The Local Delivery Plan (LDP) Process. Local Delivery Plans (LDPs) are the Acute Trusts’ (commonly known as Providers) main source of income. LDP income is specifically patient related. NHS funds flow from Central Government to Primary Care Trusts (also known as Commissioners) to purchase healthcare on behalf of their resident population.
The LDPs are agreed with all providers such as Acute Trusts, Community and Mental Health NHS Trusts. Within negotiations with the Commissioners activity quotas by specialty (e.g. cardiology, dermatology etc) and patient class (e.g. outpatients, emergencies etc) are agreed. There is a national requirement for the Trust to plan its annual expenditure (i.e. set a budget) based on its agreed income for the year. The LDP also includes an agreement in terms of quality and standards and information requirements.
Quality standards would include maximum waiting times for procedures and information requirements would include monthly performance management data. The Trust currently has LDPs worth approximately £410m.
The largest commissioner is Birmingham East and North PCT which has a contract worth over £160m. The next two largest are Solihull Care Trust (£78m) and South Staffordshire PCT (£32m).
The Trust’s contract with the West Midland Specialised Commissioning Group is worth £55m. The Trust has a number of smaller contracts with PCTs mainly in the Midlands that make up the balance of its LDP income.
Activity is the currency used with the associated price to monitor performance against LDP plans. Individual currencies are:
- Elective and Emergency hospital spells
- Maternity Admissions
- Day cases hospital spells
- Outpatient Attendances at clinic
- Accident & Emergency Attendances
- And other condition specific currencies such as Renal Dialysis
Each directorate not only has a set budget for the year but also has an agreed level of activity, which, has been commissioned by the PCTs. Directorates need to plan to contain activity and costs to within these agreed amounts.
The budgets given to Directorates are “cash limited” which means that any over spends must be contained within the Trust. Prices and Cost for most hospital activity is now covered by the national system of Payment by Results (PbR). This is a national set of prices and rules for charging that all Hospital Trusts must adhere to. Prices are calculated by the Department of Health annually and are an average of every Trusts reference cost submission. Therefore if a Trust can deliver its activity for less than the national average cost of doing so it will in theory generate a surplus of income over cost.
Negotiation of LDPs
The process of agreeing the LDPs with the commissioners is an extremely time intensive process which is carried out annually from August to February. This involves extensively modelling activity using forecast outturn from the current year and applying variables such as referral growth, the transfer of activity into Primary Care and patient class movements. This then shows the modelled activity we would anticipate for next year.
We then enter negotiations with PCTs to ascertain the level of activity they wish to commission. This will be based on the following elements:
- National targets
- Current activity levels and forecasts
- Waiting list targets in terms of numbers and times for the following year
- Quality standards (e.g. A&E waits etc.)
These assumptions / standards will be agreed jointly by the Trust and its Commissioners, and turned into a set of activity plans on which Trust expenditure budgets and capacity plans will be based.
For a number of reasons, actual activity levels experienced in a year may be more or less than the agreed LDP targets. Reasons may include increases in demand (emergencies and outpatients referrals), access to beds and theatre capacity etc.
The total LDP activity is profiled for the year based on historical trends adjusted for known variations i.e. Bank Holidays etc. Actual activity is then compared to profile activity with any under or over performances showing as a variance.
These variances are then investigated within the year, which will then feed the forecast to year-end and ultimately the LDP process for the following year.
Since the advent of PbR if the Trust over-performs against its contracted activity levels it will usually receive that income at 100%. Similarly if it delivers less activity than in the contract it will repay income at 100%.
Since Foundation status, all of this is covered in a legally binding contract with each of the Trust’s commissioners. This contains all the activity and quality targets applicable to each year and is used as a framework by commissioners to manage their contracts with the Trust.
The Trust is subject to inspection and regulation by a wide range of external agencies. Independent inspections and findings regarding the Trust can be found at the locations below.
The Healthcare Commission
The Healthcare Commission is the independent watchdog for healthcare in England. They promote continuous improvement in the services provided by the NHS and independent healthcare organisations. They carry out an Annual Health Check, this is the most important of the Healthcare Commission’s activities to drive improvements in healthcare for patients. It involves assessing and rating the performance of each NHS trust in England during the financial year from 1 April to 31 March.
Monitor regulates NHS foundation trusts, making sure they are well-managed and financially strong so that they can deliver excellent healthcare for patients.
Dr Foster is an independent provider of healthcare information on a range of health services.
The National Health Service Litigation Authority (NHSLA)
The NHSLA is a Special Health Authority (part of the NHS), responsible for handling negligence claims made against NHS bodies in England. They also have an active risk management programme to help raise standards of care in the NHS to reduce the number of incidents leading to claims.
Improving Working Lives
The Heart of England Foundation Trust was accredited Practice Plus status in 2005 for Improving Working Lives, which recognises the training and support given to staff.
Patient Environment Action Team (PEAT)
The PEAT audit has developed from the Cleaner Environment Initiative. Every inpatient healthcare facility in England with more than ten beds is assessed annually and given a rating.
Information Commissioner’s web site
Lord Chancellor’s Department web site
NHS Freedom of Information web site
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