Role of the Strategic Health Authority

1
Role of the Strategic Health Authority

• Tim Lowe
• Head of Finance (Capital Investment Estates)
• CIPFA NE Region - 4th June 2007

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Role of the Strategic Health Authority

• Recent changes in NHS Yorkshire the Humber
• Role objectives of the SHA
• How the SHA operates
• Finance functions within the SHA
• Some issues now into the future

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Recent Organisational Change

• 3 SHAs into 1 (of 10 in England)
• - coterminous with Govt Office, Yorkshire
  Forward
• 34 PCTs into 14
• - largely coterminous with Local Authorities
• 3 Ambulance Trusts into 1 (Yorkshire)
• development of Foundation Trusts
• - now 10 FTs, with 12 further NHS Trusts to go

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Role Objectives of the SHA

• Outcomes
• - Patient Care Quality Assurance
• - Improving the Health of the Population
• Enablers
• - System Reform Market Management
• - Delivery Efficiency
• - Corporate Responsibility

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Patient Care Quality Assurance

• Ensure achievement of key national priorities
  across Yorkshire and the Humber including
• - Achieving a maximum wait of 18 weeks from GP
  referral to start of treatment of patients
• - To deliver the national target for reductions
  in MRSA rates to set local targets for
  reducing other infections
• - To develop specific regional targets to
  improve patient care, experience and outcomes in
  diabetes stroke care
• - To establish an effective system for learning
  from and managing adverse clinical
  events/practices.

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Improving the Health of the Population

• To develop and implement plans for delivery of
  key priorities, such as
• - To set specific targets for each PCT to reduce
  inequalities in their area and thereby make a
  significant contribution to 2010 life expectancy
  targets.
• - To have an additional 38,949 four-week
  smoking quitters by the end of March 2008
• - To deliver the national target that by 2008
  everyone referred to a sexual health GUM clinic
  should be offered an appointment within 48 hours.

• Tim Lowe - CIPFA NE Region - 4th June 2007

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System Reform Market Management

• Demand Side Reforms
• - Commission and develop the use of data on
  patient experiences and public expectations
  perceptions, to lead and drive commissioning
  across the region.
• - To ensure patients are offered and able to
  exercise informed choice when selecting their
  primary and secondary health services.

• Tim Lowe - CIPFA NE Region - 4th June 2007

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System Reform Market Management

• Supply Side Reforms
• - The establishment of viable markets to ensure
  real choice, with diversity of supply, whilst
  ensuring viable service providers are developed
  sustained.
• - To ensure all NHS providers progress to FT
  status with five more Trusts becoming FTs in
  2007/8.
• - To identify those services where a regional
  overview is required and set out a framework for
  service reconfigurations

• Tim Lowe - CIPFA NE Region - 4th June 2007

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System Reform Market Management

• Workforce Development Reforms
• - To commission medical, nursing and
  professional training which is fit for and aids
  the reform of the NHS.
• - To develop a Leadership and Talent programme
  across Yorkshire and the Humber.
• - To support all NHS organisations in Yorkshire
  and the Humber in the development of training
  for a fit for purpose workforce.
• .

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Delivery Efficiency

• Build on the sound financial management of NHS
  Yorkshire and the Humber ensuring
• - Continued good financial management and
  control
• - All organisations within the region achieve
  their statutory financial duties
• - Organisations with historic debts have robust
  plans to pay these off over realistic timescales
• .

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Delivery Efficiency

• Provide strategic leadership and direction
  ensuring all organisations develop their
  leadership capability to deliver effective health
  services resulting in
• - Strong commissioning, ensuring best possible
  services and value for money across Yorkshire
  and the Humber
• - The effective introduction of GP
  practice-based commissioning region-wide
• - The successful implementation of the
  Connecting for Health IM T programme in
  Yorkshire and the Humber

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Corporate Responsibility

• To play an active role in the management of the
  NHS nationally, including lead on specific
  projects
• To ensure all NHS organisations have the highest
  standards of corporate governance.
• To ensure all NHS organisations meet the
  requirements of the Civil Contingencies Act in
  emergency preparedness.
• To build relationships with key stakeholders
  across Yorkshire and the Humber to deliver the
  wider health and social care agenda.

• Tim Lowe - CIPFA NE Region - 4th June 2007

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How the SHA operates

• Mainly outward facing, but with operational
  elements
• Accountability without direct managerial control
• Performance management line predominantly
  through PCTs
• Development of Trusts to FT status
• Earned autonomy / targeted support
• Influencing upwards with DH

• Tim Lowe - CIPFA NE Region - 4th June 2007

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SHA Finance Functions

• Workforce and corporate
• Performance management
• Turnaround Provider development
• Commissioning
• Capital investment estates

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Workforce Corporate

• Financial management accounting functions to
  support workforce hosted budgets (gt600m total)
• Education contracts
• - legal contracts with HEIs FTS
• - funding flows / quasi-contracts with other NHS
  orgs
• Corporate governance / audit liaison etc.
• Transaction support outsourced

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Performance Management

• Receiving / chasing monitoring reports from NHS
  organisations (except FTs)
• QA and onward reporting to DH
• Cash management
• banking function / strategic investment fund

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Turnaround Provider Development

• Active challenge support to organisations with
  financial difficulties
• Diagnostic developmental support to Trusts
  pursuing FT applications
• Advice expertise around funding flows
• - Payment by Results
• - patient level costing
• - development of tariffs for non PBR services

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Commissioning

• Diagnostic support for PCTs to strengthen
  finance input to commissioning process
• Financial models to support commissioning
• - Practice based commissioning
• - Specialist / collaborative commissioning
• Contract implementation decision support

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Capital Investment Estates

• Review / approval of business cases
• - in line with delegated limits
• - technical / economic appraisal
• - strategic fit investment priorities
• Financial management
• - Implementation of new capital regime for
  Trusts
• - Support for PCTs / use of strategic capital
• Private finance issues (PFI / LIFT)

• Tim Lowe - CIPFA NE Region - 4th June 2007

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Current future issues

• Impacts of organisational change
• Diverse nature of area health inequalities
• 2008/09 financial cliff edge
• Built in obsolescence
• Regulation / developing relationship with
  Monitor

• Tim Lowe - CIPFA NE Region - 4th June 2007