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Infographics: Fair Shares Fair Shares a guide to NHS allocations Infographics (updated and expanded for CCG allocations 2019/20 onwards) NHS England and NHS Improvement Table of Contents Fair Shares - a guide to NHS allocations Annex Vocabulary 3 Introduction Glossary of terms used in NHS allocations 25 4 Contact details Overview of NHS funding Populations Issues with GP populations 27 5 How much do we spend on patient healthcare? Projecting GP populations for future years 26 6 Where does the money go? Update to population baselines and projections 28 7 What are CCGs? Hospital data quality directly affects CCG allocation 29 8 Fair Shares? Approaches to allocations Taking better account of health inequalities 30 9 Portion control – making it more fair Updates to Community services formula 31 10 Using cartograms for clearer data visualisation new formula Mental Health Formula Refresh 32 11 What evidence is used to show variation in need? Market Forces Factor (MFF) 33 12 Examples of need variation in England Mathematics Understanding the formula 34 13 Components of target allocations Constructing the formula 35 14 How a CCG’s share is adjusted Need weights Showing the effect of updating the model 36 15 Combine adjustments to get target share Evaluation Comparison with other CCGs 37 16 Summary of adjustments included Waterfall chart – age vs deprivation 38 17 From target shares to final allocations Converting Limitations of model, areas for further work 39 18 Pace of change policy – core ideas target shares Advice Independent advice and support 40 19 Pace of change calculation into cash Map key Find my CCG 41 20 Examples of targets and final allocations Further reading 42 21 Moving targets Changelog 43 22 Key steps in the allocations process Contact us 44 23 Changes to 2019/20 allocations Latest updates 2 Introduction slidedoc (n.) A visual document, developed in presentation software, intended to be read on screen and referenced instead of projected. Nancy Duarte Overview of NHS allocations NHS England and NHS Improvement are currently merging, but this is beyond the scope of this document. As CCG allocations are an NHS England commissioning function, this name persists in these slides. NHS England leads the National Health Service (NHS) in England. We set the priorities and direction of the NHS and encourage and inform the national debate to improve health and care. We want everyone to have greater control of their health and their wellbeing, and to be supported to live longer, healthier lives by high quality health and care services that are compassionate, inclusive and constantly improving. NHS England shares out more than £100 billion in funds and holds organisations to account for spending this money effectively for patients and efficiently for the taxpayer. A lot of the work we do involves the commissioning of health care services in England. We commission the contracts for GPs, pharmacists, and dentists and we support local health services that are led by groups of GPs called Clinical Commissioning Groups (CCGs). CCGs plan and pay for local services such as hospitals and ambulance services. We strongly believe in health and high quality care for all, now and for future generations. We use a statistical formula to make distribution of financial resources fair and objective, so that it more clearly reflects local healthcare needs and hopefully reduces any health inequalities. This updated and expanded summary of our Allocations Technical Documentation details the recent updates in the 2019/20 allocations model. We have used infographics and metaphors to help make some complex ideas easier to digest. We hope you find these slides useful in explaining some of the methods used. The annex includes more complex slides, where we describe some of the ideas in a bit more detail. 3 Contact details Infographics (updated and expanded for CCG allocations 2019/20 onwards) Document Title Fair Shares – a guide to NHS allocations Written and illustrated by Roman Tatarek-Gintowt, Analysis and Insight for Finance With thanks to colleagues in NHS England and NHS Improvement Correspondence address Allocations Team, Quarry House 8E25, Quarry Hill, Leeds LS2 7UE Web address www.england.nhs.uk/allocations/ page where latest version is published We are continually developing both the allocations process and related documentation. We welcome your comments and feedback to help us improve them. Email [email protected] (Subject: Allocations Infographics) Document published by NHS England and NHS Improvement Date 10 February 2020 Latest version 2.0 Publications Approval Reference 001520 Printing These slides are designed for viewing on screen, rather than printed. Please consider if you really need to print them out. We suggest printing 2 slides per A4 sheet, double sided = total 11 pages. NHS England and NHS Improvement 4 How much do we spend on patient healthcare? UK budget Taxes Spending Borrowing (deficit) 29 The chancellor’s job is to balance a public 130 Health (England) spending plan against money raised in taxes 64 Education plus borrowing (deficit), Income tax 339 reflecting government 28 Defence values & priorities. 90 Other public services 101 State pensions VAT 137 101 Other welfare Corporation Tax 58 Borrowing 47 Investment Council Tax 36 40 Debt interest 2019/20 £29 bn The NHS in England has a Business Rates 31 25 Tax credits (personal) deficit Fuel Duty 28 budget of £130 billion. Capital Taxes 31 Total UK health spending is £151 billion, around debt Other Taxes 96 214 Other spending 18% of the budget (7% of GDP) Overall debt Other receipts 55 £1,878 bn (82% of GDP) Devolved parliaments in £841 bn Scotland, Wales and Northern Debt Interest £841 bn Ireland receive a public services 2018/19 £40 bn budget (including health), to spend £ billions according to local priorities Source: Office for Budget Responsibility (OBR) – UK Government Revenue & Spending Forecast 2019/20 (figures rounded) 5 Where does the money go? Healthcare Services % Directly Commissioned 100 Public Health (screening programmes, child 1% NHS Commissioning health info, immunisation, sexual assault) prison healthcare, armed forces families, % 87% some specialised services 5 Other Primary Care 3.4% DHSCDH Programmes Programmes 4.3% Community pharmacy, dental services, 5.3% ophthalmic (eye tests, glasses) 4% NHS Support Activity Total CCG place-based allocations % including Data Collection / IT Services 61 Quality Monitoring and Regulation Specialised Services Support and Improvement Running Care for some uncommon conditions, Education and Workforce Training costs for which there are few providers Business Services, Litigation cap or costs are very high. 12.5% % CCGs 1 1% Clinical Commissioning General Practice Primary care – GP surgeries, Groups GPs and practice teams 6% 0.6% Cost of medicines prescribed Public by GPs for their patients 7% Health Public Health Grants Social Care Health improvement and evidence based 2.7% including care homes, Community Health interventions to tackle substance misuse, drop-in centres, voluntary Community nursing/ other support 6% smoking & tobacco, children’s health, sector Continuing Healthcare 4% sexual health, obesity, physical activity, and preventing infectious disease. LAs Better Care Fund (BCF) - programme Also pandemic flu vaccines (0.35%). 152 Local to join up health and social care services 3% Public Health Grants to LAs distributed by PHE. Authorities Section 7a budgets direct from DH to NHS England. Acute Care Central funding + council tax Accident and Emergency (A&E), maternity, outpatient, acute hospital care, elective/ Simplified funding flows – % of total NHS budget (calculated from expenditure in 2016/17 or earlier) are day case, non-elective, ambulances 33% indicative to give a sense of scale and may not reconcile back to accounts (numbers rounded) Due to the nature of funding flows some Local Authority/ Better Care Fund (BCF) expenditure may be double counted in other areas of CCG expenditure. Mental Health reported figures vary depending on the definition Mental Health used, total spending on MH across all settings was estimated to be £10.8bn (9.5%) in 2015/16. Treatment in dedicated facilities and Public Health grants are under review as part of local government financial reform. PH spending may be higher other care settings, Improving Access under OECD definition (could also include dental services / GP disease prevention – smoking, obesity) to Psychological Therapies (IAPT) 6.5% We hope to update this slide soon, early indications are that percentages have remained fairly stable. 6 What are CCGs? Led by GPs and nurses, Clinical Commissioning Groups (CCGs) work together with patients, communities and GP practices GPs nurses within their area to ensure that the right NHS services are in place managers to support people and help improve their health and wellbeing. hospital public CCGs fund health services for their population: Hospitals, community care etc. doctors Annual allocations to CCGs are not ring fenced. It is for CCGs to decide their priorities for spending, balancing local priorities and planning guidance, to commission (process of planning, agreeing and monitoring) services from a range of providers. Providers Patients Purchasers 211 CCGs (2013) 135 acute non-specialist trusts (84 foundation) 59.7 million patients (2019) 209 CCGs (2015) 207 CCGs (2017) 17 acute specialist trusts (16 foundation) registered with a GP practice in England (NHS Digital) 195 CCGs (2018) 56 mental health trusts (42 foundation) 191 CCGs (2019)* 7,454 GP practices 56.0 million people (2018) NHS England estimated in England (ONS) 35 community providers - 11 NHS trusts, Direct commissioning 6 foundation trusts and 17 social enterprises Co-commissioning and 1 limited company Resident and GP populations are different due to a variety of factors, 853 for-profit and not-for-profit independent including cross-border flows, temporary migration and list inflation. See slide Issues with GP populations sector organisations, providing care to NHS patients from 7,331 locations *The allocations model described was based on 192 CCGs, as the CCG merger in Devon had not been confirmed in time to include it.
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