening
  hours, walk in services, IT)
• Development of community services for those with
  long term conditions
• Development and implementation of a strategy for
  intermediate care, rehabilitation and end-of-life
  care
• Meeting new standards and new targets

To improve quality and access to services
ensuring better access to the right care in the
right place, at the right time providing more
integrated care in the local community

• Raising the profile of the health improvement
  agenda, with more innovative, community
  development approaches
• Improving the scope, reach and take-up of
  screening and immunisation services
• A particular focus on sexual and reproductive
  health amongst young people

To promote a healthier Haringey by improving
health and well-being and tackling health
inequalities
To improve the mental health and well-being of
our population

• Developing primary care mental health services
• Small scale, incremental investment to get the
  best out of existing investment

To improve our performance and the way in which
we commission services to enable us to commission
world class care, whilst ensuring that we
maintain long-term financial stability

• Focus on delivering on key national and local
  priority targets
• Small scale, incremental investment to improve
  performance and maximise the benefit from
  existing services or assets
• Developing commissioning capacity and capability

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National and local priorities

• Expected future performance against key targets
  has been reviewed
• Vital Signs, challenging areas of Annual Health
  Check, Local Area Agreement
• Set out in detail in the Appendix
• Planned investment has been mapped against key
  targets, and some additional requirements
  identified to improve performance in the current
  year
• Some of the population health targets are
  requiring a more innovative approach, for which
  there is a less established evidence base
• Eg Social marketing to address early booking for
  antenatal care, chlamydia screening
• Despite planned investment, certain targets
  remain challenging, including
• Smoking cessation
• Teenage pregnancy
• Chlamydia screening
• Maternity early access to antenatal care
• Immunisation given the scale of the catch up
  required
• Breast screening
• Breastfeeding prevalence due to data collection

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Prioritisation

• Builds on the earlier work of the panel
• Identifies a small number of additional
  investment priorities
• E.g. diabetic retinopathy, hospice funding,
  cardiac prevention
• Greater focus on what is needed to deliver on
  local and national priority targets in 08/09
• E.g. stroke, screening, Choose Book
• Now includes a programme of non-recurrent spend
• Additional commissioning capacity
• More pragmatic view of lead times for
  implementation
• Delayed expenditure offset by a need for more
  one-off initiatives
• Identifies indicative level of resources for a
  number of priority areas previously held over for
  Phase II
• Recognition of the need to develop Adults Older
  People strategy, but with package of measures to
  improve short term provision and performance
  while this strategy is developed
• In addition to 12m SLA investment already agreed
  for growth in 08/09, proposed investment plan is
  now
• 6m cash spend in 08/09, 14m spend in 09/10,
  14m recurrently thereafter
• Retains flexibility for future cost pressures and
  emerging priorities

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The visible difference
Highlights of the expected impact of recent and
planned investments include
Strategic Goals
More than 90 of Haringey residents referred to a
specialist will be seen and treated at a hospital
of their choice within 18 weeks, by December 2008
Everyone living in Haringey will have access to
12x7 GP services, by July 2009
To improve quality and access to services
ensuring better access to the right care in the
right place, at the right time providing more
integrated care in the local community
Everyone living in Haringey will have access to a
network of sexual health clinics and will be able
to get an appointment within 48 hours, by October
2009 During 2008/09, Haringey residents will
start to see the shift in emphasis towards health
promotion and screening
To promote a healthier Haringey by improving
health and well-being and tackling health
inequalities
To improve the mental health and well-being of
our population
Every adult living in Haringey will have access
to a primary care mental health service meeting
nationally recognised standards, by July 2009
To improve our performance and the way in which
we commission services to enable us to commission
world class care, whilst ensuring that we
maintain long-term financial stability
The tPCT expects to achieve the Healthcare
Commission rating of good, both for quality of
services and for use of resources for 2008/09
(published October 2009)
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Enablers
The executive team has identified certain
enablers which are necessary, in part to support
successful implementation of this investment
plan. A number of these have already been
implemented.

• One additional public health consultant
• Two additional collaborative commissioning
  managers
• Commissioning manager for sexual health services
• Immunisation lead
• Associate Director of Performance
• Health Intelligence capability

Commissioning capacity and skills

• Project to develop over-arching Adults Older
  People strategic framework to link
• Supporting independent living and long term
  conditions
• Stroke / neuro-rehab
• Intermediate care and rehab
• End of life care
• Development of contestability framework, to
  describe TPCTs approach to competitive
  procurement

Preparatory projects

• Strengthening of investment planning, including
  financial and activity analysis
• Strengthening of procurement function
• Stakeholder engagement
• Strengthening specialist commissioning across
  London

Processes and systems
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Financial profile of investment plan
The majority of the proposed new investment plan
is in out-of-hospital services, health screening
and health promotion. Less than 2m is allocated
to hospital and hospice services.
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Financial flexibility
The investment plan retains significant
flexibility
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Other issues Funding Primary Care buildings

• The current budget and 5 yr plan includes
  specific amounts to cover the revenue costs of
  the Lordship Lane and Hornsey Central LIFT
  schemes (838k and 857k per annum,
  respectively). No other major new schemes are
  assumed in the 5 yr plan
• Lordship Lane is about 2,500 sq metres. Hornsey
  Central is c4,500 sq m. The latter was an
  existing PCT-owned site, so the TPCT is paying
  for the building not the land
• A scenario for implementation of the Primary Care
  strategy might require
• development of one or two new neighbourhood
  health centres
• development / redevelopment of other primary care
  premises
• in addition, existing primary care estate may
  require significant upgrading
• potential costs might be up to 6m per annum, if
  financed as revenue rather than capital projects
• As far as timing is concerned, 2011/12 is
  probably the earliest for any major project. This
  is beyond the three year period covered by this
  investment plan
• This investment plan allocates 1m for Primary
  Care development in 09/10 and 2m in 10/11.
  Specific projects have yet to be identified. This
  2m could be available recurrently from 11/12
  onwards as revenue funding for LIFT or
  equivalent building developments. Any further
  funding would have to come from other PCT
  reserves.
• Potential savings may arise from S.106
  recoveries. These represent potential upside

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Next steps

• CE and DoF approval of overall strategy and plan
  agreed Tuesday 8th July
• Priorities Panel approval of overall strategy and
  plan - agreed Thursday 10th July
• Board approval of overall strategy and plan
• Commissioning of 08/09 projects
• Subject to final sign off ahead of contractual
  commitment, in line with usual delegated
  authorities
• Implementation of key enablers

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Appendix Investment plan by area

• Introduction
• Adults Older People
• Children Young People
• Primary Care
• Public health Wellbeing
• Sexual Reproductive Health
• Vulnerable Adults
• Commissioning capacity

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Introduction to Appendix

• This appendix is laid out as follows
• Adults Older People
• Children Young People
• Primary Care
• Public health Wellbeing
• Sexual Reproductive Health
• Vulnerable Adults
• Commissioning capacity
• Each section contains
• Mapping of the planned investment in the current
  (08/09) financial year against performance
  targets
• Summary of the planned expenditure by project,
  over the three years of this plan
• Individual projects have been divided into five
  groups, as follows
• Already committed
• 08/09 - key targets those projects which are
  necessary to support delivery of the key targets
• 08/09 - other other projects to be implemented
  in 08/09
• 09/10 project to be implemented in 09/10, but
  likely to require substantial work in 08/09 to
  procure
• Future allocations allocation of resource
  against a known priority area, but without
  detailed proposals