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86b69309-ae6a-407a-8087-3a209df3a2b9.xls £ 22 M Savings Initiative Overview
Objective: To make recurrent savings of £ 25 M
m
Urgent Care
Existing investment plan projects to reduce non- elective (urgent care) demand. These projects form a key part of the strategy, with £4.5m ROI in 09-10 and £11m in 10-11 in the original plan. it is critically
important to get a good assessment of the risk of non or under achievement of these projects, identify the key blockers to delivery where they exist and revise plans and reconfigure effort to ensure delivery £4.20
Planned Care
Project Elective care project to reduce review OPA and Consultant to consultant referrals to top quartile performance, peer review/conferral of elective referrals
We are commissioning for top quartile performance in efficient elective care utilisation. These projects will be managed through the Elective care project group (MH and SM) £1.10
Corporate
Savings
We intend to improve our business efficiency as a corporate organisation £3.25
Specialised
Services
Expanding list of 'never events' not funded. Savings from specialised services commissioning agency and polled budgets £2.70
Disinvestment Prioritisation of initiatives from the £20m investment plan is ongoing led by CSJ. A further £11.4m will need to be released from the investment plan, after accounting for disinvestments already included under
the above projects, to close the gap. These figures assume all projects achieve intended savings and almost worse case in the financial modelling. If actual case moves towards best case, then the gap could
reduce considerably. £13.00
Subtotal: £24.25
CMB Meetings SRG Meetings
Date Time Location Date Time Location
Tuesday 17th November 2009 1.00 – 3.00pm Assembly Room Thursday 7 January 9 -11:30 Assembly Room, Mosely Hall
th
Tuesday 8 December 2009 12.30 – 2.30pm Venue TBC Thursday 4 February 9 -11:30 Assembly Room, Mosely Hall
th
Tuesday 19 January 2010 1.00 – 3.00pm Assembly Room Thursday 4 March 9 -11:30 Assembly Room, Mosely Hall
Tuesday 16th February 2010 1.00 – 3.00pm Assembly Room Thursday 1 April 9 -11:30 Assembly Room, Mosely Hall
Tuesday 16th March 2010 1.00 – 3.00pm Venue TBC Thursday 6 May 9 -11:30 Assembly Room, Mosely Hall
Tuesday 20th April 2010 1.00 – 3.00pm Assembly Room Thursday 3 June 9 -11:30 Assembly Room, Mosely Hall
Tuesday 18th May 2010 1.00 – 3.00pm Assembly Room Thursday 1 July 9 -11:30 Assembly Room, Mosely Hall
th
Tuesday 15 June 2010 1.00 – 3.00pm Assembly Room Thursday 5 August 9 -11:30 Assembly Room, Mosely Hall
th
Tuesday 13 July 2010 1.00 – 3.00pm Assembly Room Thursday 2 9 -11:30 Assembly Room, Mosely Hall
th 1.00 – 3.00pm Assembly Room September
Thursday 7 October 9 -11:30 Assembly Room, Mosely Hall
Tuesday 17 August 2010
th
Tuesday 14 September 1.00 – 3.00pm Assembly Room Thursday 4 9 -11:30 Assembly Room, Mosely Hall
2010 1.00 – 3.00pm November2
Tuesday 12th October 2010 Assembly Room Thursday 9 -11:30 Assembly Room, Mosely Hall
1.00 – 3.00pm December
Tuesday 19th October 2010 Assembly Room
Tuesday 16th November 2010 1.00 – 3.00pm Assembly Room
Tuesday 21st December 2010 1.00 – 3.00pm Assembly Room
11/17/2010 1
86b69309-ae6a-407a-8087-3a209df3a2b9.xls £ 22 M Savings Initiative Consolidated Action Plan
Programme Savings
Status from Savings Start Date
Workstream Assignment (existing Contribution Original Status Revised Comments /
Workstream Name existing Lead contribution Deliverable / Action Responsible Party (action
Cluster project reporting non re - End Date (RAG) End Date Limiting Issue
reporting recurrent £000 open)
reference) current
Rapid Response Team Transforming Community Mike McGrath £2,082 Commissioning brief MH, PJ, WP 19/11/2009 30/11/2009 A
Urgent Care Services (including details and numbers)
Include assumption in the brief MM 19/11/2009 closed
Reporting from Peter Preparation for delivery: agree principles with MM 19/11/2009 A
March providers, Revision of contract
MDCT Transforming Community Mike McGrath Commissioning brief MH, PJ, WP 19/11/2009 30/11/2009 closed
Services (including details and numbers)
Include assumption in the brief MM 19/11/2009 04/01/10 closed
Reporting from Peter Preparation for delivery: agree principles with MM 19/11/2009 04/01/10 closed
March providers, revision of contract
End of life End of life Ruth Denton £40 Commissioning brief MH, PJ, WP 19/11/2009 30/11/2009 closed
(including details and numbers)
Include assumption in the brief RD 19/11/2009 04/01/10 closed
Reporting from Peter Preparation for delivery: agree principles with RD 19/11/2009 04/01/10 closed
March providers, Revision of contract
Discharge Planning Urgent care Dave Parks £237 Commissioning brief MH, PJ, WP 19/11/2009 30/11/2009 closed
(including details and numbers)
Include assumption in the brief DP 19/11/2009 04/01/10 closed
Reporting from Peter Preparation for delivery: agree principles with DP 19/11/2009 04/01/10 closed
March providers, Revision of contract
CareWell self care Carol Bhalla / Greg £420 G
Pastor
Kenrick Centre Older peoples well being Marion Rogerson £1,152 Commissioning brief MH, PJ, WP 19/11/2009 30/11/2009 A
including details and numbers)
Include assumption in the brief MR 19/11/2009 A
Reporting from Peter Preparation for delivery: agree principles with MR 19/11/2009 A
March providers, Revision of contract
Falls Falls prevention Jane Beach £274 Commissioning brief MH, PJ, WP 19/11/2009 30/11/2009 A savings adjusted by PJ
(including details and numbers) to 250 from 413
Include assumption in the brief MR 19/11/2009 A
Reporting from Peter Preparation for delivery: agree principles with MR 19/11/2009 A
March providers, Revision of contract
GP Led Health Centre n/a Audrey Toms £0 Identify new programme lead BVG 19/11/2009 16/12/2009 A
01/01/2010- Hold for now
Decide whether to commission more activity RB and RH (high level 16/12/2009 A
meeting) 01/01/2010- Hold for now
Pursue cat C diversion with WMAT (ongoing) AT / contracting team & 16/12/2009 A
D.Parkes 01/01/2010- Hold for now
Decide whether relocation feasible (A&E or RH (high level meeting as 16/12/2009 A
Maybe Merge nearer) [ waiting for a high level meeting at UHB above)
to decide] 01/01/2010- Hold for now
GP in A&E PBC leads (Ross B) Identify new programme lead BVG 19/11/2009 16/12/2009 G 21 Dec Agenda Item
(may need to wait
until disinvestments
decided)
All Urgent Care Finance templates and negotiating brief to be PJ & D.Parkes closed
Programme revised week beginning 16th November 09
All Urgent Care UC projects included in the investment HS closed
Programme prioritisation meeting 12th November
All Urgent Care Discussion with CMB in January Executive 19 Jan CMB January G On 19 Jan CMB
Programme Agenda agenda
All Urgent Care Begin contract negotiations with providers from Negotiation team 04/01/10 closed
Programme 17th of November
All Urgent Care High level finance negotiation meeting with UHB RH 04/01/10 closed
Programme FD. TBA
11/17/2010 2
86b69309-ae6a-407a-8087-3a209df3a2b9.xls £ 22 M Savings Initiative Consolidated Action Plan
Programme Savings
Status from Savings Start Date
Workstream Assignment (existing Contribution Original Status Revised Comments /
Workstream Name existing Lead contribution Deliverable / Action Responsible Party (action
Cluster project reporting non re - End Date (RAG) End Date Limiting Issue
reporting recurrent £000 open)
reference) current
Urgent Care £4,205
Planned Care Achieving peer benchmark Reporting should be Sultan M, Barbara K, £500 Identify 3 categories of review OPA over SM, BK, MH closed
Projects for new : review OPA ratio provided by the Martin Harris benchmark
• Diabetes Performance Team: Martin • A Review OPA of limited clinical value (e.g.
• Cardiology Harris and Sultan M. intra specialty variation not explained by case
• Rheumatology mix, OPA following negative diagnostic tests )
• ENT • B Review OPA for care normally carried out in
• Max fax general practice (QoF) e.g. diabetes annual
• Pain management review, annual TFTs
•Dermatology? • C Review OPA which could be carried out in
community for which new care pathway has
already been developed; rheumatology, diabetes,
pain management
• D Review OPA where new care pathway not
been developed locally, including 1 stop shop
ideas
Signoff negotiation (commissioning) brief SG 19/11/2009 21/12/2009 closed
Detailed review of what to include in the contract MH /DR / SG 19/11/2009 04/01/09 A
Split of specialties by category MH 30/11/2009 04/01/09 A
Inclusion of metrics in the contract MH 30/11/2009 04/01/09 A
Draft recommendation on what to include in the MH 30/11/2009 January G Recommendations
contracts for planned care, include high level issued; waiting for
pathway
responses
Consultant to consultant SM, BK, MB £200 Identify costed list of CON CON referrals over the SM November G
referrals benchmark and/or clinically undesirable
Signoff negotiation (commissioning) brief 19/11/2009 23/1//2009 closed Brought to CMB for
discussion
Detail view how to include in the contract 19/11/2009 04/01/09 A
Detail the specialties this relates to MH 30/11/2009 04/01/09 A
Never events not paid for QSS (Quality, Safety and Denise P, JC £0 List devised and costed(Monday BVG) JC, Denise P 30/11/2009 07/12/09 closed
Standards) Group Bring back the list (the final proposal)
DP Previoulsy was Obtain proposal to include in commissioning brief Phil Johns closed
£372, does not
seem likely we
will have this kind
of savings)
Inclusion & Signoff negotiation (commissioning) 19/11/2009 closed
brief
Detail view how to include in the contract, after Karen 19/11/2009 19/1/2009 A
the never events are identified in discussion with
the providers and costed 4 Jan Agenda Item
D/W providers at contract negotiation meetings Contracting /negotiation ongoing A
including financial framework teams 4 Jan Agenda Item
Devise procedure for event identification Contracting /negotiation 10/01/09 G
teams
Contact CBSA to monitor (to contact for reports - Phil Johns / Denise P. 23/11/2009 07/12/09 closed
Marie Ovens) Not good outcome,
not able to track.
Need to develop way
11/17/2010 3
86b69309-ae6a-407a-8087-3a209df3a2b9.xls £ 22 M Savings Initiative Consolidated Action Plan
Programme Savings
Status from Savings Start Date
Workstream Assignment (existing Contribution Original Status Revised Comments /
Workstream Name existing Lead contribution Deliverable / Action Responsible Party (action
Cluster project reporting non re - End Date (RAG) End Date Limiting Issue
reporting recurrent £000 open)
reference) current
Need to agree with CBSA to adjust coding so that Denise P / Jim Cowan 07/12/09 21/12/2009 closed
we will be able to monitor the savings from never
events. meeting with CBSA
Meeting scheduled next week for discussion with not successful, need
CBSA. Report back on the following meeting to adjust
UHB and ROH should report on an ongoing basis Denise P 07/12/09 A
on the never events.
Contract schedule devised CBSA account manager? 10/01/09 A
Non PBR review project PJ also investment £0 Review and benchmark non PBR spend PJ 21/12/2009 A Moved to Action item
prioritisation CSJ for 25
Agree possible disinvestment CMB/CMT/investment 21/12/2009 A
prioritisation process 7 Jan SRG
Review contractual terms Contract negotiation teams 21/12/2009 A
Negotiate with providers Contract negotiation teams 21/12/2009 A
Confirm proposal completed (BVG Mon) PJ 21/12/2009 A
18 Jan BVG
Signoff negotiation (commissioning) brief 21/12/2009 A
Detail view how to include in the contract 21/12/2009 A
PBC referral management PBC Governance (or SRG) PBC leads and Locality £500 JT CMB 17th November 17/11/2009 closed
project Managers
Allocate new leader (after disinvestment) BVG 19/11/2009 21/12/2009
Rita S. Skills audit OPA specialties across each cluster LDs 31/12/2009 G
Set prices using pricing framework already Jonathan Mason 31/12/2009 G
developed
?low tech willing provider accreditation for D.Parkes 31/1/2010 G
providers
GP providers on CAB (choose & book) ND 30/2/2010 G
Alternatively/also design referral peer review tbc G
process (SBIC model)
Decommissioning LES’s no Primary Care Contracting Audrey T, Ken D £100 Discuss action after the primary care contracting BVG 19/11/2009 closed
longer required Group discussion
RH / SG List the LES that can be decommissioned. S Gidda 30/11/2009 closed
Circulate the paper prior the meeting on the
21/12 21/12/2009
Audrey Toms to complete paper on how to Audrey Toms. Sarb 20/11/09 closed
decommission LES (recommendation on which
services should be decomissioned); bring
forward to review.
Review should take place at next CMB meeting
4/1/2009
Identify redundant LES’s through LES review and AT & CSJ 14/12/2009 G 19/1/2009
prioritisation of investment process. Needs to be
reviewed as part of clinical meeting
Need time line
Approve decommissioning plan Primary Care contracting G
group/ HQCFA
group/CMB/CMT 21/12/2009 Need time line
Give notice in required timescale (3 or 6 months) Mary C, Jonathan M 31/1/2010 G
Need time line
Send the notice out that certain LES's will be MG, S Gidda G
decommissioned 7/12/2009 Need time line
PMS review Primary Care Contracting Sarb G- primary care ROI £100 Existing Project Plan (PMS review paper S Gidda 18/01/2009 G
Group project presented at the meeting)
To provide update at the BVG will be discussed on
Prove Savings the 18/1
RH / SG Follow w/Sarb for progress report JT 20/11/2909 G
QIPPP SRG Await SHA QIPP summary profile R Symons 11/19/09 31/12/2009 G
11/17/2010 4
86b69309-ae6a-407a-8087-3a209df3a2b9.xls £ 22 M Savings Initiative Consolidated Action Plan
Programme Savings
Status from Savings Start Date
Workstream Assignment (existing Contribution Original Status Revised Comments /
Workstream Name existing Lead contribution Deliverable / Action Responsible Party (action
Cluster project reporting non re - End Date (RAG) End Date Limiting Issue
reporting recurrent £000 open)
reference) current
Planned Care £1,100
Corporate Savings Review of corporate Audit Committee RH £1,500 Review current budgets against out turn and R Hardy 04/01/10 closed
budgets structure
RH Formulate options and principles RH/DR/CMT 07/12/09 A
Re-write corporate policy and procedure e.g. Abbie C, John McI 07/12/09 A
travel bookings, hospitality
Meetings with all directors to identify recurrent RH (Andrea H) with All 07/12/09 A
savings and commitments not funded
Savings plan formulated to inform budget setting AH 07/12/09 A
for 10 11
Prescribing QSS (Quality, Safety and Jonathan H £500 Continue formulary development J Horgan / Satnaam 17/03/10 G
Joint formulary (MM Standards) Nandra
strategy)
Come back with a view of how to include in the Jonathan / Satnaam 04/01/10 closed
contracts
Devise implementation plan J Horgan / Satnaam 17/02/10 G
Nandra
Monitor prescribing against formulary SN 21/12/2009 A
Prescribing efficiency QSS (Quality, Safety and JH £750 Develop plan JH 21/12/2009 G
Standards)
Shared services agency Audit Committee RH £250 JT (Fin Dir at BEN) presentation BEN/RH 31/12/2009 G
review RH
• IT
• Estates
• Primary Care services
• Financial Services
Joint procurement across RH £250 D/W HPC RH 31/12/2009 G
City
Corporate Savings £3,250
specialised Continuing care- spot SRG Karen Farrough, Denise £700 Participates in group work to produce project plan Denise P 30/11/2009 A
services purchasing reduction and P to release savings Agenda item 25 Jan
planning assumptions Action Item from 11
Jan - Rachel to follow
Rita S RH to chase BEN re intentions. Formal letter. RH 18/1/2009 closed
Follow up confirmation of assumptions for next ??? 11/01/09
year.
Review Assumptions RH 20/11/2009 A
Mental Health SRG RH £500 Agree £120k deaf services invest to save RH, Jane Collier 30/11/2009 closed
Managing overspend
Rita S Review Assumptions RH 20/11/2009 A
Mental Health SRG RH £500 Clear statement of intent to BEN via associate Contracting lead 30/11/2009 closed
Further efficiency commissioner meetings in contracting round
Provide response to BEN Karen Farrel 11/01/09 need to agree
timeline
Rita S Review Assumptions RH 20/11/2009 A
LD pooled budget, removal Board RS £1,000 Check assumptions with BEN (Andy Donald) and RS 30/11/2009 A Don't assume this is
of cost pressure by LA LA (John Tomlinson) in our plan. 11 Jan
Action - Rachel to
fullow w/Jhn T.
Review Assumptions RH 20/11/2009 A 11 Jan Action -
Rachel follow for next
year's planning
assumption
11/17/2010 5
86b69309-ae6a-407a-8087-3a209df3a2b9.xls £ 22 M Savings Initiative Consolidated Action Plan
Programme Savings
Status from Savings Start Date
Workstream Assignment (existing Contribution Original Status Revised Comments /
Workstream Name existing Lead contribution Deliverable / Action Responsible Party (action
Cluster project reporting non re - End Date (RAG) End Date Limiting Issue
reporting recurrent £000 open)
reference) current
Specialised
services £2,700
Disinvestment Procedures of limited SRG CSJ Jim C £3,000 Review costed list against contractual headings CSJ 17/11/2009 closed
clinical value at CMB 17th November
CSJ Consultation plan, with PIAG, wider PBC Steph B CSJ/Rita 11/30/09 R
etc(Prioritise and need to agree and ready care
disinvestments)
Add results of discussions to negotiating briefs D Parkes, P Johns 11/30/09 A
Agree on the process of sign off the final list. CSJ 12/08/09 A
Sign off brief and intentions at CMB December.
Draft a process paper
Agree on the final list by early January CSJ 31/1/2009 G
Sign off consultations with primary and DR/CSJ 01/12/10 G
secondary care clinicians UHB interface
Discuss at UHB high level meeting and other RH 14/12/2009 G
provider contract negotiation meetings
Design policing and appeals processes for Contracting team lead 01/30/10 G
identified procedures
Discuss with Moira what the consultation with the CSJ 01/30/10 G
public should look like
Develop prior approval schedule in contracts 31/12/2009 G
Contract team lead for
each contract
Agree process and content with providers Contract negotiating team 31/12/2009 G
leads
1) Disinvestment from SRG , CMB Rita/CSJ £10,000 Prioritisation process with discretionary contracts CMT 11/30/09 07/01/10 A
current strategy, and 10 11 investment strategy
2) Discretionary contracts
Prioritisation process with 10 11 strategy programme leads
review, 3)
investment and current investment program
Disinvestment from 2010
11 strategy To agree where the cut off line of disinvestment CSJ
will come. Discuss at SRG meeting in January
Prioritisation process with current strategy and CMT
discretionary contracts
Disinvestment £13,000
11/17/2010 6
86b69309-ae6a-407a-8087-3a209df3a2b9.xls £ 22 M Savings Initiative Risk & Issues
Impact Target
Date
# Programme Cluster Programme Risk Severity (likelyhoo Mitigation Steps Responsible Party Resolution RAG
Identified
d) Date
1 Urgent Care All Urgent care projects do not deliver ROI through High
failure to reduce non elective demand, £4.2m
ROI this year £11m next
2 Urgent Care All Failure to agree new urgent care developments High
within existing resource
3 Urgent Care All Increased urgent care capacity and cost High
4 Planned Care Projects All CMB do not agree which Con Con referrals High
come out of the contract/ unable to negotiate
contract with providers
5 Planned Care Projects All CMB are unable to agree which review OPA to High
be returned to general practice or not done.
6 Planned Care Projects All FTs do not implement clinical pathways already High
developed
7 Planned Care Projects All CMB/PBC do not agree to manage referrals High
internally
8 Disinvestment All Insufficient procedures of limited clinical value High
are identified
9 Disinvestment All Prior approvals schemes for PoLCV are not High
identified
10 Disinvestment All CBM cannot achieve agreement on PoLCV not to High
be done
11 Disinvestment All Public do not support reduction in PoLCV High
12 Disinvestment All Prior approvals scheme not developed or High
negotiated in contract
13 Planned Care Projects All No agreement reached re never events and High
mechanisms for identification and non payment
14 20/11/2009 Corporate Savings All Not enough resources High
15 20/11/2009 Specialised Services All Not able to deliver the plan (savings) High
16 20/11/2009 Corporate Savings All Not able to deliver the plan (savings) High
17 20/11/2009 Specialised Services All Reliance on partners without the ability to High
influence the outcome
18 20/11/2009 Corporate Savings All Reliance on partners without the ability to High
influence the outcome
Target
Date
# Programme Cluster Programme Issue Resolution Steps Responsible Party Resolution RAG
Identified
Date
1 RATS Fully recruited Mike McGrath
Reducing complexity in MAU.
Urgent Care Need to ensure capacity fully used
2 MDCT Key rate limiting step is agreement with provider Mike McGrath
Urgent Care to recruit within existing resource
3 Urgent Care End of life Cannot happen without MDT in place Ruth Denton
4 Discharge Key issue is getting referrals to service from Dave Parks
Urgent Care Planning UHB staff.
5 Kenrick Centre Cannot happen unless capacity envelope Marion Rogerson
remains the same.
Contract negotiation with provider arm needs to
produce agreement that Kenrick will be
replacement, not additional beds within existing
resource.
Bed review shows where resource can come
from. Needs to be discussed with provider arm,
agreed and incorporated in contract
Urgent Care
6 GP led HC GP led HC is working over agreed activity profile Audrey Toms
Urgent Care with no A&E diversion
7 GP in A&E No shared concept yet as to model of care PBC leads (Ross B)
between commissioners and UHB.
No operational plan yet, provider(s) not identified
No savings identified
Urgent Care
11/17/2010 7
86b69309-ae6a-407a-8087-3a209df3a2b9.xls £ 22 M Savings Initiative Risk & Issues
Target
Date
# Programme Cluster Programme Issue Resolution Steps Responsible Party Resolution RAG
Identified
Date
8 Planned Care Projects Achieving peer No agreement with providers re benchmark ratios Sultan M, Barbara K
benchmark for as desirable.
new : review Diabetes re-design in progress. Commissioner
OPA ratio and provider wish diabetes centre in community.
• Diabetes No agreement yet re pathway implementation.
• Cardiology
Move to community cardiology service does not
• Rheumatology
save money.
• ENT
• Max fax Rheumatology pathway agreed but reluctance to
• Pain implement by acute provider and commissioner.
management Enabling LES behind schedule.
ENT and max fax, no specific plans
9 Planned Care Projects Consultant to No consensus amongst commissioners locally or SM, BK, MB
consultant regionally regarding undesirable CON CONs
referrals
10 Planned Care Projects Procedures of Time consuming work CSJ Jim C
limited clinical Public consultation may be necessary.
value No commissioning process identified for removal
from contract
Overlap between this work, other PCTs and
regional and national work
No costed process identified for policing/ hearing
appeals
11 Planned Care Projects Never events not May be problems in identifying events within Denise P, JC
paid for HES data and mapping events onto HRG or
procedure codes.
Concern re disincentive to incident reporting
12 Planned Care Projects PJ also Project not started. PJ also investment prioritisation CSJ
investment Difficult to negotiate especially with provider
prioritisation organisation
CSJ
13 Planned Care Projects PBC referral PBC leads and Locality
management Still in a conceptual stage in PBC leads minds. Managers
project Good example from SBIC ? transferable to a
larger cluster/whole PCT
Previous single practice referral conferral project
unsuccessful
14 Planned Care Projects Decommissionin Unpopular with GP practices. Audrey T, Ken D
g LES’s no Need to be sure LES activity genuinely not
longer required required and no increase in secondary care
activity
15 Planned Care Projects PMS Review Difficulty in identifying finance against activity. Sarb G- primary care ROI
Unclear if any savings possible from 11 PMS project
practices
Primary care dis-investment may increase
secondary care costs
16 Corporate Savings Review of Current budgets do not reflect commitments. RH
corporate Director time/skills to review own budgets
budgets
17 Corporate Savings Prescribing Slow process developing the formulary because Jonathan H
Joint formulary of complexity of stakeholders
(MM strategy)
18 Corporate Savings Prescribing MM team will need to engage practices with the Jonathan H
efficiency plans. Base on better care better value indicators
19 Corporate Savings Shared services BEN commission shared services. Difficult to RH
agency review influence. Poorer quality of commissioning
• IT
• Estates
• Primary Care
services
• Financial
Services
20 specialised services Continuing care- Budget managed by BEN Denise P
spot purchasing
reduction and
planning
assumptions
21 specialised services Mental Health Pooled budget managed by BEN from April 10 RH
22 specialised services Managing Pooled budget managed by BEN from April 10 RH
overspend
23 specialised services Mental Health Pooled budget managed by BEN from April 10 RS
24 specialised services Further LA pick up of overspend may not happen
efficiency
11/17/2010 8
