## Everyone Counts: Planning For Patients 2014/15 To 2018/19 Nhs England  Information  Reader  Box

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Guidance
Document Purpose
Everyone Counts: Planning for Patients 2014/15 - 2018/19
Document Name
NHS England
Author
20 December 2013
Publication Date
Target Audience
CCG Clinical Leaders, CCG Accountable Officers, Care Trusts CEs, 
NHS Trust CEs, Foundation Trusts CEs, Local Authority CEs, NHS 
England Regional Directors, NHS England Area Directors, NHS Trust 
Board Chairs, Directors of Finance, Communications Leads, Directors 
of Operations and Delivery Voluntary organisations
Additional Circulation List Description
This guidance sets out the need for bold and ambitious five year 
strategic plans from NHS commissioners. It describes an approach to 
deliver transformational change with the first critical steps over the next two years, to achieve the continued ambition to secure sustainable high 
quality care for all, now and for future generations.
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Contact Details for further information
Dame Barbara Hakin/Paul Baumann Chief Operating Officer/Chief Finance Officer
NHS England Quarry House
Leeds LS2 7UE
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## Document Status

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## Contents

FOREWORD 
3
Part 1: Our ambition 
6
High quality care for all, now and for future generations 
6
Delivering Transformational Change 
9
- Citizen participation and empowerment 
10
- Wider primary care, provided at scale 
13
- A modern model of integrated care 
14
- Access to the highest quality urgent and emergency care 
16
- A step-change in the productivity of elective care 
17
- Specialised services concentrated in centres of excellence 
17
- Implementation choices determined locally 
17
Maintaining the focus on essentials  
18
- Quality 
18
- Access to services - Convenient for Everyone 
22
- Driving Change through Innovation 
23
- Value for money, effectiveness and efficiency 
23
Leading the Way through Commissioning 
24
Part 2: How we are going to achieve these ambitions 
26
The Strategic and Operational Planning Process 
26
A new approach to planning 
26
Planning fundamentals 
28
Improving outcomes 
28
Joint working and involvement 
28
Aligned planning across health economies 
34
Balancing plans 
35
Planning timetable 
36
| Plan submission	                                                      | 36                                            |
|------------------------------------------------------|-----------------------------------------------|
| Assurance of Plans                                   | 37                                            |
| On-going assurance                                   | 40                                            |
| Overview of Planning Support                         | 40                                            |
| Universal support package                            | 41                                            |
| Tailored local support to meet local challenges      | 42                                            |
| Any town health system                               | 43                                            |
| 1.                                                   | Strategic, Operational and Financial Planning |
| Strategic Plan Overview                              | 44                                            |
| Operational Plan Overview                            | 44                                            |
| Financial Plan Overview                              | 44                                            |
| Financial allocations and the efficiency challenge   | 45                                            |
| Programme and administrative costs                   | 46                                            |
| Financial Planning assumptions                       | 47                                            |
| Strategic Enablers                                   | 48                                            |
| - The NHS standard contract                          |                                               |
| 48                                                   |                                               |
| - Pricing and incentives                             | 49                                            |
| - The Quality Premium: rewarding commissioners       | 49                                            |
| - Commissioning for Quality and Innovation (CQUIN)   | 49                                            |
| - Non recurrent funds                                | 50                                            |
| 2. NHS England Direct Commissioning                  | 51                                            |
| Direct Commissioning Overview                        | 51                                            |
| Content of Plans                                     | 51                                            |
| Financial Planning assumptions                       | 52                                            |
| 3. Better Care Fund Planning                         | 53                                            |
| Better Care Fund Overview                            | 53                                            |
| Funding for integrated care                          | 53                                            |
| Glossary                                             |                                               |
| 55                                                   |                                               |
| Annexes                                              |                                               |
| 57                                                   |                                               |
| Annex A: Outcomes measures                           | 57                                            |
| Annex B: NHS Constitution measures                   | 60                                            |
| Annex C: Activity measures                           | 62                                            |
| Annex D: Primary care measures                       | 63                                            |
| Annex E: Specialised services measures               | 64                                            |
| Annex F: Public health section 7A services measures  | 65                                            |
| Annex G: Health and Justice measures                 | 67                                            |
| Annex H: Direct Commissioning Supporting Information | 68                                            |
| Annex I: Better Care Fund measures and information   |                                               |
| 73                                                   |                                               |
| Annex J: Template contents                           |                                               |
| 87                                                   |                                               |

Sir David 

Nicholson 

KCB, CBE 

Chief Executive

NHS England is a new organisation. We were established in 2011 but only took on our full powers in April 2013. Put simply, our role is to invest the £96 billion we receive from the government each year to deliver great outcomes for our patients. We have been established as an independent organisation, at arms-length from government. Each year the 

government gives us a mandate1 setting out its ambitions for the NHS. This details the outcomes that the 

government wants us to achieve for patients, but gives us the flexibility to determine how to deliver the mandate through our own direct commissioning and through Clinical Commissioning Groups. Delivering the mandate is central to our work but we also are determined to go further. Our vision and purpose flow from the single idea that we exist to ensure high quality care for all, now and for future generations. We want everyone to have greater control over their health and wellbeing, supported to live longer, healthier lives by high quality health and care services that are compassionate, inclusive and constantly improving. Our work is underpinned by the following values:

●
●
We prioritise patients in every decision we take.
●
●
We listen and learn.
●
●
We are evidence-based.
●
●
We are open and transparent.
●
●
We are inclusive.
●
●
We strive for improvement. 
Significant advances have already been made as a consequence of last year's planning guidance. Now for the next phase. 

This planning guidance sets out how we propose that the NHS budget is invested so as to drive continuous improvement and to make *high quality care for all, now and for future generations* into a reality:
High quality care. We will be driven by quality in all we do. No longer can we accept minimum standards as good enough - our patients rightly expect the best possible service. High quality care **for all**. We need to ensure that access to all services is on an equal footing whether the patient's need is for mental or physical help and support. We must put the greatest effort in providing care for the most vulnerable and excluded in society. High quality care for all, now. But high quality is not just an aspiration. The NHS provides high quality care, often to the highest standards of anywhere in the world, but we need to spread excellence more widely. 

We have to learn from the best and get better at sharing good practice rapidly across the NHS. High quality care for all, now **and for future generations**. We are investing not just for today but for the future. We have a responsibility to ensure that the NHS is on as strong a footing as possible, capable of remaining focused on quality through the significant economic challenges ahead. There is great urgency to plan strategically to start making the changes that are required to deliver models of care that will be sustainable in the longer term. That is why this planning guidance is bold in asking commissioners to work with providers and partners in local government to develop strong, robust and ambitious five year plans to secure the continuity of sustainable high quality care for all, now and for future generations.

Sir David Nicholson Chief Executive

## Vision: High Quality Care For All, Now And For Future Generations Commissioning For Transformation (With Clinical Leadership) Part 1: Our Ambition High Quality Care For All, Now And For Future Generations

1.	
People consistently tell us that what they want from the NHS and the wider care system is great outcomes. This requires a relentless focus on the provision of high quality care - care that is safe, clinically effective and provides as good an experience for the patient as possible. They also tell us that they want services to be available when they need them, offered in a way which is convenient for them and that their needs must be met. They want to be helped to stay well and get the best treatment when they are ill. That is why NHS England wants the delivery of high quality care and the achievement of excellent outcomes for patients to be the central focus of our work.
2.	
Put simply, the outcome of care or a treatment is the impact it has on a patient - on their symptoms and on their ability to live the life they want to live. An outcomes-based approach means focusing less on what is 
done for patients, and more on the *results* of what is done. It means focusing on how well patients feel after treatment and helping them to stay well, whether suffering from physical or mental ill-health. 
3.	
Our aspiration is to develop an NHS that delivers great outcomes, now and for future generations. That means reflecting the government's objectives for the NHS set out in their mandate to us, adding our own stretching ambitions for improving health and delivering better services and supporting local leaders to go even further to tailor care to their citizens' needs.
4.	
This document builds on the great work done last year in response to Everyone Counts: Planning for Patients 2013/14 
2. 
Part 1 focuses on the outcomes we want for patients and describes our bold ambitions to deliver them. It describes the emerging findings from our strategy, which lead us to six new models of care which together will deliver the transformational change needed if the NHS is to deliver improving outcomes 
at a time of increasing need, unprecedented 

7.	
These offers represented what we then saw as the key enablers of change. They were 
new treatment options and economic 

identified early in NHS England's life when 
restraint. In our role as leaders of the 

we had not begun the work on our emerging 
commissioning system we emphasise where 

strategy. We consider that these early 
our focus will lie - delivering the 

choices have stood the test of time; they 
government's mandate to us and going 

remain central to the next stage of 
beyond that to secure even better care. It 

development and can now be 
concludes by reaffirming our commitment to 

accommodated in the broader context of our 
a clinically led commissioning system with 

strategic thinking. High standards of quality 
CCGs as local leaders. NHS England is also 

are still at the heart of everything we do, 
a local commissioner and throughout we 

recognise our dual role - a local 
and 7 day services, a key driver of quality, 
commissioning partner as well as the 
now are moving from aspiration to reality. 
coordinator and leader of a commissioning 
This year's guidance describes the further 
system on which better health and better 
progress we want to see on these as well as 
care depend.
describing in the next level of detail how transparency and more widely available information empower citizens and patients 
5.	
Part 2 of this document outlines the planning 
and help them make the best choices for 
process and details of the plan which needs 
their services and their care.
to be produced. The first chapter provides an overview of the fundamental planning considerations for all plans, outlines the 
8.	
Much of the basis for the government's 
strategic enablers, describes how plans will 
mandate to us is the NHS Outcomes 
be submitted and assured and provides an 
Framework which describes the five main 
overview of the support available for the 
categories of better outcomes we want to 
process. Subsequent chapters describe in 
see:
more detail the content of plans and the core 
●
●
We want to prevent people from dying 
financial allocations and assumptions which 
prematurely, with an increase in life 
must underpin them.
expectancy for all sections of society. 
●
●
We want to make sure that those people 
6.	
Last year we made five offers:
with long-term conditions, including 
●
●
NHS services, seven days a week
those with mental illnesses, get the best 
possible quality of life. 
●
●
More transparency, more choice
●
●
We want to ensure patients are able to 
●
●
Listening to patients and increasing their 
recover quickly and successfully from 
participation
episodes of ill-health or following an 
●
●
Better data, informed commissioning, 
injury.
driving improved outcomes
●
●
We want to ensure patients have a great 
●
●
Higher standards, safer care 
experience of all their care. 
●
●
We want to ensure that patients in our 
●
●
Making significant progress towards 
care are **kept safe** and protected from 
eliminating avoidable deaths in our 
all avoidable harm. 
hospitals caused by problems in care.
9.	
Our ambitions will always be focused on 
11.	
Additionally, there are three more key 
delivering the outcomes in these five 
measures that are vitally important and on 
domains.
which we expect to see significant focus and rapid improvements.
10.	
However, it is vital that we translate these outcomes into specific measurable ambitions 
12.	
The first is **improving health,** which must 
which we believe are critical indicators of 
have just as much focus as treating illness. 
success and against which we can track our 
At national level we will work closely with 
progress. Working with clinicians and staff in 
Public Health England to create the best 
NHS England, in CCGs and with key 
environment for all localities. At a local level 
stakeholders we have defined seven specific 
all stakeholders will address these issues 
ambitions:
through Health and Wellbeing Boards. We need to ensure that the key elements of 
●
●
Securing additional years of life for the 
Commissioning for Prevention are delivered 
people of England with treatable mental 
and that every contact really does count in 
and physical health conditions.
taking the opportunity to promote a healthy 
●
●
Improving the health related quality of 
environment and healthy lifestyles. Everyone 
life of the 15 million+ people with one or 
must make sure they work with all partners 
more long-term condition, including 
so that all those things which affect the 
mental health conditions.
broader determinants of health 
●
●
Reducing the amount of time people 
are addressed.
spend avoidably in hospital through better and more integrated care in the 
13.	
And as we strive to improve outcomes, we 
community, outside of hospital.
must place special emphasis on reducing 
●
●
Increasing the proportion of older people 
health inequalities. We need to ensure that 
living independently at home following 
the most vulnerable in our society get better 
discharge from hospital.
care and better services, often through 
●
●
Increasing the number of people with 
integration, in order to bring an acceleration 
mental and physical health conditions 
in improvement in their health outcomes.
having a positive experience of hospital care.
14.	
We are absolutely committed to moving 
●
●
Increasing the number of people with 
towards **parity of esteem,** making sure that 
mental and physical health conditions 
we are just as focused on improving mental 
having a positive experience of care 
as physical health and that patients with 
outside hospital, in general practice and 
mental health problems don't suffer 
in the community.
inequalities, either because of the mental health problem itself or because they then 
delivered. People are living longer, and our don't get the best care for their physical ability to treat and help to manage conditions health problems. 

that were previously life-threatening is improving all the time. With this has come a 

15.	
This is our ambition for the NHS and the 
change in what can be delivered safely, 

wider care system - not only delivering the 
effectively and efficiently in different settings. 

key elements in the government's mandate 
For example, patients can be cared for in 

but also going beyond those ambitions in our 
their own homes, supported by experienced 

national thinking and unleashing the power 
clinicians and technology which enables 

of local systems to deliver the ambitions of 
them to monitor their condition and get 

their population. This will not be a task for 
expert help to manage it. The result is that 

the NHS alone. CCGs, as the local leaders 
patients who would previously have needed 

of the NHS supported by Commissioning Support Units, NHS England, and all NHS 
hospital treatment can now stay at home.

providers, will need to work closely with all the key partners on the Health and 
18.	
That is why in July 2013, NHS England 
Wellbeing Boards. It will be vital that NHS 
along with our national partners launched 
commissioners work closely with Local 
A Call to Action 
4 which set out the 
Authorities, who have such an important part 
challenges and opportunities faced by the 
to play in securing the broader determinants 
health and care systems across the country 
of health as well as delivering high quality 
over the next five to ten years. Put starkly, 
social care services, and Healthwatch who 
we need to find ways to raise the quality of 
will ensure the patient perspective is 
care for all in our communities to the best 
paramount. 
international standards while closing a potential funding gap of around £30 billion by 2020/21. This was a call for creativity, 
16.	
Working together we can make the biggest 
innovation and transformation. It will require 
difference, ensuring great outcomes for 
a significant shift in activity and resource 
everyone delivered through convenient 
from the hospital sector to the community. 
services, under strong financial discipline, 
The funding and implementation of the 
with enthusiastic and committed staff, 
Better Care Fund has the potential to 
adopting the 6Cs in Compassion in 

improve sustainability and raise quality, 
Practice 
3, truly empowering patients and including by reducing emergency citizens and making everyone's lives better, admissions; hospital emergency activity will both now and for future generations.

have to reduce by around 15 per cent. CCGs will need to make significant progress 

## Delivering Transformational Change

towards this during 2014/15.

17.	
Fulfilling our long-term ambitions will require a change in the way health services are 
19.	
The response to this Call to Action has been 
22.	
That means identifying the models of care 
impressive. Over 250 local events involving 
that will apply in five years' time and 
clinicians, patients and public have been 
determining the steps needed to realise that 
held to debate the future shape of services. 
vision. NHS England has identified that any 
Nationally, we have opened up discussion 
high quality, sustainable health and care 
on the future of those services NHS England 
system in England will have the following six 
commissions with Calls to Action on general 
characteristics in five years:
practice, community pharmacy and 
●
●
A completely new approach to ensuring 
specialised services. And we have brought 
that citizens are fully included in all 
together patients, public and clinical and 
aspects of service design and change 
managerial experts in a series of events to 
and that patients are fully empowered in 
share the best analysis and thinking on 
their own care.
prevention, mental health and parity of 
●
●
Wider primary care, provided at scale.
esteem, and future landscape for providers, 
●
●
A modern model of integrated care.
learning from the best in class in the world. 
●
●
Access to the highest quality urgent and 
In parallel, the development of integration 
emergency care.
pioneers and the ministerial focus on 
●
●
A step-change in the productivity of 
vulnerable older people have been strong 
elective care.
influences on the Call to Action.
●
●
Specialised services concentrated in centres of excellence.
20.	
There is a good degree of consistency in the themes emerging. The strongest message is that citizens must be at the centre of all our 

## Citizen Participation And Empowerment

planning; their interests and aspirations must 
23.	
We know that citizens want to be fully 
be the organising principles for the future of 
engaged in making positive choices about 
health and care.
their own health and lifestyles; participating in the shaping and development of health 
21.	
Taking this principle as our starting point, we 
and care services; well served by access to 
know that different, identifiable groups within 
transparent and accessible data and advice 
our population have different needs, and that 
about health and services; and able to 
the way services organise themselves to 
choose which health services they can use 
respond has a direct impact on outcomes 
and how to access them. We know that the 
and best use of resources. For many years, 
public want a much greater say in how local health systems in this country and health services are organised, and we know overseas have tested and developed new that patients and their carers want much approaches for some groups covering some more say in how their personal care is services. NHS England believes it is now delivered. We also know that patients and time to draw out the lessons and propose a the public want much more and better direction of service development, based on information about how they can stay well or meeting the needs of whole populations, to help to manage their own illness and to have be applied consistently across the country.

services reflect the needs of local people. 

information that is of high quality and readily We have set out our approach to supporting accessible about different services and CCGs with these important duties in different treatments so that they can make Transforming Participation in Health and informed choices about what will be the best for them. Empowered in this way, citizens Care 
5. The stronger role for user voice within and patients become co-providers of and services will also be strengthened through active participants in health care. 

the roll-out of Personal Health Budgets from April 2014. CCGs will be able to offer Personal Health Budgets, including as a 

## I) Listening To Patients' Views

Direct Payment, to all patients who may 

24.	
We need to make sure that public, patient 
benefit, and NHS Continuing Healthcare 

and carer voices are at the centre of our 
patients will have a right to have a Personal 

healthcare services from planning to 
Health Budget from October 2014. In 

delivery. We also want commissioners to be 
addition, we will expand existing 

informed by insightful methods of listening to 
programmes of patient reported outcome 

those who use and care about services. The 
measurement to give patients and carers the 

extension of the Friends and Family Test to 
greatest ability to manage and share data on 

maternity services in October 2013, to 
their own care.

community and mental health services by December 2014, to GP Practices from the 

## Ii) Delivering Better Care Through The

end of December 2014 and to the rest of 

## Digital Revolution

NHS services by the end of March 2015, will enhance the information that patients can 
25.	
Changes in technology and the way we 
use to make choices, such as for their 
communicate have made vast differences to 
maternity care. The Friends and Family Test 
everyone's lives. We need to ensure that the 
provides real time feedback on the quality of 
NHS harnesses the use of this to deliver 
services and gives front line staff a powerful 
better care and to make it more convenient 
incentive to make practical and timely 
for patients. For example, we expect all 
improvements to the services they provide. 
people with a long-term condition to have a 
There are two duties for NHS commissioners 
personalised care plan which is accessible, 
to support better patient and public 
available electronically and linked to their GP 
participation. The first requires 
health record, and that conforms to the 
commissioners to ensure patients and carers best-practice standards that we will be are able to participate in planning, managing developing. That will mean they receive and making decisions about their care and safer care and don't need to repeat their treatment through the services they details at every new contact. Greater access commission. The second requires the to web tools like NHS Choices and the effective participation of the public in the creation of a digital 'front door' will help commissioning process itself, so that transform the way patients, their families and carers access information about NHS 
that is provided and lead to improvements services and will provide self-management in quality.

materials and information to further empower them to manage their own condition. 

27.	
We also know that effectively collecting, 
Greater use of telehealth and telecare will 

sharing and interpreting data is fundamental to the transformation we need to deliver. The 
also be important in supporting people with 

steps we have already taken include the 
long-term conditions to manage their own 

promotion of a single set of data and data 
health and care. We are committed to 

transmission standards to facilitate a 
ensuring that nobody is left behind as we 

nationwide exchange of health information. 
give patients and citizens greater control. 

Called *care.data* this will safely join up 
For this reason, we have launched a major 

existing clinical data sets, held securely 
health literacy programme with the Tinder 

within the Health and Social Care 
Foundation, which will help 100,000 people 

Information Centre, and extend and expand 
each year learn how to use the Internet for 

them so that they provide the data that 
health benefit, and Care Connect, an 

commissioners need to support the delivery 
initiative to test how telephone and social 

of high quality care and improved outcomes. 
media channels can improve public 

Offering the opportunity for patients to 
participation.

access their own health information also forms part of this ground breaking work. 

## Iii) Transparency And Sharing Data

These opportunities need to be factored into 
26.	
For too long the NHS has been unable to 
commissioner plans. By the summer of 2014 
share the information patients need to 
we anticipate that data in at least 5 per cent 
understand their condition and make choices 
of GP practices will be linked to hospital 
about the best treatment for them; including 
data. By the end of March 2015 this will have 
where and how they receive it. We are 
increased to 90 per cent. We expect 
determined to make apparent the different 
strategic plans to set out when 100 per cent 
clinical outcomes that different treatments, 
coverage will be completed.
organisations and individual specialists achieve. Consultant level activity and clinical 
28.	
Everyone Counts: Planning for Patients 
outcomes data for ten surgical specialties 
2013/14 set out the expectation of universal 
have now been published. This gives 
adoption of the NHS number as the primary 
patients and citizens, as well as their 
identifier by all providers. However, a 
commissioners and clinicians, enhanced 

significant number of providers are still not 
access to data and information. We plan to 

compliant. Such behaviour can have a 
extend this so that data from all appropriate 

detrimental impact on patient outcomes, as it 
NHS funded national clinical audits is made 

hinders the effective flow of information 
available before 2020. This will continue to 

between primary and secondary care. 
provide vital insight for both patients and 

Working with EHI Intelligence we have 
healthcare professionals about the care developed the Clinical Digital Maturity Index (CDMI) which will allow us to identify the Wider primary care, provided at scale scale of digitisation in each provider, including use of the NHS number. As a first 

31.	
For those patients with a moderate mental or 
step, we shall work with CCGs to secure 

physical long-term condition (about 20 per 
immediate improvement from those 

cent of the population) we need to secure 
providers who are in the bottom quartile of 

access to all the support and care they need 
digitisation. Following that, our intention is to 

from wider primary care, provided at scale. 
consider the possibility of introducing a 

This will mean access to a broader range of 
range of increasingly stringent sanctions on 

services in primary care, in their own homes 
poorly performing providers, from contractual 

and in their communities, centred on a much 
fines through to the withdrawal of contracts.

more pivotal and expanded role for general practice to co-ordinate and deliver 
29.	
The 2014/15 GMS contract will help 
comprehensive care in collaboration with 
empower patients by enabling practices to 
community services and expert clinicians.
register patients from outside traditional catchment areas, thereby creating greater 

## I) Transforming Primary Care Services

patient choice. It introduces a new requirement for practices to promote and 
32.	
Our strategic framework for commissioning 
offer to all patients the ability to book 
of general practice services, to be published 
appointments, order repeat prescriptions and 
in 2014, will set out the action we are taking 
access their medical notes online. NHS 
at national level to support commissioners in 
England will develop metrics to identify the 
developing joint strategies for primary care 
number of practices with access to online 
as part of their five year strategic plans. One 
services.
of our key aims is to enable general practice, community pharmacy and other primary care services to play a much stronger role, at the 
30.	
The 2014/15 GMS contract introduces a new 
heart of a more integrated system of 
requirement for GP practices to upload 
community-based services, in improving 
information about medicines, allergies and 
health outcomes. It is clear from the Call to 
adverse reactions onto the Summary Care 
Action that there is a widespread appetite for 
Record. Commissioners should encourage 
developing new models of primary care that 
out-of-hours, NHS111 and A&E providers to 
provide more proactive, holistic and 
access this information to improve quality 
responsive services for local communities, 
and outcomes. The contract also requires particularly for frail older people and those that practices use the NHS number as the with complex health needs; play a stronger primary identifier for all clinical role in preventing ill-health; involve patients correspondence from April 2014 and use and carers more fully in managing their electronic systems to transfer patient records health; and ensure consistently high quality between practices.

of care. NHS England and CCGs have a joint responsibility to drive up all aspects of quality in primary care services.

33.	
There is a growing consensus that this will 
36.	
CCGs will be expected to support practices 
mean enabling general practice to work at 
in transforming the care of patients aged 75 
greater scale and in closer collaboration with 
or older and reducing avoidable admissions 
other health and care organisations, whilst 
by providing funding for practice plans to do 
retaining personal continuity of care and 
so. They will be expected to provide 
strong links with local communities. NHS 
additional funding to commission additional 
England will create the strategic framework 
services which practices, individually or 
for this approach and work with CCGs to 
collectively, have identified will further 
stimulate new models of care and in 
support the accountable GP in improving 
developing innovative forms of 
quality of care for older people. This funding 
commissioning and contracting to support 
should be at around £5 per head of 
these new models.
population for each practice, which broadly equates to £50 for patients aged 75 and over. Practice plans should be 
A modern model of integrated care
complementary to initiatives through the 
34.	
For the 5 per cent of patients with multiple, 
Better Care Fund.
often complex, mental or physical long-term conditions, often compounded by being 
37.	
In some instances, practices may propose 
elderly and perhaps frail, we need a modern 
that this new funding be used to commission 
model of integrated care with a senior 
new general practice services that go 
clinician taking responsibility (through a 
beyond what is required in the GP contract 
personal relationship) for active coand the new enhanced service. We will 
ordination of the full range of support from 
make arrangements for NHS England to be 
lifestyle help to acute care. 
involved under these circumstances in order to help identify the contractual arrangements 
i) Ensuring tailored care for vulnerable 
and help provide appropriate oversight and 
and older people
governance. In other instances, practices may propose that this money be invested in 
35.	
The government has determined that there 
other community services to secure 
will be a specific focus during 2014/15 on 
integration with primary care provision. 
those patients aged 75 and over and those 
Practices should have the confidence that, 
with complex needs. The new GP contract 
where these initial investment plans 
secures specific arrangements for all 
successfully reduce emergency admissions, 
patients aged 75 and over to have an 
it will be possible to maintain and potentially 
accountable GP and for those who need it to 

increase this investment on a recurrent 
have a comprehensive and co-ordinated 

basis.
package of care. Our expectation is that similar arrangements will apply to increasing numbers of people with long-term conditions 

38.	
In addition, CCGs will need to demonstrate 
in future years.

how individual practices can have as much influence as they need over the commissioning of associated community 
provider organisations. It may mean services, community nursing, especially integrated commissioning between CCGs district nursing, and end of life care, so that and NHS England and Local Authorities. 

their accountable GPs can discharge their responsibilities and so as to ensure that But what matters is that patients experience these services are co-ordinated with the holistic care which is joined up and is a services provided by the practice itself and single tailored package for them. Each provide integrated care for patients.

integrated care model will look different depending on the community served but is likely to include the following features:

39.	
The 2014/15 General Medical Services (GMS) contract will support more proactive, 
●
●
senior clinicians (within a team) taking 
integrated and personalised care, through:
full responsibility for people with multiple long-term conditions;
●
●
ensuring that all people aged 75 and 
●
●
full responsibility lasting from 
over have a named, accountable GP 
presentation to episodic care, including 
who is responsible for overseeing their 
personalised care planning for those 
care;
who would benefit; and
●
●
introducing more systematic 
●
●
co-ordination of care including lifestyle 
arrangements for risk profiling and 
support and advice, social care, general 
proactive care management, under the 
practice care and hospital episode 
supervision of a named GP, for patients 
co‑management.
with the most complex health and care needs; and
41.	
With CCGs assuming responsibility for 
●
●
giving GP practices more specific 
Special Educational Needs commissioning 
responsibilities for helping monitor the 
from September 2014, they will need to work 
quality of out-of-hours services for their 
closely with Local Authorities and schools to 
patients and supporting more integrated 
meet the wider pledge for better health 
working with out-of-hours services.
outcomes for children and young people.

## Ii)	 Care Integrated Around The Patient

42.	
We have also begun to shift our focus from treating the consequences of poor care to 
40.	
Delivering care in a way which is integrated 
the causes of preventing poor care. The 
around the individual patient is essential to a 
£3.8 billion Better Care Fund that comes into 
new way of working which truly puts the 
operation in 2015/16 is aimed at supporting 
patient at the heart of what we do. Our early 
the integration of health and social care. 
focus will be the integration of care around 
The fund is an opportunity for local services the most frail, often elderly patients but it will to transform and improve the lives of the be important for all those who receive people that need it most. The fund will be complex care. This may mean integration available in 2015 but the planning has across health and social care and across already started across the country. We different elements of NHS care. It may mean expect commissioners to include in their integrating specific services or integrated plans their vision for how health and social 

45.	
NHS 111 services will be a key component of 
care services work together to provide better 

the urgent care service. NHS 111 services 
support at home and earlier treatment in the 

will be rolled out to cover the whole of 
community to prevent people needing 

England. In addition, NHS England and 
emergency care in hospital or care homes. 

CCGs will produce a new service 
All CCGs must include in their plans the 

specification for 111 to support the future 
actions they will take in 2014/15 to create 

commissioning of a comprehensive and high 
the funding required to make the Better Care 

quality service.
Fund affordable when it is introduced in 2015/16 in order to fulfil their duty to 

46.	
We expect local resilience planning, led 
commission sustainable services for 

through Urgent Care Working Groups 
patients.

(UCWGs), to be a continuous process, with preparations simply continuing on from this 
Access to the highest quality urgent and 

winter to lead us into next winter. UCWGs 
emergency care

should refresh their membership and ensure that all relevant stakeholders are involved at 
43.	
All citizens deserve access to the highest 
an appropriately senior level when the full 
quality urgent and emergency care. The 
group convenes. We recognise that a 
report on the first phase Urgent and 
smaller core group will be needed to support 
Emergency Care review 
6 sets out an 
day to day activities. It is essential that GP 
exciting vision for how we deliver NHS 
practices and out-of-hours providers, as well 
services in a way that complements modern 
as all those who deliver other community 
day lifestyles and preferences. It suggests 
and mental health services, are fully 
that the quality of urgent and emergency 
involved. UCWGs must also engage 
care would be enhanced if patients were 
effectively with local independent and 
treated as close to home as possible and if 
voluntary sector providers, and we are 
networks were established, with major 
developing a framework to support UCWGs 
specialised services offered in between 
in doing this. UCWGs should agree an 
40 and 70 major emergency centres, 
appropriate mechanism for providers such 
supported by other emergency centres and 
as ambulance trusts, who will relate to many 
urgent care facilities.
UCWGs, to engage with them all effectively, e.g. through lead commissioning 
44.	
The review will take some time to implement. 
arrangements. It is similarly equally 

Meanwhile, there are immediate issues 
important that all local CCGs whose patients 

around planning for seasonal variation, 
use the acute trust at the centre of urgent 

emergency situations and times of 
care plans have a mechanism for full 

varying demand.
engagement through the lead CCG. 

comparisons suggest that, as well as quality 

47.	
We expect UCWGs will build on their plans 
improvements, there are significant 

for 2013/14 in the spring and will have a fully 
productivity gains to be made if we can 

refreshed set of plans before summer 2014. 
change our model of delivering elective care 

NHS England, working with NHS Trust 
- giving us the opportunity to treat even 

Development Authority (TDA), Monitor and 
more patients at the same or lower cost.

partners in local government, will assess the effectiveness of each UCWG and, for those 
Specialised services concentrated in centres 

where there are concerns, will oversee the 
of excellence

necessary changes required to ensure that these groups are well led and can play a 
49.	
For those who need them, specialised 
comprehensive and effective role in the 
services for less common disorders need to 
management of urgent care in 2014/15 
be concentrated in centres of excellence 
especially during the winter. In particular, we 
where we know that the highest quality can 
expect UCWGs to be the vehicle for 
be delivered. Maximising quality, 
reaching agreement on the investment plans 
effectiveness and efficiency means working 
to be funded by the retained 70 per cent 
at volume and connecting actively to 
from the application of the marginal rate rule. 
research and teaching. Specialised services 
Prior to any contracts being in place there 
are currently being delivered out of too many 
must be absolute transparency about the 
sites, with too much variety in quality and at 
use of this money to reduce pressures on 
too high a cost in some places. Through 
A&E departments over the winter, and the 
NHS England's direct commissioning we 
acute trust must be satisfied that the plans 
shall be looking to reduce significantly the 
for the use of that money addresses their 
number of centres providing NHS 
needs.
specialised services, require standards of care to be applied consistently across 
A step-change in the productivity of elective care

England and maximise synergy from research and learning. Our strategy for 
48.	
For people who need episodic, elective care, 
specialised services is still in the early 
access to services must be designed and 
stages of development, but we can foresee 
managed from start to finish to remove error, maximise quality, and achieve a major step 
a concentration of expertise in some 15 to 
- change in productivity. We expect to see 

30 centres for most aspects of specialised 
centres that can deliver high quality 

care. Academic Health Science Networks 
treatment, treating adequate numbers to be 

will play an important role as the focus for 
expert, and with the most modern equipment 

many of these.
available. If we are going to transform out of hospital care and look to concentrate 

Implementation choices determined locally
specialised services in fewer sites then we 

50.	
These characteristics of a high-performing 
need to review how we deliver routine 

health system will not need to be delivered 
planned admissions for patients for less 

in the same way everywhere. Local 
complex treatments. International 

communities need to come together to 
feasible, NHS England will work with the determine the best way to deliver services Care Quality Commission (CQC) to agree for patients. For example, integrated care the quality standards that apply to NHS 
models for the 5 per cent of our population services, with the CQC making the definitive with greatest need could be developed out of judgements on quality in providers. The existing NHS Trusts or NHS Foundation lessons from the Francis Report, Trusts, out of extended primary care built on Winterbourne View and the Berwick Report general practice, or through new offers. 

are that quality is as much about our The outcome is what matters rather than behaviours and attitudes to patients as the process or organisational form. NHS 
human beings as it is about the transactions England wants local partners to determine we need to make to ensure services the delivery vehicle which best suits local geographies and capabilities.

improve. There are three non‑negotiable items that we expect to be part of every relationship between a commissioner and 

## Maintaining The Focus On Essentials

provider:

51.	
There are a number of essential elements 
●
●
The Francis Report 
7 into the systemic 
that will apply to all of the characteristics of 
failings at the Mid Staffordshire NHS 
every successful and sustainable health 
Foundation Trust provides us all with 
economy:
important learning to ensure we expect 
●
●
quality;
and deliver the best possible care for our 
●
●
access;
patients. NHS England supports the 
●
●
innovation; and
government's response set out in Hard Truths 
8. The National Quality Board's 
●
●
value for money.
How to ensure the right people, with the right skills, are in the right place at the 
52.	
We expect to see how a specific focus will be 
right time 
9 sets out an approach to 
maintained on each of these in local plans in 
improving nursing, midwifery and care 
a way which clearly demonstrates how they 
staffing for the benefit of patients. 
will be implemented to drive up outcomes for 
Getting the right staff with the right skills 
patients and local communities.
to care for our patients all the time is not 
something that can be mandated or 

## Quality

secured nationally. Providers and 

53.	
In everything we do, quality - covering 
commissioners, working together in 

effectiveness, experience and safety - must 
partnership, listening to their staff and 

be the central theme. All NHS 
patients, are responsible for making 

commissioners must put quality at the centre 
these expectations a reality.

of all their discussions with providers. Where 
●
●
Transforming Care: A national response 
●
●
support for patient choice.
to Winterbourne View Hospital10 set out 
the basis on which CCGs, Local 
55.	
A number of vital aspects of quality need to 
Authorities and specialised 
be considered:
commissioners should work together to implement the core specification. This 

## I) Patient Safety

describes the core principles that must 
56.	
Knowing that they will be safe in our care 
be present in all education, health and 
is of paramount importance to patients. 
social care services for children, young 
We are introducing a number of approaches 
people, adults and older people with 
to improve patient safety and reduce 
learning disabilities and/or autism who 
avoidable harm:
either display, or are at risk of displaying, 
●
●
Regional and Area Team Quality 
behaviour that challenges.
Surveillance Groups to provide a wealth of evidence and intelligence to support 
●
●
Further to the government's response to 
early intervention when issues develop;
the Berwick review into patient safety 
11, 
●
●
a new Patient Safety Alerting System to 
CCGs are expected to take an active 
support organisations to understand and 
part in their local patient safety 
take rapid action in relation to patient 
improvement collaborative and address 
safety risks;
how their commissioning can support local improvement. Commissioners 
●
●
continued zero tolerance of MRSA 
should ensure they have systems in 
bloodstream infections and ongoing 
place to satisfy themselves that the 
focus on reducing *Clostridium difficile* 
providers they commission services from 
infections;
are effectively reporting and learning 
●
●
we will set up and support the Patient 
from safety incidents and implementing 
Safety Collaborative Programme to 
patient safety alert actions in a timely 
create a comprehensive, effective and 
manner.
sustainable collaborative improvement system that underpins a culture of 
54.	
To ensure local autonomy and flexibility in 
continual learning and patient safety 
how NHS organisations plan and deliver 
improvement; and
service re-designs, plans need to 
●
●
we will create new NHS Safety 
demonstrate robust evidence against four 
Thermometers for mental health care, 
tests, which are that there should be:
medicines safety and maternity that can 
●
●
support from clinical commissioners;
be used by organisations to support local improvement activity.
●
●
clarity on the clinical evidence base;
●
●
robust patient and public engagement; and
implementation, including train the 

57.	
From January 2014 the CQC will provide 
trainer and master classes;

definitive quality ratings on all providers of NHS services. Commissioners are expected 
●
●
recommended methodologies to 
to take prompt action with all providers that 
strengthen forms of staff engagement 
are judged by the CQC as "require 
which can support improvements in 
improvement" or "inadequate". The CQC 
patient experience through better staff 
has committed to sharing information with 
experience;
commissioners through its Intelligent 
●
●
support for the collaborative sharing of 
Monitoring, and we expect commissioners to 
learning and good practice; and
inform the CQC if they believe a provider 
●
●
a strategy to learn from complaints and 
might have quality or risk issues.
improve the experience of making a complaint.
58.	
We also need commissioners to be more proactive in responding to complaints and 

## Iii)	Compassion In Practice

concerns expressed by patients, the public and NHS staff, whether expressed through 
60.	
Compassion in Practice, the national 
whistleblowing or other means. CCGs 
nursing, midwifery and care giving vision and 
should have a strong and collaborative 
strategy, provides a challenge for 
working relationship with their local 
commissioners to support providers through 
Healthwatch so that issues of concern can 
the adoption of the 6Cs: care, compassion, 
be dealt with early.
competence, communication, courage and commitment. The 6Cs now have wide 

## Ii) Patient Experience

acceptance and reach throughout the nursing, midwifery and care staff workforce 
59.	
Plans are expected to demonstrate 
in the NHS across England in order to 
measurable improvement in patient 
address six areas of action.
experience as well as continued investment 
●
●
help people to stay independent, 
in generating feedback. Improvement will be 
maximising well-being and improving 
supported through:
health outcomes;
●
●
tools to help establish who is receiving 
●
●
work with people to provide a positive 
poor care and where poor care is to be 
experience of care;
found;
●
●
deliver high quality care and measure 
●
●
proven methods to enhance feedback 
impact;
and insight from vulnerable patient 
●
●
build and strengthen leadership;
groups;
●
●
ensure the right staff, with the right skills 
●
●
tools to measure and improve the 
in the right place; and
experience of carers;
●
●
support a positive staff experience.
●
●
independent evaluation of improvement methodologies and easier access to proven techniques and support for their 
services and their supporting diagnostic 

61.	
Each area of action has an implementation 
services. The Forum's review points to 

plan with national, local and individual 
significant variation in outcomes for patients 

actions. This is a nursing, midwifery and 
admitted to hospital at the weekend across 

care staff strategy which is being delivered 
the NHS. This variation is seen in mortality 

by the NHS healthcare system, with national 
rates, patient experience, length of stay and 

bodies and regulators leading on a range of 
re-admission rates.

initiatives. CCGs are asked to ensure that the local areas of action within the Compassion in Practice implementation 
64.	
There is no 'one size fits all' answer to 
plans are reflected in the services they 
introducing seven day urgent and 
commission.
emergency care services. Local solutions will need to be found. We shall work with 

## Iv) Staff Satisfaction

Health Education England on the workforce implications of transforming services. The 
62.	
Staff satisfaction is an important indicator of 
Forum has developed a set of clinical 
quality. There is good evidence that happy, 
standards describing the standard of urgent 
well-motivated staff deliver better care and 
and emergency care that all patients should 
that their patients have better outcomes. 
expect to receive seven days a week. The 
NHS staff work very hard, often under great 
standards have been developed through 
pressure; and we must ensure that we work 
extensive engagement with stakeholders 
with all providers of NHS services to make it 
and include a comprehensive supporting 
possible for them to do the best job they can. 
evidence base. Local contracts for 2014/15 
We must ensure that clinical leadership in 
should include an Action Plan to deliver the 
front line teams flourishes and drives 
clinical standards within the Service 
innovation and better care. The results of the 
Development and Improvement Plan 
staff survey and, as it comes on stream, the 
Section, and a local CQUIN should be 
staff Friends and Family Test should be used 
considered, based on the clinical standard 
when considering the quality of services 
for time from arrival to initial consultant 
being provided.
assessment.

## V) Seven Day Services

65.	
Consideration is being given to how data and information on the extent to which the 
63.	
The NHS Services, Seven Days a Week 
clinical standards are being delivered, and 
Forum, chaired by the National Medical 
the provision of seven day services, can be 
Director, has reported to NHS England on 
published in an accessible format that lends 
how NHS services can be improved to 
itself to comparisons. There is work to be 
provide a more responsive and patient 
undertaken both nationally and locally to 
centred service across the seven day 

determine how these standards can be 
week 
12. The Forum was asked to focus, as a 
delivered affordably.
first stage, on urgent and emergency care 

## Vi)	Safeguarding

outcomes worse and can even make services unsafe. We also know that our 

66.	
The safeguarding of all those who are 
services can only improve outcomes for 

vulnerable is an enormous obligation for all 
patients if they are available to them, and 

of us who work in the NHS and partner 
they receive those services quickly, when 

agencies. There is still much to do to ensure 
they need them, and in a way which is 

this happens. In March 2013, NHS England 
convenient for them and fits with their 

published the Safeguarding Vulnerable 
daily lives. 

People in the Reformed NHS; Accountability and Assurance Framework 
13. The 
69.	
Disadvantaged and minority groups need 
Framework provides a clear set of principles 
specifically tailored services which suit their 
and guidance to ensure the new system 
circumstances or they will simply not be 
delivers improved outcomes for children and 
accessible to them. There are many minority 
vulnerable adults. A strategic national 
groups who will struggle to get the care they 
steering group has been established to 
need if they are expected simply to fit in with 
ensure the framework is embedded, and it 
what works for the majority. 
provides a national forum to enable safeguarding leaders in NHS England to 
70.	
During 2014/15, we will also oversee pilots 
implement cross governmental policy. A 
designed to extend access to general 
number of key priorities are emerging which 
practice services and stimulate innovative 
include policies to prevent child sexual 
ways of providing primary care services, 
exploitation, female genital mutilation, sexual 
supported by the Prime Minister's £50 million 
violence and domestic abuse, and which will 
challenge fund. There will be at least nine 
ensure effective implementation of national 
pilots covering around half a million patients 
legislation and policies relating to vulnerable 
and testing new ways of providing evening 
children and adults.
and weekend access, making greater use of email and phone consultations, joining up 
67.	
Demonstrating how safeguarding duties will 
urgent care and out-of-hours care, and 
be discharged needs to be reflected in all 
providing a range of other flexibilities in how 
local plans and NHS England will seek 
citizens access services. 
continuous assurance on this important issue.
71.	
The NHS Constitution identifies a range of standards to which patients are entitled and 
Access to services - Convenient for Everyone

which NHS England has committed to deliver. Every local plan will need to identify 
68.	
Our patients have consistently told us how 
both how they will make services generally 
important it is that they don't have to wait for 
accessible but also how they will specifically 
treatment. They tell us that waiting can be 
deliver the standards in the constitution.
the most distressing part of their illness. And we know that waiting can make clinical 
of the system play their part in delivering 

## Driving Change Through Innovation

better care within their allocated resource.

## I) Supporting Our Staff To Innovate

72.	
NHS England is committed to innovation to 
75.	
We have already set out that there is a 
deliver significant improvements in quality 
potential funding gap of around £30 billion by 
and efficiency in the NHS. In 2013/14 we 
2020/21. Plans need to be explicit on how 
introduced a Regional Innovation Fund to 
they will close this gap in a local context 
support and promote the adoption of 
whilst maintaining or enhancing the quality of 
innovation and the spread of best practice 
services provided to patients. NHS England 
across the NHS. We will be looking to 
does not underestimate the scale of this task 
facilitate fresh perspectives or partnerships, 
and will do all in our power to support local 
bringing in different types of expertise or 
health communities to take the bold 
capacity to support the adoption of current 
decisions they need to transform services. 
innovations or the development of new 
We shall review our funding mechanisms so 
ideas.
that they are truly supportive of improving outcomes.

## Ii) Research

76.	
In helping to deliver value for money for the 
73.	
Research and evaluation across the whole 
taxpayer, commissioners and providers 
patient pathway including with partners in 
should support the implementation of Better 
local government and Public Health England 
Procurement, Better Value, Better Care14. 
will contribute to improving outcomes and 
This is a procurement development 
spreading innovation and economic growth. 
programme which includes an ambitious 
A marker of quality within NHS organisations 
package of measures to help the NHS save 
is those with research activity able to 
£1.5 billion to £2 billion through improved 
demonstrate evidence of improved patient 
procurement whilst supporting economic 
outcomes and health service delivery. 
growth by improving access of opportunity 
Commissioners should actively seek out 
for small and medium enterprises and 
research opportunities, understand where 
ensuring the NHS is transparent in all its 
research is taking place within the providers 
commercial relationships and procurement 
with whom they contract and support that 
information.
activity wherever possible, through their commissioning decisions.
77.	
It is absolutely critical that all commissioners can demonstrate a systematic approach to 

## Value For Money, Effectiveness And Efficiency

securing value for money, so that our patients can be assured that the best 
74.	
Of course, all of this must be delivered 
possible quality of care is secured for every 
against the backdrop of ensuring that 
pound spent on their behalf.
patients and citizens get the very best out of every pound that is spent and that all parts 
81.	
It is now for local communities and all those who commission or deliver care to them to 

## Leading The Way Through Commissioning

create the robust plans which will be their roadmap to better outcomes for their citizens. 
78.	
Last year's guidance identified stronger 
CCGs as the local leaders of health 
commissioning as a key theme for driving 
commissioning will take the lead in working 
change. This section has set out those 
with all key stakeholders, especially Local 
things which local commissioners need to 
Authorities, to develop those plans. NHS 
include in their plans which will deliver the 
England will be alongside them in this 
change they want to see. CCGs and NHS 
planning as co-commissioners and in 
England, supported by CSUs, must work as 
providing support and oversight. Health and 
a coordinated whole and with other non-NHS 
Wellbeing Boards will be a key forum for 
commissioners of care.
agreeing plans with all stakeholders and accounting to the local community that these 
79.	
Our commitment to clinical commissioning 
plans meet their needs and are delivered. 
remains strong, ensuring that commissioning 
In some instances, CCGs will work together to 
decisions are firmly based on clinicians' 
create a bigger footprint as their unit of 
close relationships with their patients and 
planning. In all instances, CCGs will need to 
their understanding of clinical processes.
work with their neighbours to ensure that each plan demonstrates how services delivered 
80.	
In this first section of the document we have:
across a broader geography, such as 
●
●
reiterated the five domains of the 
ambulance services or specialised services, 
outcomes we want to deliver for our 
are commissioned and delivered consistently 
patients;
and cohesively. They will need to demonstrate how they deliver all the aspects of the 
●
●
translated those into a set of practical 
government's mandate to the commissioning 
measurable ambitions which describe 
system. They will need to take account of 
the progress we want to see in delivering 
NHS England's ambitions and steers on 
the outcomes;
strategic approach. They will need to include 
●
●
identified a further three measures which 
their own ambitions for the things their citizens 
it is vital that we deliver;
tell them will meet their needs.
●
●
signalled six patterns of service, emerging from our early Call to Action 
82.	
This approach will allow us to articulate and 
work, which we believe will be necessary 
quantify what we are aiming to achieve for 
to deliver the transformation we need; 
the patients and communities we serve, both 
and
locally and nationally. The scale of our 
●
●
identified four essential elements for the 
ambitions will be determined by how bold 
delivery of services.
we, and the communities we serve, are prepared to be and by how well we collaborate with partner organisations, particularly local government and the 
town (see section 2 paragraph 41). The two voluntary and community sector. Outcomes year operational plans and the local based commissioning is now fundamental to approach to the Better Care Fund will need our approach and will maximise health gain to demonstrate how they are driven by the for the citizens of England and value for strategic plan.

money for taxpayers.

83.	
Plans must be owned locally and driven by 
85.	
Part 2 also identifies the comprehensive 
local needs. Unlike previous years, this 
range of support which is on offer.
document is not prescriptive in how CCGs achieve this ambition, nor does it attempt to 
86.	
Nationally, NHS England will organise and 
apportion to individual CCGs specific targets 
prioritise our work to support a move in this 
across a host of areas where our collective 
strategic direction. There is an important set 
action will need to deliver and exceed the 
of changes in day to day practice which 

government's mandate. It makes the 
will support these patterns of care, as well as 

assumption that individual patches will want 
a set of enablers we need to develop 
to go even further in delivering the best for 
nationally to give local systems the freedom 
their citizens. NHS England does, however, 
to innovate. As the Call to Action work draws 
have a key role in assuring that all plans are 
to a conclusion in the spring/early summer 
sufficiently robust, that they will collectively 
2014, we shall be working with national 
deliver our commitments and that all citizens 
health and local government partners to 
across England are supported by equally 
identify the further financial, regulatory, 
high quality services. We also need to make 
leadership and workforce development 
sure the commissioning system is effective 
enablers which will accelerate the move 
and efficient and that local flexibility does not 
towards high quality, sustainable health and 
translate into inefficiency or duplicated effort.
care systems across the country.
84.	
Part 2 of this guidance sets out in greater 
87.	
We expect the strategic vision work locally to 
detail our expectations of these plans, but 
be open and inclusive, involving patients, 
most importantly it creates the framework for 
citizens and providers as well as 
planning which will help everyone to deliver. 
commissioning partners on Health and 
We expect each local system to use this 
Wellbeing Boards. We will harness the very 
framework and the associated tools to make best of what new technologies and new the right changes happen. The five year ways of working now offer to the changing strategic plans are the starting point for the needs of local populations and groups, whole planning process. Each strategic plan relentlessly focusing on improving outcomes. 

needs to be tested against the six In every part of the country this will be characteristics of a sustainable health and brought together into a compelling care system, ensuring that it reflects the description of the local care delivery system needs of local citizens, the conclusions of that local health and social care communities local Call to Action conversations and want to build, underpinned by a clear and insights from modelling tools such as Any credible local plan to get there.

## Part 2: How We Are Going To Achieve These Ambitions

1.	
Part 2 of this guidance is structured to provide an overview of the planning process and details of the plans which need to be produced. It comprises four sections:

## The Strategic And Operational Planning Process

●
●
The Strategic and Operational Planning process - provides an overview of the fundamental planning considerations for 

## A New Approach To Planning

all plans, describes how plans will be submitted and assured and provides an 
2.	
NHS planning has in the past been 
overview of the support available for the 
successful in supporting the delivery of 
process.
annual incremental improvement. However, 
the NHS is facing an unprecedented 
●
●
Strategic, Operational and Financial 
challenge. We are committed to transforming 
Planning - provides a high level 
outcomes for patients and to playing our role 
overview of the structure and 
in minimising inequalities within and between 
requirements of the 3 plans, sets out the 
communities. *A Call to Action* forecasts a 
financial allocations and core financial 
financial gap of around £30 billion by 
planning assumptions and outlines the 
2020/21, and the affordability challenges in 
related strategic enablers.
2014/15 and 2015/16 are real and urgent.
●
●
Direct Commissioning - provides an overview of planning for direct 
3.	
Therefore, we now need to take a longer 
commissioning and the associated 
term view of the planning of services to 
financial planning assumptions.
reflect the step changes required to 
●
●
Better Care Fund - provides an 
tackle these unprecedented challenges. 
overview of Better Care Fund planning and the funding for integrated care.
26
The planning process has changed to address this:

●
●
Stretching local ambitions for outcomes should be developed against each of the outcomes ambitions set out in Part 1 paragraph 10 of this guidance, along with credible and costed plans to deliver them.
●
●
Through this guidance we are setting out a challenge for commissioners to plan for the transformation of services on a five year basis. Each commissioner's five year plan must drive its decisions to ensure its providers are best placed to deliver high quality and sustainable services for patients, and in particular we would expect to see alignment with the six service models outlined in Part 1.
●
●
Each five year plan should include the first two years of operational delivery in detail so that patients, their carers and other key stakeholders can be satisfied 

## How Could This Planning Process Look Different?

that progress is being made against the longer term goals and the service transformation needed to realise them.

●
●
As set out in Part 1 paragraph 18, plans must be explicit in dealing with the financial gap and contain appropriate risk and mitigation strategies.
●
●
The planning process and timeline have been aligned with our national partners, including NHS commissioners, Monitor, the NHS Trust Development Authority, the Local Government Association and Health Education England.
●
●
In addition to completing a complete set of plans for their own organisation, CCGs have been asked to choose their own footprint for strategic health and social care planning. This may involve working as part of a larger 'Unit of Planning' to enable wider issues which affect more than one commissioner to be dealt with at scale.
●
●
a stratified support programme has been 
6.	
Either through submission of the planning 
put in place to support the new planning 
templates or separately, each strategic and 
process.
operational plan must explicitly set out in detail the approach to delivering the fundamentals set out in the table opposite, 
4.	
Both short-term transactional change and 
the five year ambition and the plans for the 
long-term transformation need to be guided 
first two years to move towards the longby an explicit model of change and to be 
term ambition. 
supported by a strong research and evidence base. The NHS Change Model15 has been created to support the NHS to 

## Improving Outcomes

adopt a shared approach to leading change and transformation. Developed with 
7.	
Part 1 paragraph 10 of this guidance sets 
hundreds of our senior leaders, clinicians, 
out our seven ambitions which the NHS is 
commissioners, providers and improvement 
striving to achieve for the people of England.
activists and supported by a robust evidence base, the NHS Change Model brings 
8.	
The seven outcomes ambitions are set out in 
together collective improvement knowledge 
Annex A of this document, together with the 
and experience from across the NHS. 
measures that CCGs should use in planning. 
Application of the eight components of 

NHS England Area Teams should use the 
change brings together improvement in a 

same measures, where relevant to their 
systematic and sustainable way, and we 

commissioning responsibilities, with further 
would expect to see this approach reflected 

measures also included in Annexes D-G of 
in local strategic and operational plans.

this guidance. 

## Planning Fundamentals Joint Working And Involvement

5.	
Strategic and operational plans must be 
9.	
NHS England is working closely with Monitor 
explicit in dealing with local ambitions for 
and the NHS Trust Development Authority to 
outcomes within funding available. They 
ensure plans are sustainable and deliverable 
should also be developed based on some 
across commissioning and provision in local 
fundamental planning principles. Plans 
health economies. For plans to be 
should be:
deliverable, we are committed to ensuring 
●
●
bold and ambitious;
that one organisation's plan does not put 
●
●
developed in partnership with providers 
another's at risk or generate behaviours that 
and Local Authorities; and
work against patients' interests. 
●
●
locally led.

| Fundamental                      | Key features to be demonstrated in plans   |
|----------------------------------|--------------------------------------------|
| Delivery across the five         |                                            |
| 1                                | domains and seven outcome                  |
| measures                         |                                            |
| 2                                | Improving health                           |
| Outcomes                         |                                            |
| 3                                | Reducing health inequalities               |
| 4                                | Parity of esteem                           |
| New approach to ensuring         |                                            |
| that citizens are fully included |                                            |
| in all aspects of service        |                                            |
| 5                                |                                            |
| Patient                          |                                            |
| services                         |                                            |
| design and change and that       |                                            |
| patients are fully empowered     |                                            |
| in their own care                |                                            |
| -                                              | -   |
|------------------------------------------------|-----|
| your understanding of your current position    |     |
| on outcomes as set out in the NHS              |     |
| Outcomes Framework                             |     |
| -                                              | -   |
| the actions you need to take to improve        |     |
| outcomes                                       |     |
| -                                              | -   |
| working with H&WB partners, your planned       |     |
| outcomes from taking the 5 steps               |     |
| recommended in the "commissioning for          |     |
| prevention" report                             |     |
| -                                              | -   |
| identification of the groups of people in your |     |
| area that have a worse outcomes and            |     |
| experience of care and your plans to close     |     |
| the gap                                        |     |
| -                                              | -   |
| implementation of the 5 most cost effective    |     |
| high impact interventions recommended by       |     |
| the NAO report on health inequalities          |     |
| -                                              | -   |
| implementing EDS2                              |     |
| -                                              | -   |
| the resources you are allocating to mental     |     |
| health to achieve parity of esteem             |     |
| -                                              | -   |
| identification and support for young people    |     |
| with mental health problems                    |     |
| -                                              | -   |
| plans to reduce the 20 year gap in life        |     |
| expectancy for people with severe mental       |     |
| illness                                        |     |
| -                                              | -   |
| how you will commission services so that       |     |
| patients and citizens have the opportunity     |     |
| to take control                                |     |
| -                                              | -   |
| how you will put real time patient and         |     |
| citizen voice at the heart of decision making  |     |
| -                                              | -   |
| how you will include authentic citizen         |     |
| participation in the design of your plans      |     |
| -                                              | -   |
| how you will promote transparency in local     |     |
| health services                                |     |

## Fundamental Key Features To Be Demonstrated In Plans

Wider primary care, provided 
6
at scale
7
A modern model of integrated 
care
Patient 
services 
(continued)
8
Access to the highest quality 
urgent and emergency care
9
A step-change in the 
productivity of elective care
| -                                             | -       |
|-----------------------------------------------|---------|
| your understanding of  the potential          |         |
| contribution of primary care to delivery of   |         |
| your ambition                                 |         |
| -                                             | -       |
| working with partners and the public to       |         |
| develop an integrated approach to primary     |         |
| and community services, with joint            |         |
| commissioning as appropriate                  |         |
| -                                             | -       |
| how you will enable primary care to operate   |         |
| at greater scale to improve access and        |         |
| continuity of care and to enable your urgent  |         |
| and emergency care network to function        |         |
| effectively                                   |         |
| -                                             | -       |
| what you are doing to ensure people with      |         |
| multiple long-term conditions and clinical    |         |
| risk factors are offered a fully integrated   |         |
| experience of support and care                |         |
| -                                             | -       |
| how your strategic plan is in line with the   |         |
| vision set out in the Urgent and Emergency    |         |
| Care Review Phase One Report                  | http:// |
| www.nhs.uk/NHSEngland/keogh-review/           |         |
| Documents/UECR.Ph1Report.FV.pdf               |         |
| -                                             | -       |
| how you will you be ready to determine the    |         |
| footprint of your urgent and emergency        |         |
| care network during 2014/15, working with     |         |
| key partners and informed by a detailed       |         |
| understanding for your area of:               |         |
| a)	patient flows;                                               |         |
| b)	the number and location of emergency                                               |         |
| and urgent care facilities;                   |         |
| c)	 the services they provide; and                                               |         |
| d)	the most pressing needs for your                                               |         |
| population                                    |         |
| -                                             | -       |
| how you will be ready in 2015/16 to begin     |         |
| the process of designation for all facilities |         |
| within your network                           |         |
| -                                             | -       |
| how you have considered your model of         |         |
| elective care for your local providers to     |         |
| achieve a 20% productivity improvement        |         |
| within 5 years, so that existing activity     |         |
| levels can be delivered with better           |         |
| outcomes and 20% less resource                |         |

## Fundamental Key Features To Be Demonstrated In Plans

Patient 
Specialised services 
10
services 
concentrated in centres of 
(continued)
excellence.
Convenient access for 
11
everyone
Access
12
Meeting the NHS Constitution 
standards
Response to Francis, Berwick 
13
and Winterbourne View
Quality
14
Patient safety
| -                                             | -   |
|-----------------------------------------------|-----|
| how your strategic plans address whether      |     |
| your providers are seeing and treating a      |     |
| sufficiently high enough volume of patients   |     |
| to meet specified clinical standards, in line |     |
| with the need to concentrate specialised      |     |
| services in 15-30 centres of excellence,      |     |
| linked to Academic Health Science             |     |
| Networks                                      |     |
| -                                             | -   |
| how your plans are ensuring that              |     |
| specialised services in your area are         |     |
| connecting actively to and maximising the     |     |
| opportunities of working with research and    |     |
| teaching                                      |     |
| -                                             | -   |
| how you will deliver good access to the full  |     |
| range of services, including general          |     |
| practice and community services,              |     |
| especially mental health services in a way    |     |
| which is timely, convenient and specifically  |     |
| tailored to minority groups                   |     |
| -                                             | -   |
| that your plans include commissioning         |     |
| sufficient services to deliver the NHS        |     |
| Constitution rights and pledges for patients  |     |
| on access to treatment as set out in Annex    |     |
| B and how they will be maintained during      |     |
| busy periods                                  |     |
| -                                             | -   |
| how your plans will reflect the key findings  |     |
| of the Francis, Berwick and Winterbourne      |     |
| View Reports                                  |     |
| -                                             | -   |
| how you will address the need to              |     |
| understand and measure the harm that can      |     |
| occur in healthcare services, to support the  |     |
| development of capacity and capability in     |     |
| patient safety improvement                    |     |
| -                                             | -   |
| how you will increase the reporting of harm   |     |
| to patients, particularly in primary care and |     |
| focused on learning and improvement           |     |

## Fundamental Key Features To Be Demonstrated In Plans

| 15          | Patient experience     |
|-------------|------------------------|
| 16          | Compassion in practice |
| Quality     |                        |
| (continued) |                        |
| 17          | Staff satisfaction     |
| 18          | Seven day services     |
| -                                                | -   |
|--------------------------------------------------|-----|
| how you will set measureable ambitions to        |     |
| reduce poor experience of inpatient care         |     |
| and poor experience in general practice          |     |
| -                                                | -   |
| how you will assess the quality of care          |     |
| experienced by vulnerable groups of              |     |
| patients and how and where experiences           |     |
| will be improved for those patients              |     |
| -                                                | -   |
| how you will demonstrate improvements            |     |
| from FFT complaints and other feedback           |     |
| -                                                | -   |
| how your plans will ensure that local            |     |
| provider plans are delivering against the six    |     |
| action areas of the Compassion in Practice       |     |
| implementation plans                             |     |
| -                                                | -   |
| how the 6Cs are being rolled out across all      |     |
| staff                                            |     |
| -                                                | -   |
| an in-depth understanding of the factors         |     |
| affecting staff satisfaction in the local health |     |
| economy and how staff satisfaction locally       |     |
| benchmarks against others                        |     |
| -                                                | -   |
| how your plans will ensure measureable           |     |
| improvements in staff experience in order        |     |
| to improve patient experience                    |     |
| -                                                | -   |
| that the action plans submitted by your          |     |
| providers (a requirement within the Service      |     |
| Development and Improvement Plan                 |     |
| section of the NHS Standard Contract) give       |     |
| you confidence that they will be able to         |     |
| comply with all ten of the Seven Day             |     |
| Service Clinical Standards by 2016/17            |     |
| -                                                | -   |
| if not, how your strategic and operational       |     |
| plans are going to ensure these standards        |     |
| are being met for patients                       |     |
| -                                                | -   |
| how your strategic plans are addressing          |     |
| the need to provide consistently high            |     |
| quality urgent and emergency care services       |     |
| outside of hospital across the seven day         |     |
| week                                             |     |

## Fundamental Key Features To Be Demonstrated In Plans

|                                  | 19         | Safeguarding            |
|----------------------------------|------------|-------------------------|
| 20                               | Innovation | Research and innovation |
| Financial resilience; delivering |            |                         |
| 21                               |            |                         |
| Delivering                       |            |                         |
| value for money for taxpayers    |            |                         |
| value                            |            |                         |
| and patients and procurement     |            |                         |
| -                                           | -   |
|---------------------------------------------|-----|
| how your plans will meet the requirements   |     |
| of the accountability and assurance         |     |
| framework for protecting vulnerable people  |     |
| -                                           | -   |
| the support for quality improvement in      |     |
| application of the Mental Capacity Act      |     |
| -                                           | -   |
| how you will measure the requirements set   |     |
| out in your plans in order to meet the      |     |
| standards in the prevent agenda             |     |
| -                                           | -   |
| how your plans fulfil your statutory        |     |
| responsibilities to support research        |     |
| -                                           | -   |
| how you will use Academic Health Science    |     |
| Networks to promote research                |     |
| -                                           | -   |
| how you will adopt innovative approaches    |     |
| using the delivery agenda set out in        |     |
| Innovation Health and Wealth: accelerating  |     |
| adoption and diffusion in the NHS           |     |
| -                                           | -   |
| meeting the business rules on financial     |     |
| plans including surplus, contingency and    |     |
| non-recurrent expenditure.                  |     |
| -                                           | -   |
| clear and credible plans for QIPP that meet |     |
| the efficiency challenge and are evidence   |     |
| based, including reference to benchmarks    |     |
| -                                           | -   |
| the clear link between service plans,       |     |
| financial and activity plans                |     |

10.	
Plans need to reflect local priorities, as 
13.	
Where CCGs choose to associate to form a 
determined by each Health and Wellbeing 
'Unit of Planning' they should consider the 
Strategy, with the assumption that local 
following principles:
discussions will resolve any differences. 
●
●
each CCG to belong to one unit only;
We expect commissioners and providers to 
●
●
the Unit has been locally agreed and 
cooperate in planning, and to be able to 
has clear clinical ownership and 
explain any differences in their assumptions. 
leadership;
The assurance processes described later in 
●
●
it is based on existing health economies 
this section will have a particular focus on 
that reflect patient flows across Health 
localities where there are significant 
and Wellbeing Board areas and local 
differences in plans.
provider footprints with no CCG to be split across boundaries;
11.	
A Call to Action has reinforced the need for 
●
●
it has sufficient scale to deliver 
active and on-going participation with local 
geography wide clinical improvements;
communities and the people within them. 
●
●
it enables the pooling of resources to 
These participation activities need to be 
reduce the risk associated with large 
extensive, rigorous and demonstrably central 
investments;
to every five year strategic plan. 
●
●
it does not cut across existing locally agreed collaboration agreements; 
●
●
engagement has been secured from 

## Aligned Planning Across Health Economies

Local Authorities; and
●
●
engagement has been secured from the 
12.	
Each CCG is accountable for developing a 
Local Education and Training Board 
Strategic, Operational and Financial plan. 
(LETB).
To enable wider and more strategic health economy planning, all CCGs will work in close 
14.	
The diagram below demonstrates the 
collaboration with relevant Area Teams, 
potential components of a Unit of Planning.
providers and Local Authorities and where appropriate they may also choose to join with 
15.	
Commissioner plans need to be submitted 
neighbouring CCGs in a larger 'Unit of 
on the templates issued alongside this 
Planning' to aggregate plans, ensure that the 
guidance. There are five templates:
strategies align in a holistic way and maximise 
●
●
Strategic plan; 
the value for money from the planning resources and support at their disposal. 
●
●
●
Financial plan;
●
●
Direct Commissioning plan; and
●
●
Better Care Fund.
16.	
Broader strategic plans constructed by Units of Planning will be a consolidation of individual organisations' strategic plans.
17.	
The Better Care Fund plan is developed at Health and Wellbeing Board level. This will mean that in some cases more than one CCG will be involved in the development of this plan.
18.	
Further details on plans for the Better Care Fund are included in Annex I of this guidance.
21.	
The CCG Outcomes Indicators Set16 (CCG 
OIS) should be used by CCGs as a tool to 
19.	
NHS England's plans for directly 
understand trends in outcomes and to help 
commissioned services may not always fit 
them identify potential priorities for 
neatly to a single Unit of Planning, so Area 
improvement and for inclusion in plans. Not 
Teams will ensure their plans dovetail into all 
all outcomes will be relevant for every plan. 
relevant Units of Planning. Similarly, on 
CCGs and NHS England may wish to refer 
some occasions a provider's plan may need 
to indicators in the CCG OIS to help them 
to be reflected in more than one Unit of 
gain a rounded picture of local outcomes as 
Planning, and when that happens, 
part of the assurance process.
commissioners need to be satisfied that they are sighted on the totality of the Trust's plan.
22.	
NHS England will look to ensure that plans are consistent across primary, secondary and specialist care (i.e. that CCG and Area 

## Balancing Plans

Team plans are aligned). We will work with Monitor and the NHS Trust Development 
20.	
It is important that plans are balanced and 
Authority to develop a shared view about the 
aligned across the respective strategic, 
recovery action that might be required where 
operational and financial elements 
health economies are demonstrating 
illustrated below.
pressure to such an extent that the quality of services provided to patients may be at risk of deterioration.
23.	
The operational plans must demonstrate that the strategic plan is the driving force behind transformational change. The operational plans should contain outcomes and relevant local metrics which show the journey towards the tangible achievement of the overarching strategy.

## Planning Timetable

24.	
This guidance is issued at the same time as our allocations to commissioners. The planning timetable is detailed in the table opposite. It will be challenging for everyone; but it is important that we lay strong foundations for delivery during what will be a testing time for all NHS organisations.
25.	
We will work closely with Monitor, NHS Trust Development Authority and Health Education England throughout this process to provide feedback to CCGs and providers and to ensure alignment and deliverability. This will be an iterative process as providers respond to commissioner plans.

| Activity                    | Deadline         |
|-----------------------------|------------------|
| First submission of plans   | 14 February 2014 |
| Contracts signed            | 28 February 2014 |
| Refresh of plan post        |                  |
| contract sign off           |                  |
| 5 March 2014                |                  |
| Reconciliation process with |                  |
| NHS TDA and Monitor         |                  |
| From 5 March 2014           |                  |
| Plans approved by Boards    | 31 March 2014    |
| Submission of final 2 year  |                  |
| operational plans and draft | 4 April 2014     |
| 5 year strategic plan       |                  |
| Submission of final 5 year  |                  |
| strategic plans             |                  |
| Years 1 & 2 of the 5 year   |                  |
| 20 June 2014                |                  |
| plan will be fixed per the  |                  |
| final plan submitted on 4   |                  |
| April 2014                  |                  |

## Plan Submission

26.	
The diagram below illustrates the submission process.
27.	
The central email address for strategic and 
●
●
Boards and governing bodies should 
financial plan submission is: 

satisfy themselves that the outcomes or 
NHSCB.financialperformance@nhs.net
recommendations of the plan assurance process have been appropriately addressed prior to plan sign off.

## Assurance Of Plans

30.	
The lead responsibilities for plan production 
28.	
Plan assurance will address the scale of 
and assurance are shown in the following 
ambition and plans for implementation of the 
table.
planning fundamentals set out in paragraph 6 of Part 2 of this guidance, in the two and 
31.	
The NHS England national support centre 
five year time horizons. 
will support regions and areas throughout the process, providing challenge and advice 
29.	
To maximise opportunities for mutual 
through a series of risk-based checkpoint 
assurance across all health and social care 
meetings.
services and minimise complexity, we will adopt the following principles for the 
32.	
The review and triangulation of plans will 
assurance process:
include:
●
●
Assurance of the overall strategic plan 
●
●
the finances to secure delivery of the 
will be at Unit of Planning level, including 
output objectives and adherence to the 
engagement with patients and public in 
requirements outlined in the planning 
the local community; 
guidance;
●
●
Operational plans will be assured at 
●
●
ensuring the finance and activity 
CCG and at Health and Wellbeing Board 
projections are supported by reasonable 
level, and at Area Team level for NHS 
and deliverable planning assumptions 
England's directly commissioned 
including level of assumed QIPP delivery 
services;
and underlying activity growth;
●
●
Area Teams to lead the assurance of 
●
●
triangulation of finance and activity; 
CCG plans; 
●
●
coherence with the other planning and 
●
●
Regional Teams manage the assurance 
output assumptions; and 
of Direct Commissioning plans;
●
●
testing the strength of local relationships, 
●
●
Area Teams to assure the overall 
which are key to ensuring delivery. 
consolidated commissioning position and strength of local partnerships;
●
●
Area Teams and CCGs to ensure mutual assurance of Direct Commissioning plans, with escalation by exception; and

| Plan                            | Produced by…     |
|---------------------------------|------------------|
| Responsible                     |                  |
| for driving                     |                  |
| development,                    |                  |
| Contribute to plan development  |                  |
| completing &                    |                  |
| submitting plan                 |                  |
| -                               | -                |
| Patients & carers               |                  |
| -                               | -                |
| Healthwatch                     |                  |
| -                               | -                |
| CCG                             |                  |
| -                               | -                |
| Provider                        |                  |
| -                               | -                |
| HWB                             |                  |
| Strategic                       | Unit of Planning |
| -                               | -                |
| Local Authority                 |                  |
| -                               | -                |
| NHS England Area Team           |                  |
| -                               | -                |
| Health Education England        |                  |
| -                               | -                |
| Local Education and Training    |                  |
| Board (LETB)                    |                  |
| -                               | -                |
| Provider                        |                  |
| -                               | -                |
| Local Authority (contracts with |                  |
| Operational                     | CCG              |
| community/social care           |                  |
| providers)                      |                  |
| -                               | -                |
| Provider                        |                  |
| -                               | -                |
| Local Authority (contracts with |                  |
| Financial                       | CCG              |
| community/social care           |                  |
| providers)                      |                  |
| Responsible for ensuring        |                  |
| Responsible for providing       |                  |
| that their work triangulates    |                  |
| formal assurance of plan        |                  |
| with plan                       |                  |
| -                               | -                |
| CCG                             |                  |
| -                               | -                |
| Provider                        |                  |
| -                               | -                |
| HWB                             |                  |
| NHS England Regional Team       |                  |
| -                               | -                |
| Local Authority                 |                  |
| -                               | -                |
| Area Teams                      |                  |
| -                               | -                |
| Provider                        |                  |
| -                               | -                |
| HWB                             |                  |
| NHS England Area Team           |                  |
| -                               | -                |
| Local Authority                 |                  |
| -                               | -                |
| Unit of Planning                |                  |
| -                               | -                |
| Provider                        |                  |
| -                               | -                |
| HWB                             |                  |
| NHS England Area Team           |                  |
| -                               | -                |
| Local Authority                 |                  |
| -                |
|------------------|
| Unit of Planning |
| Plan                           | Produced by…   |
|--------------------------------|----------------|
| Responsible                    |                |
| for driving                    |                |
| development,                   |                |
| Contribute to plan development |                |
| completing &                   |                |
| submitting plan                |                |
| -                              | -              |
| CCG                            |                |
| Provider                       | Provider       |
| -                              | -              |
| Local Authority (depending on  |                |
| provider type)                 |                |
| -                              | -              |
| Patients and carers            |                |
| -                              | -              |
| Healthwatch                    |                |
| -                              | -              |
| Local Authority                |                |
| Better Care                    |                |
| Fund                           |                |
| HWB                            |                |
| -                              | -              |
| NHS England Area Teams         |                |
| -                              | -              |
| PHE                            |                |
| -                              | -              |
| Monitor                        |                |
| -                              | -              |
| NTDA                           |                |
| -                              | -              |
| NHS England Regional Team      |                |
| Direct                         | NHS England    |
| Commissioning                  | Area Team      |
| -                              | -              |
| Provider                       |                |
Responsible for ensuring 
Responsible for providing 
that their work triangulates 
formal assurance of plan
with plan
●
●
CCG
●
●
HWB
Monitor
●
●
Local Authority
NHS Trust Development 
Authority
●
●
NHS England Area Teams 
●
●
Unit of Planning
Ministers
●
●
CCGs
HWB
●
●
Provider
NHS England Area Team
●
●
Units of Planning
| -                         | -   |
|---------------------------|-----|
| Provider                  |     |
| NHS England Regional Team |     |
| -                         | -   |
| CCG                       |     |

36.	
The support programme includes:

## On-Going Assurance

●
●
universal, nationally developed tools, including information packs, exemplars 
33.	
NHS England has published assurance 
and Strategic Planning Workshops that 
frameworks for both CCGs17 and our direct 
will bring together local partners to 
commissioning18 functions. These are 
support them in agreeing their approach 
integral to our approach to assurance of 
and priorities in developing and 
plans. In line with the principles set out in the 
delivering aligned strategic plans;
assurance frameworks, discussions will take 
●
●
bespoke support based around ten key 
place on the basis of six consistent 
specifications;
assurance domains.
●
●
an intensive support package for 
34.	
Assurance will be informed by robust and 
economies with deep financial and/or 
diverse sources of evidence, underpinned by 
quality issues, developed and owned 
a developmental and supportive approach. 
jointly by NHS England, NHS Trust 
Where delivery concerns are identified, 
Development Authority, Monitor and the 
improvement actions will be agreed. NHS 
Local Government Association; and
England has broad powers available through 
●
●
support to a number of Health and 
legislation to ensure that these 
Wellbeing Boards aligned and 
improvements are made. This guidance sets 
interwoven across both the universal 
out the expectations for NHS 
and bespoke elements of support.
commissioners, and the assurance process will be an important way of ensuring that 
37.	
The diagram that follows shows the support 
both NHS England and CCGs are mutually 
package which will be made available to 
accountable for delivering the improvements 
support the planning process.
we want to see delivered.

## Overview Of Planning Support

35.	
The support package that we will provide puts these requirements at the centre of the development and delivery of five year strategic plans. It has been developed in consultation with commissioners in CCGs and Area Teams and will be made available for commissioners to draw on where needed. A detailed communication on support will be published by the end of December. 
What support will be made available?  
to make certain that public participation 

## Universal Support Package

reaches all parts of local communities. There should be particular focus on 

38.	
The universal support package, available to 
seeking and achieving input from 

all commissioners, will include: 
communities which have traditionally not provided sufficient input into NHS 

●
●
Practical support on participation 
decision-making. 

- Our interactive web based Transforming Participation in Health and 
●
●
Any town health system and Better 
Care tool already provides advice, good 
Care Fund models - To support CCGs 
practice, evidence and case studies on 
in preparing plans, the Any town health 
approaches to good public participation. 
system model will be published in 
This will be supplemented by resources 
January. The Better Care Fund 
that will be made available through 
modelling tool enables HWBs to model 
Commissioning Support Units (CSU) 
high level integration interventions. 
aimed at engaging local communities in developing and commissioning services 
●
●
Data packages - data and analysis 
that meet their needs, and using insight 
packs showing the local opportunities for 
and market research techniques to 
improvement and relative performance 
better understand those needs. The 
e.g. Commissioning for Value packs 
expectation is that local and regional 
released in October.
voluntary sector organisations will work 
●
●
Strategic planning workshops - Local 
workshops designed to kick-start the planning process and build local relationships to create a joint vision and prepare for planning submissions. 
They will provide practical and technical advice about translating a strategy into a financial and operating plan and will support joint ways of working through advice on creating local governance arrangements aimed at galvanising action and initiating stakeholder discussions.
●
●
Learning collaborative - This will 
support the spread and adoption of learning, best practice and technical expertise. We are planning to create a programme of webinars and learning events on key topics across three broad areas; best practice sharing; thought leadership; and support for the technical aspects of planning and delivery.

## Tailored Local Support To Meet Local Challenges

39.	
The local support offer will be available to CCGs, Area Teams and Units of Planning that would benefit from additional more bespoke support in key areas. 
40.	
Ten different specifications have been identified, which relate to the three main areas of planning activity: building a shared vision for health and social care across multiple partners in the Unit of Planning; development of plans which deliver that vision; and implementation of plans. These are shown in the following diagram.

## Any Town Health System

41.	
The Any town health system model is a resource designed to help local areas identify potential improvements to service delivery, and enable them to understand what the quality and financial impacts of those improvements may be. The tool provides case studies and analysis of a number of interventions that could be applied in a local health economy to achieve improved clinical outcomes and financial performance. It shows how a typical CCG could achieve financial balance over the strategic period covered.

## Any Town

42.	
A number of 'High Impact Interventions' have been fully impact assessed and included in the report. Twelve 'Early Adopter Interventions' are also included; these have not been impact assessed to the same specification as the 'High Impact Interventions', but are innovative, cutting edge ideas which may be promising. 
43.	
To help understand the impact different interventions will have in different settings, three scenarios have been created: Urban CCG, Suburban CCG and Rural CCG. There is a version of Any town for each scenario CCG. Local areas are, therefore, able to understand how each intervention might affect performance in an area that is demographically similar to their own. 

## 1 Strategic, Operational And Financial Planning Strategic Plan Overview Operational Plan Overview

44.	
Each strategic plan needs to have the 
49.	
The operational plan will include the key 
ownership and buy-in of the whole local 
operational metrics needed to support the 
health economy and reflect a joint vision for 
assurance of, and measure performance 
the area, including the road map required to 
against, strategic plans. The plan will be 
attain this. All organisations should be 
structured around the four headings:
satisfied that the plan will support the 
●
●
Outcomes;
delivery of improvements for patients and 
●
●
NHS Constitution;
service users. The plan should be short and 
●
●
Activity; and
focused, and it should describe to those 
●
●
Better Care Fund.
outside the system what the system plans to achieve in a way that informs and engages. 
50.	
Details regarding the content of the Operational Plan template can be found 
45.	
It is essential for these plans to be at the 
in Annex J.
forefront of the planning process; they set the vision, ambitions and framework against 

## Financial Plan Overview

which operational and financial planning will be determined. 
51.	
The financial plan will provide the detailed 
46.	
Plans should be clear on proposed future 
financial breakdown of each plan. It will 
activity levels, referenced to historical trends 
include the key financial metrics to support 
and future service proposals. The plans 
the assurance of, and measure performance 
must demonstrate a clear link between 
against, strategic plans. It will require 
activity and finances. 
information under the following headings: 
●
●
Revenue resource limit;
47.	
The strategic plan will require the creation 
●
●
Planning assumptions;
of a:
●
●
Financial plan detail 14/15-18/19;
●
●
System narrative 'plan on a page'; and
●
●
QIPP 14/15-18/19;
●
●
Organisation specific key highlights.
●
●
Risk;
●
●
Investment;
48.	
Details regarding the content of the Strategic 
●
●
Statement of financial position;
Plan template can be found in Annex J.
●
●
Cash;
●
●
Capital; and
●
●
Contract value 14/15-18/19.
NHS England in public health will be 

52.	
Details regarding the content of the Financial 
budgeted on a programme basis.

Plan template can be found in Annex J.
56.	
The implication of the distribution of resources is a differing level of efficiency 

## Financial Allocations And The Efficiency Challenge

challenge in 2014/15 and 2015/16 by commissioner. In 2014/15, specialised 
53.	
The 2014/15 and 2015/16 income allocated 
commissioning remains the area with the 
to CCGs and direct commissioning has been 
most challenging efficiency requirement. In 
published alongside this guidance. 
2015/16, with the introduction of the Better Care Fund, CCGs face a more significant 
54.	
The funding objectives contained within the 
efficiency challenge. Over the two years the 
mandate require NHS England to run a 
efficiency challenge for both CCGs and 
transparent allocation process to ensure 
specialised commissioning is similar at 
"equal access for equal need". The 2012 
approximately 9 per cent, including the 
Health & Social Care Act also requires NHS 
provider efficiency deflator. 
England to have regard to reducing inequalities in access to and outcomes from 
57.	
To support commissioners to manage this 
healthcare. Consequently, the intention is to 
challenge over the two year period we 
implement an approach to allocation of 
propose to prioritise access to drawdown of 
funding that has regard for population on a 
surpluses from prior years for specialist 
per capita basis and takes into account both 
commissioning in the first year and CCGs in 
inequalities and the impact of an ageing 
the second year.
population on demand for healthcare.
58.	
For 2016/17 to 2018/19 commissioners as a 
55.	
For CCGs, NHS England has adopted a 
whole should assume a continuity of the 
revised funding formula recommended by 
current allocations policy, although no 
the Advisory Committee on Resource 
decisions on allocations beyond 2015/16 
Allocation. For direct commissioners of 
have yet been taken. For subsequent years, 
primary care, NHS England is adopting a 
commissioners should assume that income 
new funding formula which aims to allocate 
growth increases in line with the GDP 
primary care funding based on need. 
deflator. 
Adjustments are made to both formulae to reflect the need to address unmet or 

| 2016/17   | 2017/18   | 2018/19   |
|-----------|-----------|-----------|

inappropriately met need, particularly 
relating to our most deprived communities. 

| 1.8%   | 1.7%   | 1.7%   |
|--------|--------|--------|

Funds for specialised commissioning, health and justice and armed forces in 2014/15 and 

59.	
Continuity of the current policy would mean 
2015/16 will continue to be allocated on a 

that CCGs and primary care commissioners 
national basis and the investment made by 

would continue to move towards target on 
on 17 December 2013. The assumption that the basis of the trajectory set in 2014/15 and the planned 10 per cent reduction in overall 
2015/16. 

health sector administration costs in 2015/16 will be applied to CCGs and NHS England 

60.	
From 2014/15 commissioners will be 
will be confirmed in due course. For planning 

required to count the use of provisions as a 
purposes, commissioners should assume 

utilisation of their allocated resource, in line 
that the overall running cost envelope will 

with HM Treasury accounting rules. 
remain flat in cash terms for 2014/15 and reduce by 10 per cent in 2015/16. Individual 

## Programme And Administrative Costs

CCG running cost allocations will be adjusted to take into account population 

61.	
Income is allocated separately for 
change.  Commissioners should assume for 

programme and administrative costs. 
years 3 to 5 of the planning period that the 

Expenditure against these allocations will be 
overall running cost envelope remains flat in 

monitored separately. Commissioners are 
cash terms. As in 2014/15 and 2015/16, at 

asked to ensure that plans are in place to 
individual CCG level running costs in years 

ensure administrative costs are not 
3 to 5 will be adjusted to take into account 

overspent. Underspends on administrative 
population change. These will be based on 

costs may be spent on programme costs. 
the latest available ONS population projections.  Running cost projections for the 

62.	
Overall running cost assumptions for the 
five year period for each CCG will be made 

commissioning sector were set out in the 
shortly available.

allocations paper to the NHS England Board 

CCGs
Demographic growth
Local determination using age profiled population projections.
Non-demographic growth
Local determination based on historic analysis and evidence.
Tariff changes
See below.
Price inflation - prescribing
Local determination - expected to be in a range of 4% to 7% per 
annum increase.
Price inflation - continuing 
Local determination - expected to be in a range of 2% to 5% per 
health care
annum increase.
2015/16-2018/19
2014/15
●
●
Minimum 0.5% contingency 
●
●
Minimum 0.5% contingency 
●
●
1% cumulative surplus carry forward
●
●
1% cumulative surplus carry forward
Business rules
●
●
1% non-recurrent spend
●
●
2.5% non-recurrent spend (including 1% for transformation).
●
●
Better Care Fund spend as notified separately.

67.	
For emergency admissions, commissioners 

## Financial Planning Assumptions

should budget for all admissions at 100 per cent of the tariff. They should only pay 30 
63.	
Published alongside this planning guidance 
per cent for emergency admissions over the 
is the Call to Action technical paper. This 
2008/9 baseline with the 70 per cent to be 
sets out the key financial and activity 
invested in relevant demand management 
assumptions that underpin the £30bn 
schemes. Full details of the operation of 
challenge which was published in July. This 
these rules are set out in the 2014/15 
guidance is based on additional work which 
National Tariff Payment System which can 
has been undertaken to develop these 
be found at: http://www.england.nhs.uk/
assumptions further.
resources/pay-syst/national-tariff/. Commissioners need to engage with 
64.	
The core financial planning assumptions for 
relevant providers with input from Urgent 
CCGs to use are shown in the table on the 
Care Working Groups when developing 
previous page. More detail is included in 
plans for the investment of the 70 per cent 
subsequent paragraphs. 
balance. These plans should be published on the commissioner's website and shared 
65.	
Surpluses and deficits accumulated at 
with all relevant stakeholders. The tariff 
31 March 2014 and subsequent years will be 
document also contains details of the 
carried forward into the following financial 
specific circumstances in which baselines 
years. Commissioners are asked to include 
should be adjusted, e.g. for service change.
proposals for access to historical surpluses, if required, in their plans. The plans will be 
68.	
NHS England and Monitor are currently 
assessed with reference to the impact on 
developing a medium term pricing strategy 
outcomes and subject to the maximum 
for 2015/16 and beyond. As set out in our 
drawdown available. The maximum 
joint consultation in May, we will be 
expected level of the national surplus 
considering how best to develop an 
drawdown will be finalised with the 
approach to pricing that supports improved 
Department of Health and HM Treasury. 
outcomes and in particular more integrated services for patients. As part of our work we 
66.	
The National Tariff for 2014/15 was 
will consider the case for implementing new 
published jointly by NHS England and 
currencies and contracting models, and 
Monitor on 17th December. The tariff prices 
whether a more segmented approach to 

are generally the 2013/14 prices rolled 
pricing is more appropriate. However, for the 

forward and adjusted for inflation and 
purposes of planning, commissioners should 

efficiency. The cost uplift for 2014/15 is 2.5 
assume continuity of current pricing policy. 

per cent and the efficiency requirement is 4 
Where appropriate, they should also 

per cent, giving an overall adjustment to tariff 
consider the scope to use the local 

prices of (1.5) per cent. This should be also 
flexibilities introduced in 2014/15, specifically 

the starting point for adjustments to the price 
regarding local pricing variations where they 

for services without a national price. 
are in the best interests of patients.

Tariff assumptions
FY 14/15
FY 15/16
FY 16/17
FY 17/18
FY 18/19
Secondary Care health cost 
inflation
2.3%
2.2%
3.0%
3.4%
3.4%
Provider sector efficiency
4.0%
4.0%
4.0%
4.0%
4.0%
Tariff uplift
-1.7%
-1.8%
-1.0%
-0.6%
-0.6%

69.	
Commissioners should plan on the basis that the underlying level of provider efficiency remains in the 2 to 2.5 per cent range over the five year period. To support delivery of this range, for planning purposes, commissioners should assume that the efficiency factor in tariff remains at 4 per cent. The difference is currently referred to as "leakage" which we believe is the result of some providers and commissioners working together to balance budgets without delivering the full headline level of real efficiency improvement. NHS England and Monitor are however committed to introducing greater transparency into pricing and therefore expect that over time, the difference between underlying efficiency and the efficiency factor will converge. As evidence of greater transparency emerges 

Tariff assumptions
2014/15
2015/16
2016/17
2017/18
2018/19
Projected underlying provider 
efficiency 
2%
2.5%
2%
2%
2%
Efficiency factor assuming 
reduced leakage
4%
4%
3.1%
2.8%
2.6%
Efficiency factor assuming 
constant leakage
4%
4%
4%
4%
4%

over time, we project that the headline efficiency factor could begin to move towards the second row in the table below.

## Strategic Enablers The Nhs Standard Contract

70.	
The NHS standard contract remains the form of contract which commissioners must use for all contracts for clinical services, other than primary care. 
71.	
After a significant re-drafting for 2013/14, the 2014/15 contract will retain the same structure and much of the same detailed content, allowing commissioners and providers to become familiar with using it in practice.
72.	
There will be significantly greater flexibility 
75.	
We expect commissioners to ensure that 
for commissioners to determine the duration 
robust, good value contracts are signed by 
of the contract they wish to offer, within the 
28 February 2014.
framework of national guidelines and regulations on procurement, choice and 

## Pricing And Incentives

competition. The standard contract enables innovative contracting models such as the 
76.	
A strategic review of pricing and incentives is 
prime provider approach; with increased 
underway as part of the Call to Action work. 
flexibility on contract duration, together with 
It has the aim of developing a fully integrated 
new tariff flexibilities (Local Payment 
set of arrangements which support the 
Variations). Commissioners will be equipped 
emerging strategic priorities and provide the 
with the tools to enable longer-term, 
flexibility to implement the new service 
transformational, outcomes-based 
models which will be required. Arrangements 
commissioning approaches. 
for 2014/15, described below, aim to preserve stability in the short term while providing sufficient local flexibility to enable 
73.	
The framework of sanctions within the 
innovation to flourish.
standard contract has been reviewed in depth, with significant input from 
The Quality Premium: rewarding commissioners

stakeholders. The contract for 2014/15 will contain a more consistent and proportionate 
77.	
The measures to be used to determine the 
set of sanctions. We expect commissioners 
Quality Premium paid to CCGs in 2015/16 
to enforce the standard terms of the 
on the basis of performance during 2014/15 
contract, including the application of 
align with our outcomes ambitions and 
sanctions.
reflect local decision-making with Health and Wellbeing Boards. NHS England will publish 
74.	
An online system for completing the NHS 
the full methodology to be used for 
standard contract (the eContract) was made 
calculation of the Quality Premium in 
available in February 2013 and an improved, 
December 2013.
more robust system will be available for use for 2014/15. The eContract approach has 
Commissioning for Quality and Innovation (CQUIN)

significant benefits, for instance in enabling the tailoring of contract content to reflect the 
78.	
A CQUIN scheme will be in place for 
specific range of services being 
2014/15. The key aim is to secure 
commissioned. We strongly encourage 
improvements in the quality of services and 
CCGs and CSUs to use the eContract during 
better outcomes for patients. Providers will 
the 2014/15 contracting round. NHS England 

be able to earn up to 2.5 per cent of their 
anticipates that use of the eContract 

annual contract outturn, excluding any 
approach will become the norm for directly 

income for high cost drugs and devices 
commissioned services in 2014/15.

excluded from national prices. 
79.	
One fifth of the CQUIN scheme will be for 

## Non Recurrent Funds

achievement of national improvement goals, as follows:
82.	
As in previous years, commissioning 
●
●
Friends and Family Test - where 
organisations are required to set aside some 
commissioners will be encouraged to 
of their funding for non-recurrent 
incentivise high performing providers;
expenditure. Recognising the need to accelerate efficiencies in 2014/15 both to 
●
●
Improvement against the NHS Safety 
prepare for the challenges in 2015/16 and 
Thermometer, particularly pressure 
to create funding for service change, we 
sores;
have increased the level of resource 
●
●
Improving dementia and delirium care, 
reserved for non-recurrent expenditure in 
including sustained improvement in 
2014/15 to 2.5 per cent. Of the total 2.5 per 
Finding people with dementia, Assessing 
cent, commissioners are asked to plan for 
and Investigating their symptoms and 
1 per cent of this spend to be applied to 
Referring for support (FAIR); and
transformation of local services. This 
●
●
Improving diagnosis in mental health - 
transformation fund is intended to be 
providers will be rewarded for better 
used at a local health economy level by 
assessing and treating the mental and 
commissioners working together to develop 
physical needs of their service users.
and implement plans for change, focusing in particular on any actions required to prepare 
80.	
Following three years of funding through the 
for the introduction of the Better Care Fund.
national CQUIN scheme, the VTE CQUIN scheme will not be in place for 2014/15. Providers will be expected to continue to improve their management of VTE risk, and any deterioration in risk assessment from current performance will result in a contract sanction being applied.
81.	
NHS England will publish separate guidance on the 2014/15 CQUIN scheme in December 2013, including detailed descriptions of the mandated national indicators and guidance on developing local CQUIN indicators and setting improvement trajectories, along with a list of quality assured indicators for optional use.

## 2	 Nhs England Direct Commissioning

85.	
The approach will be nationally consistent to 

## Direct Commissioning Overview

deliver quantifiable improvements for patients within principles of:
83.	
NHS England has statutory responsibilities 
●
●
equity of offer;
to commission services for patients across 
●
●
equity of access; and
five areas:
●
●
equity of outcome.
●
●
primary, medical, dental, pharmacy and optical services and secondary care dental services;

## Content Of Plans

●
●
specialised services;
●
●
public health section 7A services;
86.	
NHS England's Area Teams will produce strategic and operational plans for the 
●
●
services for members of the Armed 
services they commission on the same basis 
Forces and their families; and
as CCGs. For each of the five areas of NHS 
●
●
services for people in the justice system.
England's commissioning responsibilities, Area Teams will:
84.	
In planning for the delivery for those 
●
●
set out a five year strategic plan for how 
services, NHS England's Area Teams will 
that service will improve within available 
ensure they are aligned with CCG 
resources, including dealing with any 
commissioning plans. The approach we will 
structural deficit;
adopt is that each Area Team with responsibility for one or more of the above 
●
●
include more granular detail for the first 
areas will:
two years; and
●
●
develop a strategic plan for that service 
●
●
use the measures in the Annexes D-G to 
within which there will be greater 
identify improvement.
granularity on the first two years;
87.	
For each aspect of our commissioning, the 
●
●
ensure that each of those strategic plans 
objectives we expect to be achieved are set 
is visible within relevant Units of 
out below and should be read alongside the 
Planning;
measures to be included in plans as set out 
●
●
work with CCGs and other local partners 
in Annexes A to G of this guidance, with 
to ensure a consistent and coordinated 
supporting information in Annex H.
approach across the commissioning of all NHS services and related social care 
88.	
Details regarding the content of the Direct 
provision; and
Commissioning Plan template can be found 
●
●
ensure services are planned on the 
in Annex J.
basis of affordability and securing the best possible outcome for patients.

## Financial Planning Assumptions

89.	
The core financial planning assumptions for direct commissioning are set out below. 

## Direct Commissioning Excluding Public Health

Primary care: Local determination based on resident population in line 
with crude population projections.
Demographic growth
Other: Local determination using age profiled population projections for 
population covered by Area Teams.
Non-demographic 
growth
Local determination based on historic analysis and evidence.
Tariff changes
See above.
Primary care cost 
increase
To be confirmed.
2014/15
●
●
Minimum 0.5% contingency 
Business rules
●
●
1% cumulative surplus carry forward
●
●
2.5% non-recurrent spend.
Public health
Demographic growth
Local determination using age profiled population projections for 
population covered by Area Teams.
●
●
Minimum 0.5% contingency 
●
●
0% cumulative surplus carry forward
Business rules
●
●
0% underlying surplus
●
●
0% non-recurrent spend.
2015/16-2018/19
●
●
Minimum 0.5% contingency 
●
●
1% cumulative surplus carry forward
●
●
2% non-recurrent spend. 

## 3	 Better Care Fund Planning

should include an assessment of future 

## Better Care Fund Overview

capacity requirements across the system. CCGs and Local Authorities should also 

90.	
The Better Care Fund plan requires local 
work with providers to help manage 

areas to formulate a joint plan for integrated 
the transition to new patterns of provision 

health and social care and to set out how 
including, for example, the use of 

their single pooled Better Care Fund budget 
non‑recurrent funding to support 

will be implemented to facilitate closer 
service change.

working between health and social care services. Joint plans should be approved 

## Funding For Integrated Care

through the relevant local Health and Wellbeing Board and be agreed between all local CCGs and the Upper Tier Local 
93.	
In 2014/15, a total of £1,100 million 
Authority. Health and social care providers 
(increased from £859 million) will transfer 
should also be closely involved in plan 
to Local Authorities for social care to benefit 
development. 
health, using the same formula as 2013/14. This will become transacted through a central Section 256 transfer. In 2015/16, this 
91.	
The plan should demonstrate clearly how it 
funding will be part of the pooled Better Care 
meets all of the national Better Care Fund 
Fund; while it will continue to be allocated to 
conditions, include details of the expected 
areas on the same basis as in previous 
outcomes and benefits of the schemes 
years, the funding will be added to CCG 
involved, and confirm how the associated 
allocations.  For example, if a Local Authority 
risks to existing NHS services will be 
consists of two equal sized CCGs and it 
managed. The measures we expect CCGs 
received £10 million from the Section 256 
to use in considering the quality of the 
transfer in 2014/15, in 2015/16 the area will 
impact of the Better Care Fund are in 
still receive £10 million of the £1,100 million, 
Annex I, along with additional supporting 
but it will be divided between the two CCGs' 
information on developing Better Care 
allocations.  CCGs will be required to pass 
Fund plans.
this funding to the Better Care Fund pooled budget along with the funding from core 
92.	
It is essential that CCGs and Local 
CCG allocations, discussed below.
Authorities engage from the outset with all providers likely to be affected by the use of the Better Care Fund so that plans are 
94.	
From 2015/16, the Better Care Fund will 
developed in a way that achieves the best 
also include a £1.9 billion contribution from 
outcomes for local people. Commissioner 
core CCG funding, over and above the 
and provider plans should have a shared 
existing £300 million reablement funding and 
view of the future shape of services. This 
£130 million carers' breaks which will also be 
pooled in the Better Care Fund. Core CCG funding going to the pooled Better Care Fund will be allocated based upon the CCG allocation formula. Additional contributions to the Better Care Fund from Local Authorities, in the form of social care capital grants and disabled facilities grants, will continue to be allocated to them by central government on the same basis as for 2014/15.

54

## Glossary

CCG Outcomes Indicator Set (CCG OIS) The A Call to Action NHS England document and CCG Outcomes Indicator Set is part of the NHS 
programme of action focused on the challenge to England's systematic approach to promoting quality staff, the public and politicians to help the NHS  
improvement. Its aim is to support clinical meet future demands and tackle the funding gap commissioning groups and health and wellbeing through honest and realistic debate.

partners in improving health outcomes by providing Armed Forces Covenant Commitment The comparative information on the quality of health armed forces covenant sets out the relationship services commissioned by CCGs and the between the nation, the state and the armed forces. 

associated health outcomes - and to support It recognises that the whole nation has a moral transparency and accountability by making this obligation to members of the armed forces and their information available to patients and the public.

families and it establishes how they should expect Clinical Digital Maturity Index (CDMI) The Clinical to be treated.

Digital Maturity Index has been developed by EHI 
Better Care Fund (BCF) A single pooled budget for Intelligence in partnership with NHS England. It is a health and social care services to work more unique benchmarking tool that enables NHS Trusts closely together in local areas, based on a plan to better understand how investing and effectively agreed between the NHS and local authorities.

using, information technology can achieve better patient outcomes, reduce bureaucracy, improve Care.data A modern information system which will patient safety and deliver efficiencies.

make increased use of information from medical records with the intention of improving health Compassion in Practice Compassion in Practice services. The system is being delivered by the is the three year vision and strategy for nursing, Health and Social Care Information Centre (HSCIC) 
midwifery and care staff drawn up by NHS England and NHS England on behalf of the NHS.

and the Department of Health.

Commissioning for Quality and Innovation NHS Choices NHS Choices is the online 'front 
(CQUIN) The system introduced in 2009 to make a door' to the NHS. It is the country's biggest health proportion of healthcare providers' income website and gives all the information citizens need conditional on demonstrating improvements in to make choices about their health.

quality and innovation in specified areas of care. 

NHS Outcomes Framework The NHS Outcomes Everyone Counts: Planning for Patients 2013/14 
Framework sets out the outcomes and outlines the priorities, incentives and levers that corresponding indicators used to hold NHS England were used to improve services from April 2013, the to account for improvements in health outcomes.

first year of the new NHS, where improvement was NHS Safety Thermometer The NHS Safety driven by clinical commissioners.

Thermometer provides a quick and simple method Find, Assess and Investigate, and Refer (FAIR) 
for surveying patient harms and analysing results Improving dementia care, including sustained so that we can measure and monitor local improvement in finding people with dementia, improvement and harm-free care over time.

assessing and investigating their symptoms and Personalised Care Plan Personalised care referring for support.

planning goes beyond the normal clinical and Friends and Family Test The Friends and Family medical conditions. It extends into other areas of Test (FFT) aims to provide a simple headline metric the individual's life and recognises that many which, when combined with follow-up questions, different issues can impact on their health and can drive a culture change of continuous well-being.

recognition of good practice and potential Quality Premium The Quality Premium rewards improvements in the quality of the care received CCGs for improvements in the quality of the by NHS patients and service users.

services that they commission and for associated Liaison and Diversion Programme The improvements in health outcomes and reducing Government's commitment to having diversion inequalities. 

services in place (for children and for adults) in Unit of Planning A number of CCGs who have all local areas by 2014. These services are joined together with relevant Area Teams, providers, fundamental to the identification and assessment Local Authorities and Health and Wellbeing Boards of offenders with health needs and other to create a footprint of a size large enough to vulnerabilities to give offenders the right health enable effective strategic planning. 

and social care services. National Quality Board The National Quality Board (NQB) is a multi-stakeholder board established to champion quality and ensure alignment in quality throughout the NHS. The NQB is a key aspect of the work to deliver high quality care for patients.

56

## Annexes Annex A: Outcomes Measures

| Outcome ambition          | Measure to be used   |
|---------------------------|----------------------|
| Quality Premium           |                      |
| Potential years of life   |                      |
| 1.	 Securing additional                           |                      |
| lost from conditions      |                      |
| considered amenable to    |                      |
| healthcare - a rate       |                      |
| generated by number of    |                      |
| amenable deaths           |                      |
| years of life for the     |                      |
| people of England         |                      |
| with treatable mental     |                      |
| and physical health       |                      |
| conditions.               |                      |
| divided by the            |                      |
| population of the area.   |                      |
| 2.	 Improving the health                           |                      |
| Health related quality of |                      |
| life for people with      |                      |
| long-term conditions      |                      |
| (measured using the       |                      |
| EQ5D tool in the GP       |                      |
| Patient Survey).          |                      |
| related quality of life   |                      |
| of the 15 million+        |                      |
| people with one or        |                      |
| more long-term            |                      |
| condition, including      |                      |
| mental health             |                      |
| conditions.               |                      |
| A rate comprised of:      |                      |
| -                         | -                    |
| Unplanned                 |                      |
| hospitalisation for       |                      |
| chronic ambulatory        |                      |
| care sensitive            |                      |
| conditions.               |                      |
| 3.	 Reducing the amount                           |                      |
| -                         | -                    |
| Unplanned                 |                      |
| hospitalisation for       |                      |
| asthma, diabetes and      |                      |
| epilepsy in under         |                      |
| 19s.                      |                      |
| of time people spend      |                      |
| avoidably in hospital     |                      |
| through better and        |                      |
| more integrated care      |                      |
| in the community,         |                      |
| outside of hospital.      |                      |
| -                         | -                    |
| Emergency                 |                      |
| admissions for acute      |                      |
| conditions that           |                      |
| should not usually        |                      |
| require hospital          |                      |
| admission.                |                      |
| -                         | -                    |
| Emergency                 |                      |
| admissions for            |                      |
| children with lower       |                      |
| respiratory tract         |                      |
| infections.               |                      |
measure
Support measure(s)
Improvement to be 
locally set and no less 
than 3.2%. CCGs 
should focus on 
None
improving in areas of 
deprivation in 
developing their plans 
for reducing mortality.
IAPT roll-out:
i.	 
achieve 15% for 
CCGs below that level
●
●
Increase dementia diagnosis rate to 67 per cent by March 2015.
●
●
Achieve the IAPT recovery rate of 50%.
ii	 
Additional locally set 
improvement for those over 15% or near 15%.
As per outcome 
measure
None
| Outcome ambition            |
|-----------------------------|
| Quality Premium             |
| No indicator available at   |
| CCG level.                  |
| CCGs and Area Teams         |
| 4.	 Increasing the                             |
| will not be expected to     |
| set a quantitative level    |
| of ambition for this        |
| outcome. However, they      |
| will be expected to set     |
| out how they will           |
| proportion of older         |
| people living               |
| independently at            |
| home following              |
| discharge from              |
| hospital.                   |
| improve outcomes on         |
| this ambition in their five |
| year strategic plans.       |
| 5.	 Increasing the                             |
| Patient experience of       |
| inpatient care.             |
| number of people            |
| having a positive           |
| experience of               |
| hospital care.              |
| 6.	 Increasing the                             |
| Composite indicator         |
| comprised of (i) GP         |
| services, (ii) GP Out of    |
| Hours.                      |
| number of people            |
| with mental and             |
| physical health             |
| conditions having a         |
| positive experience         |
| of care outside             |
| hospital, in general        |
| practice and in the         |
| community.                  |
| 7.	 Making significant                             |
| Hospital deaths             |
| attributable to problems    |
| in care. This indicator is  |
| in development.             |
| progress towards            |
| eliminating avoidable       |
| deaths in our               |
| hospitals caused by         |
| problems in care.           |

All CCG OIS measures are available for planning: http://www.england.nhs.uk/ccg-ois/

measure
Support measure(s)
A level of ambition 
needs to be established 
at Health and Wellbeing 
Board level on the 
Proportion of older 
None
people (65 and over) 
who were still at home 
91 days after discharge 
from hospital into reablement/rehabilitation 
services.
Friends and Family Test: 
specific actions to 
None
improve low scores.
None
None
●
●
MRSA zero tolerance
Improving the reporting 
of medication errors.
●
●
Clostridium difficile reduction

## Annex B: Nhs Constitution Measures Referral To Treatment Waiting Times For Non-Urgent Consultant-Led Treatment

Admitted patients to start treatment within a maximum of 18 weeks from referral - 90%
Non-admitted patients to start treatment within a maximum of 18 weeks from referral - 95%
Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no 
more than 18 weeks from referral - 92%

## Diagnostic Test Waiting Times

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral - 99%

## A&E Waits

Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E 
department - 95%

## Cancer Waits - 2 Week Wait

Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected 
cancer by a GP - 93%
Maximum two-week wait for first outpatient appointment for patients referred urgently with breast 
symptoms (where cancer was not initially suspected) - 93%

## Cancer Waits - 31 Days

Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers - 96%
Maximum 31-day wait for subsequent treatment where that treatment is surgery - 94%
Maximum 31-day wait for subsequent treatment where that treatment is an anti-cancer drug 

regimen - 98%
Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy - 94%

## Cancer Waits - 62 Days

Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer - 85%
Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all 
cancers - 90%
Maximum 62-day wait for first definitive treatment following a consultant's decision to upgrade the priority 
of the patient (all cancers) - no operational standard set

## Category A Ambulance Calls

Category A calls resulting in an emergency response arriving within 8 minutes - 75% (standard to be met 
for both Red 1 and Red 2 calls separately)
Category A calls resulting in an ambulance arriving at the scene within 19 minutes - 95%

## Nhs Constitution Support Measures Mixed Sex Accommodation Breaches Minimise Breaches Cancelled Operations

All patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding date within 28 days, or the patient's treatment to be funded at the time and hospital of the patient's choice.

## Mental Health

Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA 
who were followed up within 7 days of discharge from psychiatric in-patient care during the period - 95%

## Referral To Treatment Waiting Times For Non-Urgent Consultant-Led Treatment Ambulance Handovers

All handovers between ambulance and A & E must take place within 15 minutes and crews should be ready to accept new calls within a further 15 minutes. Financial penalties, in both cases, for delays over 
30 minutes and over an hour.

## Annex C: Activity Measures Referrals

GP written referrals from GPs for a first outpatient appointment in general and acute specialties
Other referrals for a first outpatient appointment in general and acute specialties
First outpatient attendances following GP referral in general and acute specialties 

## Annex D: Primary Care Measures Annex E: Specialised Services Measures

% of all NHS England patients receiving treatment within 18 wks of referral
% of NHS England patients waiting 6 weeks or more for diagnostic tests

## Annex F: Public Health Section 7A Services Measures Vaccinations

Population vaccination coverage - Dtap/IPV/Hib (1 year old)
Population vaccination coverage - MenC
Population vaccination coverage - PCV
Population vaccination coverage - Dtap/IPV/Hib (2 years old)
Population vaccination coverage - PCV booster
Population vaccination coverage - Hib/MenC booster (2 years old)
Population vaccination coverage - MMR for one dose (2 years old) Population vaccination coverage - MMR for one dose (5 years old)
Population vaccination coverage - MMR for two doses (5 years old)
Population vaccination coverage - Hib/Men C booster (5 years)
Population vaccination coverage - Hepatitis B (1 year old)
Population vaccination coverage - Hepatitis B (2 years old)
Population vaccination coverage - HPV
Population vaccination coverage - PPV
Population vaccination coverage - Flu (aged 65+)
Population vaccination coverage - Flu (at risk individuals)

## Screening

% of pregnant women eligible for infectious disease screening who are tested for HIV, leading to a 
conclusive result
% of women booked for antenatal care, as reported by maternity services, who have a screening test for 
syphilis, hepatitis B and susceptibility to rubella leading to a conclusive result
% of pregnant women eligible for antenatal sickle cell and thalassaemia screening for whom a conclusive 
screening result is available at the day of report
% of babies registered within the local authority area both at birth and at the time of report who are 
eligible for newborn blood spot screening and have a conclusive result recorded on the Child Health 
Information System within an effective timeframe
% of babies eligible for newborn hearing screening for whom the screening process is complete within 
4 weeks corrected age (hospital programmes - well babies, all programmes - NICU babies) or 5 weeks 
corrected age (community programmes - well babies)
% of babies eligible for the newborn physical examination who were tested within 72 hours of birth
% of those offered screening for diabetic eye screening who attend a digital screening event
Abdominal Aortic Aneurysm (AAA) KPI
Breast cancer screening coverage % of eligible women screened adequately within the previous 3 years 
on 31st March
Cervical cancer screening coverage % of eligible women screened adequately within the previous 3.5 or 
5.5 years (according to age) on 31st March
Bowel Cancer screening - uptake and coverage over 2.5 years

## Family Health Services

No. of FTE Health Visitors

## Annex G: Health And Justice Measures Health Commissioned Services

Deliver chronic disease care to the same standard of process and outcomes as is required by the National Service Frameworks for: Diabetes, CHD and Long Term Conditions and Mental Health and a QOF score is available Access and waiting time Access and waiting time Learning disabilities
% of identified patients with a learning disability have an annual health check

## Mental Health

% of all prisoners returning to prison from any other Mental Health facility following treatment under the Mental Health Act (including section 3, 47, 48) are accompanied by a 117 aftercare programme

## Annex H: Direct Commissioning Supporting Information Primary, Medical, Dental, Pharmacy And Optical Services And Secondary Care Dental Services

1.	
There are two central objectives to our commissioning:
●
●
to develop more integrated out-of-hospital services that help people stay healthy and provide proactive, coordinated support, particularly for people with long-term conditions; and
●
●
for our Area Teams, CCGs and Local Professional Networks to work collaboratively with local communities to develop joint strategies for commissioning primary care and wider community services, based on patient and public insight. These should be part of an integrated strategy for out-of-hospital care.
2.	
Local strategic plans should include specific actions to support development of general practice services in ways that reflect the six key characteristics of high-quality care set out in our general practice *A Call to Action* as follows:
●
●
proactive coordination of care, particularly for people with long-term conditions and more complex health and care problems;
●
●
holistic care: addressing people's physical health needs, mental health needs and social care needs in the round;
●
●
ensuring fast, responsive access to care and preventing avoidable emergency admissions and A&E attendances;
●
●
preventing ill-health, ensuring more timely diagnosis of ill-health, and supporting wider action to improve community health and wellbeing;
●
●
involving patients and carers more fully in managing their own health and care; and
●
●
ensuring consistently high quality of care: effectiveness, safety and patient experience.
3.	
Area Teams should also work with their Local Professional Networks and, where appropriate, CCGs to develop equivalent commissioning strategies for dental care, community pharmacy care and eye care services, again as part of an integrated out-of-hospital strategy.

## Primary Care Support Services

4.	
NHS England is responsible for primary care support (PCS) services (also known as family health services or FHS). NHS England wants all practitioners to have access to a standard range of modern, efficient and effective PCS/FHS services which meet their needs.
5.	
The range of PCS/FHS services provided to primary care providers currently varies from area to area. Figures from November 2012 indicated that their costs also varied from around 80p to £2.70 per head of population. NHS England wants to reduce the PCS/FHS budget from £100 million in 2013/14 to £60 million in 2014/15, although any cost reduction must be in the context of delivering safe, high quality and effective services at all times.
6.	
NHS England will progress work through 2013 into 2014 to achieve a safe transition in PCS services. Efficiencies will be created by:
●
●
having a standard specification for core PCS/FHS services that will be funded by NHS England;
●
●
achieving 'best practice' levels of quality and cost across all services;
●
●
providing services from fewer sites; 
●
●
making more and better use of technology; and
●
●
changing some of the ways services are delivered.

## Specialised Services

7.	
As part of *A Call to Action*, NHS England is developing a five year strategy for specialised services. This will address the service specific objectives for the next five years, overarching strategic objectives for the provision of a system of specialised health care as a whole and the impact of co-dependency between service areas.
8.	
The published commissioning intentions for 2014-2016 commit NHS England to a six strand strategic commissioning approach: i.	
Ensuring consistent access to the effective treatments for patients in line with evidence based clinical policies, underpinned by clinical practice audit.
ii.	
A clinical sustainability programme with all providers focused on quality and value through:
●
●
achieving and maintaining compliance with full service specifications, and making changes to service provision where there is no realistic prospect of standards being met;
●
●
refreshing and focusing Commissioning for Quality and Innovation (CQUIN) schemes to directly contribute to improving outcomes with challenging, but achievable goals; and
●
●
providing transparency in service quality through the continued development of service level quality dashboards and improvements in data flows.
iii.	 An associated financial sustainability programme with all providers, focused on better value 
through a two year programme of productivity and efficiency improvement.
iv.	 A systematic market review for all services to ensure the right capacity is available, consolidating 
services where appropriate, to address clinical or financial sustainability issues.
v.	
Adopting new approaches to commissioning care where it promotes integrated care and clinical oversight for patients, in particular services and care pathways to include a prime contractor model and co-commissioning with CCGs.
vi.	 A systematic rules-based approach to in-year management of contractual service delivery.
9.	
In their plans we expect NHS England's Area Teams to address any structural deficit from 2013/14. Cost growth will need to be constrained, greater consistency of provision secured and the quality of services maintained or improved.

## Public Health Section 7A Services

10.	
It is our objective to ensure the effective commissioning of certain public health services: immunisation and screening programmes, children's public health services from pregnancy to age five, child health information systems, public health for people in places of detention, and sexual assault services.
11.	
We will continue the effective implementation of the section 7A agreement, of which there are two overarching ambitions:
●
●
to increase the pace of change for the full implementation of the national service specifications; and
●
●
to set performance 'floors' to address unacceptably low performance by local providers.
12.	
NHS England's Area Teams will implement the specific changes from 2014/15, in line with these ambitions:
●
●
new trajectories for roll out of the Family Nurse Partnership and the Health Visitor Programmes;
●
●
a revised specification for Pneumococcal Vaccination;
●
●
introduction of HPV testing in women with mild/borderline changes in their cervical screening;
●
●
revised performance baselines for bowel and diabetic eye screening;
●
●
extension of the bowel screening programme for men and women up to 75;
●
●
a minor change to the service specification for seasonal flu;
●
●
a meningitis C catch up programme for university entrants;
●
●
continuation of a time limited MMR campaign for people over 16 and a catch-up campaign for teenagers;
●
●
continuation of the temporary programme for pertussis for pregnant women;
●
●
implementation of DNA testing for sickle cell and thalassemia screening;
●
●
a shingles catch up programme planned for 71-79 year olds, starting with 78 and 79 year olds; and
●
●
a number of developments for Sexual Assault Referral Centres to develop the service and make it more equitable.
13.	
We intend to extend flu vaccinations to all children over time. When fully implemented this will be the largest single immunisation programme that has yet been introduced. The extent to which the 
programme can be rolled out in 2014/15 and the expected uptake rates have not yet been agreed. They remain subject to an assessment of NHS England's commissioning capacity, and the development of robust workforce models for delivery of the programme, which will be completed in early 2014. These will be confirmed through a variation to the section 7A agreement. Prior to this planned variation, the proposed section 7A agreement for 2014/15 confirms that NHS England shares the ambition to offer vaccines to all children between 2 and 4 years old and as many secondary school aged children as possible in 2014/15.

## Services For Members Of The Armed Forces And Their Families

14.	
We want to see the following achieved:
●
●
that the commissioning of services is organised in such a way as to provide the best possible patient outcomes and avoid any geographical or organisational variation;
●
●
to continue to embed the single operating model as described in Securing Excellence for Armed 
Forces and their Families;
●
●
full implementation of the Armed Forces Covenant Commitment;
●
●
to work in partnership with the Ministry of Defence (DMS Personnel and Recovery) commissioning healthcare in line with the Armed Forces National Partnership Agreement; and
●
●
to collaborate with CCGs to ensure services are locally integrated and to develop strong Armed 
Forces networks across England.

## Services For People In The Justice System

15.	
We will continue the implementation of the single operating framework and commissioning intentions (developed jointly with National Offender Management Service, Public Health England, Youth Justice Board, Home Office Immigration Enforcement and Police Custody Healthcare) in a range of Justice services settings:
●
●
Prisons;
●
●
Young Offender Institutes;
●
●
Secure Children's Homes;
●
●
Immigration and Removal Centres;
●
●
Police Custody Suites; and
●
●
Court Liaison Services.
16.	
Specifically our priorities from 2014/15 are:
●
●
to ensure that commissioning is informed by an up-to-date health needs assessment, taking account of the reconfiguration of the custodial estate, including the creation of Resettlement Prisons;
●
●
to support sustainable recovery from addiction to drugs and alcohol and improved mental health services;
●
●
promotion of continuity of care from custody to community and between establishments, working closely with Probation Services, Local Authorities and CCGs;
●
●
development of a full understanding of the healthcare needs of children and young people accommodated in the secure estate and work collaboratively to commission services to meet these needs;
●
●
continued close collaboration with our partners in the successful implementation of the Liaison and Diversion Programme; and
●
●
to ensure timely and effective transition of commissioning responsibility for healthcare in immigration and removal centres.

## Annex I: Better Care Fund Measures And Information Better Care Fund Measures What Is Included In The Better Care Fund And What Does It Cover?

1.	
The Better Care Fund (previously referred to as the Integration Transformation Fund) was announced 
in June as part of the 2013 Spending Round. It provides an opportunity to transform local services so that people are provided with better integrated care and support. It encompasses a substantial level 
of funding to help local areas manage pressures and improve long term sustainability. The Fund will 
be an important enabler to take the integration agenda forward at scale and pace, acting as a significant catalyst for change.
2.	
The Better Care Fund provides an opportunity to improve the lives of some of the most vulnerable people in our society, giving them control, placing them at the centre of their own care and support, and, in doing so, providing them with a better service and better quality of life. 
3.	
The Fund will support the aim of providing people with the right care, in the right place, at the right time, including through a significant expansion of care in community settings. This will build on the 
work Clinical Commissioning Groups (CCGs) and councils are already doing, for example, as part of the integrated care "pioneers" initiative, through Community Budgets, through work with the Public Service Transformation Network, and on understanding the patient/service user experience.

## What Is Included In The Better Care Fund And What Does It Cover?

4.	
The Fund provides for £3.8 billion worth of funding in 2015/16 to be spent locally on health and care to drive closer integration and improve outcomes for patients and service users and carers. 
In 2014/15, in addition to the £859m transfer already planned from the NHS to adult social care, a further £241m will transfer to enable localities to prepare for the Better Care Fund in 2015/16.

5.	
The tables below summarise the elements of the Spending Round announcement on the Fund:

## The June 2013 Spending Round Set Out The Following:

| 2014/15                                            |
|----------------------------------------------------|
| A further £241m transfer from the NHS to           |
| £3.8bn to be deployed locally on health and social |
| adult social care, in addition to the £859m        |
| care through pooled budget arrangements            |
| transfer already planned                           |

## In 2015/16 The Fund Will Be Created From:

£1.9bn of NHS funding
£1.9bn based on existing funding in 2014/15 that is allocated across the health and wider care 
system. This will comprise:
£130m Carers' Break funding
£300m CCG reablement funding
£354m capital funding (including £220m Disabled Facilities Grant)
£1.1bn existing transfer from health to adult social care.

6.	
For 2014/15 there are no additional conditions attached to the £859m transfer already announced, but NHS England will only pay out the additional £241m to councils that have jointly agreed and signed off two-year plans for the Better Care Fund.
7.	
In 2014/15 there are no new requirements for pooling of budgets. The requirements for the use of the 
funds transferred from the NHS to Local Authorities in 2014/15 remain consistent with the guidance19 
from the Department of Health (DH) to NHS England on 19 December 2012 on the funding transfer from NHS to social care in 2013/14. In line with this:
●
●
"The funding must be used to support adult social care services in each local authority, which also has a health benefit. However, beyond this broad condition we want to provide flexibility for local areas to determine how this investment in social care services is best used. 
●
●
A condition of the transfer is that the local authority agrees with its local health partners how the funding is best used within social care, and the outcomes expected from this investment. Health and wellbeing boards will be the natural place for discussions between NHS England, clinical commissioning groups and councils on how the funding should be spent, as part of their wider discussions on the use of their total health and care resources. 
●
●
In line with our responsibilities under the Health and Social Care Act, an additional condition of the transfer is that councils and clinical commissioning groups have regard to the Joint Strategic Needs Assessment for their local population, and existing commissioning plans for both health and social care, in how the funding is used. 
●
●
A further condition of the transfer is that Local Authorities councils and clinical commissioning groups demonstrate how the funding transfer will make a positive difference to social care services, and outcomes for service users, compared to service plans in the absence of the funding transfer"
8.	
Councils should use the additional £241m to prepare for the implementation of pooled budgets in April 2015 and to make early progress against the national conditions and the performance measures set out in the locally agreed plan. This is important, since some of the performance-related money is linked to performance in 2014/15.
9.	
The £3.8bn Fund includes £130m of NHS funding for carers' breaks. Local plans should set out the level of resource that will be dedicated to carer-specific support, including carers' breaks, and identify 
how the chosen methods for supporting carers will help to meet key outcomes (e.g. reducing delayed transfers of care). The Fund also includes £300m of NHS funding for reablement services. Local plans will therefore need to demonstrate a continued focus on reablement
10.	
It was announced as part of the Spending Round that the Better Care Fund would include funding for costs to councils resulting from care and support reform. This money is not ring-fenced, but local plans should show how the new duties are being met. i.	
£50m of the capital funding has been earmarked for the capital costs (including IT) associated with transition to the capped cost system, which will be implemented in April 2016.
ii.	
£135m of revenue funding is linked to a range of new duties that come in from April 2015 as a 
result of the Care Bill. Most of the cost results from new entitlements for carers and the introduction of a national minimum eligibility threshold, but there is also funding for better information and advice, advocacy, safeguarding and other measures in the Care Bill.

## What Will Be The Statutory Framework For The Fund?

11.	
In 2015/16 the Fund will be allocated to local areas, where it will be put into pooled budgets under Section 75 
20 joint governance arrangements between CCGs and councils. A condition of accessing 
the money in the Fund is that CCGs and councils must jointly agree plans for how the money will be spent, and these plans must meet certain requirements.
12.	
Funding will be routed through NHS England to protect the overall level of health spending and ensure a process that works coherently with wider NHS funding arrangements. 
13.	
DH will use the Mandate for 2015/16 to instruct NHS England to ring-fence its contribution to the Fund and to ensure this is deployed in specified amounts at local level for use in pooled budgets by CCGs and Local Authorities. 
14.	
Legislation is needed to ring-fence NHS contributions to the Fund at national and local levels, to give NHS England powers to assure local plans and performance, and to ensure that Local Authorities not 
party to the pooled budget can be paid from it, through additional conditions in Section 31 of the Local Government Act 2003. This will ensure that the Disabled Facilities Grant (DFG) can be included in the Fund
15.	
The DFG has been included in the Fund so that the provision of adaptations can be incorporated in the strategic consideration and planning of investment to improve outcomes for service users. DFG will be paid to upper-tier authorities in 2015/16. However, the statutory duty on local housing authorities to provide DFG to those who qualify for it will remain. Therefore each area will have to 
allocate this funding to their respective housing authorities (district councils in two-tier areas) from the pooled budget to enable them to continue to meet their statutory duty to provide adaptations to the homes of disabled people, including in relation to young people aged 17 and under. 
16.	
Special conditions will be added to the DFG Conditions of Grant Usage (under Section 31 of the Local Government Act 2003) which stipulate that, where relevant, upper-tier Local Authorities or CCGs must ensure they cascade the DFG allocation to district council level in a timely manner such that it can be spent within year. Further indicative minimum allocations for DFG have been provided for all upper-tier authorities, with further breakdowns for allocations at district council level as the holders of the Fund may decide that additional funding is appropriate to top up the minimum DFG funding levels.
17.	
DH and the Department for Communities and Local Government (DCLG) will also use Section 31 of the Local Government Act 2003 to ensure that DH Adult Social Care capital grants (£134m) will reach 
local areas as part of the Fund. Relevant conditions will be attached to these grants so that they are used in pooled budgets for the purposes of the Fund. DH, DCLG and the Treasury will work together in early 2014 to develop the terms and conditions of these grants.

## How Will Local Fund Allocations Be Determined?

18.	
Councils will receive their detailed funding allocations in the normal way. NHS allocations will be 
two-year allocations for 2014/15 and 2015/16 to enable more effective planning.
19.	
In 2014/15 the existing £859m s.256 transfer to councils for adult social care to benefit health, and the additional £241m, will continue to be distributed using the social care relative needs formula (RNF).
20.	
The formula for distribution of the full £3.8bn fund in 2015/16 will be based on a financial framework agreed by ministers. The current social care transfer of £1.1bn and the £134m of adult social care capital funding included in the Fund in 2015/16 will be allocated in the same way as in 2014/15. DFG will be allocated based on the same formula as 2014/15. The remainder of the Fund will be allocated on the basis of the CCG allocations formula. It will be for local areas to decide how to spend their allocations on health and social care services through their joint plan. 
21.	
The announcement of the two-year CCG allocations, communicated to CCGs and councils alongside this planning guidance, includes the Fund allocations in 2015/16. In 2014/15, the additional £241m will be transferred directly from NHS England to councils along with the rest of the adult social care transfer. The local authority and CCGs in each Health and Wellbeing Board area will receive a notification of their share of the pooled fund for 2014/15 and 2015/16 based on the aggregate of the allocation mechanisms. The allocation letter also specifies the amount that is included in the payment-for-performance element, and is therefore contingent in part on planning and performance in 2014/15 and in part on achieving specified goals in 2015/16.
22.	
Allocation letters will specify only the minimum amount of funds to be included in pooled budgets. CCGs and councils are free to extend the scope of their pooled budget to support better integration in line with their Joint Health and Wellbeing Strategy.
23.	
The wider powers to use Health Act flexibilities to pool funds, share information and staff are unaffected by the new Better Care Fund requirements, and will be helpful in taking this work forward.

## How Should Councils And Ccgs Develop And Agree A Joint Plan For The Fund?

24.	
Each statutory Health and Wellbeing Board will sign off the plan for its constituent councils and CCGs. The Fund plan must be developed as a fully integral part of a CCG's wider strategic and operational plan, but the Better Care Fund elements must be capable of being extracted to be seen as a stand-alone plan.
25.	
Where a unit of planning chosen by a CCG for its strategic and operational plan is not consistent with the boundaries of the Health and Wellbeing Board, or Boards, with which it works, it will be necessary for the CCG to reconcile the Better Care Fund element of its plan to the Health and Wellbeing Board 
level. NHS England will support CCGs in this position to ensure that plans are properly aligned. 
26.	
The specific priorities and performance goals in the plan are clearly a matter for each locality but it will be valuable to be able to:
●
●
aggregate the ambitions set for the Fund across all Health and Wellbeing Boards; 
●
●
assure that the national conditions have been achieved; and
●
●
understand the performance goals and payment regimes that have been agreed in each area.
27.	
To assist Health and Wellbeing Boards we have developed a template which we expect everyone to use in developing, agreeing and publishing their Better Care Plan. This is published alongside this 
guidance as a separate Word document and Excel spread sheet. The template sets out the key information and metrics that all Health and Wellbeing Boards will need to assure themselves that the plan addresses the conditions of the Fund. 
28.	
As part of this template, local areas should provide an agreed shared risk register. This should 
include an agreed approach to risk sharing and mitigation covering, as a minimum, the impact on existing NHS and social care delivery and the steps that will be taken if activity volumes do not change as planned (for example, if emergency admissions or nursing home admissions increase).
29.	
CCGs and councils must engage from the outset with all providers, both NHS and social care (and also providers of housing and other related services), likely to be affected by the use of the fund in 
order to achieve the best outcomes for local people. The plans must clearly set out how this engagement has taken place. Providers, CCGs and councils must develop a shared view of the future shape of services, the impact of the Fund on existing models of service delivery, and how the 
transition from these models to the future shape of services will be made. This should include an assessment of future capacity and workforce requirements across the system. It will be important to work closely with Local Education and Training Boards and the market shaping functions of councils, as well as with providers themselves, on the workforce implications to ensure that there is a consistent approach to workforce planning for both providers and commissioners.

30.	
CCGs and councils should also work with providers to help manage the transition to new patterns of provision including, for example, the use of non-recurrent funding to support disinvestment from services. It is also essential that the implications for all local providers are set out clearly for Health and Wellbeing Boards and that their agreement for the deployment of the Fund includes agreement to all the service change consequences.

## What Are The National Conditions?

31.	
The Spending Round established six national conditions for access to the Fund:

| National Condition                                                              |
|---------------------------------------------------------------------------------|
| The Better Care Fund Plan, covering a minimum of the pooled fund                |
| specified in the Spending Round, and potentially extending to the totality      |
| of the health and care spend in the Health and Wellbeing Board area,            |
| should be signed off by the Health and Well Being Board itself, and by the      |
| constituent Councils and Clinical Commissioning Groups.                         |
| In agreeing the plan, CCGs and councils should engage with all providers        |
| Plans to be jointly                                                             |
| likely to be affected by the use of the fund in order to achieve the best       |
| agreed                                                                          |
| outcomes for local people. They should develop a shared view of the             |
| future shape of services. This should include an assessment of future           |
| capacity and workforce requirements across the system. The implications         |
| for local providers should be set out clearly for Health and Wellbeing          |
| Boards so that their agreement for the deployment of the fund includes          |
| recognition of the service change consequences.                                 |
| Local areas must include an explanation of how local adult social care          |
| Protection for social                                                           |
| services will be protected within their plans. The definition of protecting     |
| care services                                                                   |
| services is to be agreed locally. It should be consistent with the 2012         |
| (not spending)                                                                  |
| Department of Health guidance referred to in paragraphs 8 to 11, above.         |
| Local areas are asked to confirm how their plans will provide 7-day             |
| services to support patients being discharged and prevent unnecessary           |
| As part of agreed                                                               |
| admissions at weekends. If they are not able to provide such plans, they        |
| local plans, 7-day                                                              |
| must explain why. There will not be a nationally defined level of 7-day         |
| services in health and                                                          |
| services to be provided. This will be for local determination and               |
| social care to support                                                          |
| patients being                                                                  |
| There is clear evidence that many patients are not discharged from              |
| discharged and                                                                  |
| hospital at weekends when they are clinically fit to be discharged because      |
| prevent unnecessary                                                             |
| the supporting services are not available to facilitate it. The recent national |
| admissions at                                                                   |
| review of urgent and emergency care sponsored by Sir Bruce Keogh for            |
| weekends                                                                        |

NHS England provided guidance on establishing effective 7-day services 

agreement.

within existing resources.

| National Condition                                                           | Definition   |
|------------------------------------------------------------------------------|--------------|
| The safe, secure sharing of data in the best interests of people who         |              |
| use care and support is essential to the provision of safe, seamless care.   |              |
| The  use of the NHS number as a primary identifier is an important           |              |
| element of this, as is progress towards systems and processes that allow     |              |
| the safe and timely sharing of information. It is also vital that the right  |              |
| cultures, behaviours and leadership are demonstrated locally, fostering a    |              |
| culture of secure, lawful and appropriate sharing of data to support         |              |
| Local areas should:                                                          |              |
| Better data sharing                                                          |              |
| between health and                                                           |              |
| social care, based on                                                        |              |
| -                                                                            | -            |
| confirm that they are using the NHS Number as the primary identifier         |              |
| for health and care services, and if they are not, when they plan to;        |              |
| the NHS number                                                               |              |
| -                                                                            | -            |
| confirm that they are pursuing open APIs (ie. systems that speak to          |              |
| each other); and                                                             |              |
| -                                                                            | -            |
| ensure they have the appropriate Information Governance controls in          |              |
| place for information sharing in line with Caldicott 2, and if not, when     |              |
| they plan for it to be in place.                                             |              |
| NHS England has already produced guidance that relates to both of these      |              |
| areas. (It is recognised that progress on this issue will require the        |              |
| resolution of some Information Governance issues by DH).                     |              |
| Ensure a joint                                                               |              |
| Local areas should identify which proportion of their population will be     |              |
| approach to                                                                  |              |
| receiving case management and a lead accountable professional, and           |              |
| assessments and                                                              |              |
| which proportions will be receiving self-management help - following the     |              |
| care planning and                                                            |              |
| principles of person-centred care planning. Dementia services will be a      |              |
| ensure that, where                                                           |              |
| particularly important priority for better integrated health and social care |              |
| funding is used for                                                          |              |
| services, supported by accountable professionals.                            |              |
| The Government has set out an ambition in the Mandate that GPs should        |              |
| integrated packages                                                          |              |
| of care, there will be                                                       |              |
| be accountable for co-ordinating patient-centred care for older people and   |              |
| an accountable                                                               |              |
| professional                                                                 |              |
| Local areas should identify, provider-by-provider, what the impact will      |              |
| be in their local area. Assurance will also be sought on public and patient  |              |
| Agreement on the                                                             |              |
| and service user engagement in this planning, as well as plans for           |              |
| consequential impact                                                         |              |
| of changes in the                                                            |              |
| Ministers have indicated that, in line with the Mandate requirements on      |              |
| acute sector                                                                 |              |
| achieving parity of esteem for mental health, plans should not have a        |              |
| negative impact on the level and quality of mental health services.          |              |
better care.
those with complex needs.
political buy-in.

## How Will Councils And Ccgs Be Rewarded For Meeting Goals?

32.	
The Spending Round indicated that £1bn of the £3.8bn would be linked to achieving outcomes. Ministers have agreed the basis on which this payment-for-performance element of the Fund will operate.
33.	
Half of the £1bn will be released in April 2015. £250m of this will depend on progress against four of the six national conditions and the other £250m will relate to performance against a number of national and locally determined metrics during 2014/15. The remainder (£500m) will be released in October 2015 and will relate to further progress against the national and locally determined metrics.
34.	
The performance payment arrangements are summarised in the table below:

Payment for 
When
performance 
Paid for
amount
Progress against four of the national conditions:
●
●
protection for adult social care services 
●
●
providing 7-day services to support patients being discharged and prevent unnecessary admissions at weekends 
£250m
●
●
agreement on the consequential impact of changes in the acute sector; 
April 2015
●
●
ensuring that where funding is used for integrated packages of care there will be an accountable lead professional 
Progress against the local metric and two of the national metrics:
●
●
delayed transfers of care; and
£250m
●
●
avoidable emergency admissions.
October 2015
£500m
Further progress against all of the national and local metrics.

## National And Local Metrics

35.	
Only a limited number of national measures can be used to demonstrate progress towards better integrated health and social care services in 2015/16, because of the need to establish a baseline of performance in 2014/15. National metrics for the Fund have therefore been based on a number of criteria, in particular the need for data to be available with sufficient regularity and rigour. 
36.	
The national metrics underpinning the Fund will be:
●
●
admissions to residential and care homes;
●
●
effectiveness of reablement;
●
●
delayed transfers of care;
●
●
avoidable emergency admissions; and
●
●
patient/service user experience.
37.	
The measures are the best available but do have shortcomings. Local plans will need to ensure that they are applied sensitively and do not adversely affect decisions on the care of individual patients and service users.
38.	
Further technical guidance will be provided on the national metrics, including the detailed definition, the source of the data underpinning the metric, the reporting schedule and advice on the statistical significance of ambitions for improvement.
39.	
Due to the varying time lags for the metrics, different time periods will underpin the two payments for the Fund as set out in the table below. Data for the first two of these metrics, on admissions to residential and care homes and the effectiveness of reablement, are currently only available annually and so will not be available to be included in the first payment in April 2015.

April 2015 payment 
Metric
based on performance 
October 2015 payment 
based on performance 
in
in
Admissions to residential and care 
homes
N/A
Apr 2014 - Mar 2015
Effectiveness of reablement
N/A
Apr 2014 - Mar 2015
Delayed transfers of care
Apr - Dec 2014
Jan - Jun 2015
Avoidable emergency admissions
Apr - Sept 2014
Oct 2014 - Mar 2015
Patient/service user experience
N/A
Details TBC

40.	
For the metric on patient/service user experience, no single measure of the experience of integrated 
care is currently available, as opposed to quality of health care or social care alone. A new national 
measure is being developed, but will not be in place in time to measure improvements in 2015/16. 
In the meantime, further details will be provided shortly on how patient/service user experience should be measured specifically for the purpose of the Fund.
41.	
In addition to the five national metrics, local areas should choose one additional indicator that will contribute to the payment-for-performance element of the Fund. In choosing this indicator, it must be 
possible to establish a baseline of performance in 2014/15. 
42.	
A menu of possible local metrics selected from the NHS, Adult Social Care and Public Health Outcomes Frameworks is set out in the table below:

NHS Outcomes Framework
2.1
Proportion of people feeling supported to manage their (long term) condition
2.6i
Estimated diagnosis rate for people with dementia
3.5
Proportion of patients with fragility fractures recovering to their previous levels of mobility/
walking ability at 30/120 days
Adult Social Care Outcomes Framework
1A
Social care-related quality of life
1H
Proportion of adults in contact with secondary mental health services living independently 
with or without support
1D
Carer-reported quality of life
Public Health Outcomes Framework
1.18i
Proportion of adult social care users who have as much social contact as they would like
2.13ii
Proportion of adults classified as "inactive"
2.24i
Injuries due to falls in people aged 65 and over

43.	
Local areas must either select one of the metrics from this menu, or agree a local alternative. Any 
alternative chosen must meet the following criteria:
●
●
it has a clear, demonstrable link with the Joint Health and Wellbeing Strategy;
●
●
data is robust and reliable with no major data quality issues (e.g. not subject to small numbers);
●
●
it comes from an established, reliable (ideally published) source;
●
●
timely data is available, in line with requirements for pay for performance;
●
●
the achievement of the locally set level of ambition is suitably challenging; and
●
●
it creates the right incentives.
44.	
Each metric will be of equal value for the payment for performance element of the Fund.
45.	
Local areas should set an appropriate level of ambition for improvement against each of the national indicators, and the locally determined indicator. In signing off local plans, Health and Wellbeing Boards should be mindful of the link to the levels of ambition on outcomes that CCGs have been asked to set as part of their wider strategic and operational plans. Both the effectiveness of 
reablement and avoidable emergency admissions outcomes metrics are consistent with national metrics for the Fund, and so Health and Wellbeing Boards will need to ensure consistency between the CCG levels of ambitions and the Fund plans.
46.	
In agreeing specific levels of ambition for the metrics, Health and Wellbeing Boards should be mindful 
of a number of factors, such as:
●
●
having a clear baseline against which to compare future performance;
●
●
understanding the long-run trend to ensure that the target does not purely reward improved performance consistent with trend increase;
●
●
ensuring that any seasonality in the performance is taken in to account; and
●
●
ensuring that the target is achievable, yet challenging enough to incentivise an improvement in integration and improved outcomes for users.
47.	
In agreeing levels of ambition, Health and Wellbeing Boards should also consider the level required for a statistically significant improvement. It would not be appropriate for the level of ambition to be set such that it rewards a small improvement that is purely an artefact of variation in the underlying dataset. 

## How Will Plans Be Assured?

48.	
Ministers, stakeholder organisations and people in local areas will wish to be assured that the Fund is being used for the intended purpose, and that the local plans credibly set out how improved outcomes and wellbeing for people will be achieved, with effective protection of social care and integrated activity to reduce emergency and urgent health demand. 
49.	
To maximise our collective capacity to achieve these outcomes and deliver sustainable services the NHS and local government will have a shared approach to supporting local areas and assuring plans. 
50.	
The most important element of assurance for plans will be the requirement for them to be signed-off 
by the Health and Wellbeing Board. The Health and Wellbeing Board is best placed to decide whether the plans are the best for the locality, engaging with local people and bringing a sector-led approach to the process. 
51.	
The plans will also go through an assurance process involving NHS England and the LGA to assure 
Ministers. The key elements of the overall assurance process are as follows:
●
●
Plans are presented to the Health and Wellbeing Board, which considers whether the plans are sufficiently challenging and will deliver tangible benefits for the local population (linked to the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy).
●
●
If the Health and Wellbeing Board is not satisfied, and the plan is still lacking after a process of progressive iteration, an element of local government and NHS peer challenge will be facilitated by NHS England and the LGA. 
●
●
NHS England's process for assuring CCG strategic and operational plans will include a specific focus on the element of the plan developed for the Fund. This will allow us to summarise, aggregate and rate all plans, against criteria agreed with government departments and the LGA, to provide an overview of Fund plans at national, regional and local level. 
●
●
This overview will be reviewed by a Departmental-led senior group comprised of DH, DCLG, HMT, NHS England and LGA officials, supported by external expertise from the NHS and local government. Where issues of serious concern are highlighted the group will consider how issues may be resolved, either through provision of additional support or escalation to Ministers. 
●
●
Where necessary, Ministers (supported by the senior group) will meet representatives from the relevant LAs and CCGs to account for why they have not been able to produce an acceptable plan and agree next steps to formulate such a plan.
●
●
Ministers will give the final sign-off to plans and the release of performance related funds.

## What Will Be The Consequences Of Failure To Achieve Improvement?

52.	
Ministers have considered whether local areas which fail to achieve the levels of ambition set out in their plan should have their performance-related funding withdrawn, to be reallocated elsewhere. However, given the scale and complexity of the challenge of developing plans for the first time, they have agreed that such a sanction will not be applied in 2015/16. Further consideration will be given to whether it should be introduced in subsequent years.
53.	
If a local area achieves 70% or more of the levels of ambition set out in each of the indicators in its plan, it will be allowed to use the held-back portion of the performance pool to fund its agreed contingency plan, as necessary.
54.	
If an area fails to deliver 70% of the levels of ambition set out in its plan, it may be required to produce a recovery plan. This will be developed with the support of a peer review process involving colleagues from NHS and local government organisations in neighbouring areas. The peer review 
process will be co-ordinated by NHS England, with the support of the LGA. 
55.	
If the recovery plan is agreed by the Health and Wellbeing Board, NHS England and the local government peer reviewer, the held-back portion of the performance payment from the Fund will be made available to fund the recovery plan.
56.	
If a recovery plan cannot be agreed locally, and signed-off by the peer reviewers, NHS England will direct how the held-back performance related portion of the Fund should be used by the local organisations, subject to the money being used for the benefit of the health and care system in line with the aims and conditions of the Fund.
57.	
Ministers will have the opportunity to give the final sign-off to peer-reviewed recovery plans and to any directions given by NHS England on the use of funds in cases where it has not been possible to agree a recovery plan.

## When Should Plans Be Submitted?

58.	
Health and Wellbeing Boards should provide the first cut of their completed Better Care Plan template, as an integral part of the constituent CCGs' Strategic and Operational Plans by 14 February 2014, so that we can aggregate them to provide a composite report, and identify any areas where it has proved challenging to agree plans for the Fund.
59.	
The revised version of the Better Care Plan should be submitted to NHS England, as an integral part of the constituent CCGs' Strategic and Operational Plans by **4 April 2014**.

## Annex J: Template Contents Content Of The Strategic Plan

| Segment                                                         |
|-----------------------------------------------------------------|
| A statement describing what the desired state would be for      |
| the health economy in 2018/19 - this should ideally             |
| System vision                                                   |
| describe the health and care system rather than an              |
| individual organisation view.                                   |
| Looking at the seven improving outcome ambitions                |
| identified in Everyone counts: planning for patients, how       |
| does the health economy plan to improve these and,              |
| where appropriate, what level of improvement does it            |
| Improving quality                                               |
| expect?                                                         |
| and outcomes                                                    |
| What other local quality improvement plans are in place         |
| and how do these align with the local strategic needs           |
| assessments?                                                    |
| In five years, what are the health economy goals for            |
| sustainability including reference to financial position, other |
| resources and points of service delivery? This work should      |
| Sustainability                                                  |
| reference the do nothing gap calculated for the system by       |
| 2018/19 that aligns to the challenges identified in A Call to   |
| Action                                                          |
| 21                                                              |
| .                                                               |
| To achieve the desired end state what are the key               |
| Improvement                                                     |
| improvement interventions planned at an organisational          |
| interventions                                                   |
| level and how will these deliver the quality and                |
| sustainability outcomes required?                               |
| A summary of the governance processes in place to               |
| Governance                                                      |
| oversee the delivery of the plans, including high level         |
| overview                                                        |
| description of what success looks like and who is               |
| responsible for measuring it.                                   |
| A summary of the agreed values and principles that              |
| Key values and                                                  |
| underpin the system wide working required to deliver the        |
| principles                                                      |
| vision.                                                         |
Stakeholder sign up
Individual 
organisation visions 
Detailed metrics will 
be provided in the 
operational template 
for years 3 - 5
Sign up from key 
stakeholders such as 
Health and 
Well‑being Boards
Detailed metrics 
supplied in the 
financial templates 
for each component 
organisation
Contract 
expectations 
included in the 
financial template
| Segment                                                           | Covering:                                    | Further detail:   |
|-------------------------------------------------------------------|----------------------------------------------|-------------------|
| Improvement against the measures to support the seven             |                                              |                   |
| outcome ambitions:                                                |                                              |                   |
| -                                                                 | -                                            |                   |
| Trajectory for                                                    | Clostridium difficile                        | reduction.        |
| -                                                                 | -                                            |                   |
| Trajectory for dementia diagnosis.                                |                                              |                   |
| Measures set out in                                               |                                              |                   |
| Outcomes                                                          |                                              |                   |
| Annex A.                                                          |                                              |                   |
| -                                                                 | -                                            |                   |
| Trajectory for IAPT coverage and recovery.                        |                                              |                   |
| -                                                                 | -                                            |                   |
| Trajectory for seven outcome ambition measures.                   |                                              |                   |
| -                                                                 | -                                            |                   |
| Trajectory for Quality Premium measures (where different          |                                              |                   |
| from seven outcome ambitions).                                    |                                              |                   |
| Measures set out in                                               |                                              |                   |
| NHS Constitution                                                  |                                              |                   |
| Self-certification of the delivery of all NHS Constitution rights |                                              |                   |
| and pledges.                                                      | Annex B.                                     |                   |
| Trajectories for:                                                 |                                              |                   |
| -                                                                 | -                                            |                   |
| Elective FFCEs.                                                   |                                              |                   |
| -                                                                 | -                                            |                   |
| Non elective FFCEs.                                               |                                              |                   |
| Measures set out in                                               |                                              |                   |
| Activity                                                          |                                              |                   |
| Annex C.                                                          |                                              |                   |
| -                                                                 | -                                            |                   |
| Outpatient attendances.                                           |                                              |                   |
| -                                                                 | -                                            |                   |
| A&E attendances.                                                  |                                              |                   |
| -                                                                 | -                                            |                   |
| Referrals                                                         |                                              |                   |
| Better Care Fund                                                  | Improvement against the agreed BCF measures. |                   |
| Measures set out in                                               |                                              |                   |
| Annex I.                                                          |                                              |                   |

## Content Of Financial Plan

| Segment                                                                             | Covering:                                                                       |
|-------------------------------------------------------------------------------------|---------------------------------------------------------------------------------|
| Financial plan summary                                                              | An overview of the financial plan.                                              |
| Revenue resource limit                                                              | Detail of recurrent and non-recurrent allocations expected to be received.      |
| Planning assumptions                                                                |                                                                                 |
| Provider efficiency, inflation, activity growth (demographic and                    |                                                                                 |
| non‑demographic), contingency, recurrent headroom.                                  |                                                                                 |
| Financial plan detail                                                               | Financial plan for each of the next five years (2014/15 and 2015/16 at a higher |
| 14/15-18/19                                                                         | level of detail). Planned income and expenditure for each service type.         |
| QIPP                                                                                | Detail of financial impact of QIPP schemes for each of the next five years with |
| 14/15-18/19                                                                         | profile for the first two years.                                                |
| Details and valuation of identified risks over each of the next five years          |                                                                                 |
| Risk                                                                                | (2014/15 and 2015/16 at a higher level of detail). Details of mitigation        |
| strategies.                                                                         |                                                                                 |
| Investment                                                                          |                                                                                 |
| Details of planned investment over each of the next five years including use of     |                                                                                 |
| headroom.                                                                           |                                                                                 |
| Statement of financial                                                              |                                                                                 |
| position                                                                            |                                                                                 |
| Detail of assets, liabilities and taxpayers' equity for each of the next two years. |                                                                                 |
| Cash                                                                                | Breakdown of receipts and payments over each of the next two years.             |
| Capital                                                                             | Planned capital expenditure by scheme for each of the next five years.          |
| Contract value                                                                      | Details of forecast spend on current contracts for 13/14 and anticipated        |
| 14/15-18/19                                                                         | contract value for each of the next five years.                                 |

## Content Of Direct Commissioning Financial Plan

| Segment                                                                | Covering:                                                             |
|------------------------------------------------------------------------|-----------------------------------------------------------------------|
| Area Team Summary                                                      |                                                                       |
| Summary of the financial plan for all directly commissioned services   |                                                                       |
| Financial plan summary                                                 |                                                                       |
| An overview of the financial plan for each area of direct              |                                                                       |
| Resource allocations                                                   | Details of allocation for service for each of the next five years.    |
| Assumptions                                                            |                                                                       |
| Provider efficiency, inflation, activity growth (demographic and       |                                                                       |
| non‑demographic) - assumptions for each of the next five years.        |                                                                       |
| Financial Plan Detail                                                  |                                                                       |
| Financial plan for each of the next five years (2014/15 and 2015/16 at |                                                                       |
| Detail of financial impact of QIPP schemes for each of the next five   |                                                                       |
| QIPP                                                                   | years and saving profile for each of the next two years (2014/15 and  |
| Investment                                                             |                                                                       |
| Details of planned investment over each of the next five years         |                                                                       |
| (2014/15 and 2015/16 at a higher level of detail).                     |                                                                       |
| NR proposals                                                           | Proposals for non-recurrent funding over each of the next five years. |
Details and valuation of identified risks over each of the next five 
Risk
years. Details of mitigation strategies and funding required (2014/15 
and 2015/16 at a higher level of detail).
Contract value 

Details of forecast spend on current contracts for 13/14 and 
14/15-18/19
anticipated contract value for each of the next five years. 

## Content Of Direct Commissioning Operational Plan: Nhs England Commissioning Improvement Measures

| Segment                                                | Covering:                                               |
|--------------------------------------------------------|---------------------------------------------------------|
| Improvement                                            | Improvement against the measures identified for area of |
| Measures                                               | Direct commissioning.                                   |
| NHS Constitution                                       |                                                         |
| Self-certification of the delivery of all relevant NHS |                                                         |
| Constitution rights and pledges.                       |                                                         |
| Activity                                               |                                                         |
| Trajectories for relevant activity measures for direct |                                                         |
| commissioning area                                     |                                                         |
for Area Team.
commissioning.
a higher level of detail).
2015/16 at a higher level of detail). 
Measures set out in 
Annexes D-G
Measures set out in 
Annex B.
Measures set out in 
Annex C.