20 th September 2018 Healthier. Stronger. Together Live - - PowerPoint PPT Presentation

• Healthier. Stronger. Together

Welcome to our Annual General Meeting

20th September 2018

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Financial Review

Sarah James, Chief Financial Officer

How we spent our money in 2017/18

Our key financial duties in 2017/18

Target Performance Achieved Total expenditure not to exceed total income £1.471m surplus delivered Yes CCG remains within its administration/running costs allowance £4.210m spent against allowance of £4.257m Yes

What is the breakdown of the surplus?

Target Surplus £000 Actual Surplus £000

Operational Surplus 96 99 National Prescribing Rebate 232 National Risk Reserve 1,140 1,140 Total 1,236 1,471

… key financial duties continued

Target Performance Achieved 95% of invoices by volume and value paid within 30 days >95% achieved by volume and value for NHS and non-NHS creditors Yes Cash balance at year end

• f no more than 1.25% of

cash drawn in March Cash balance of £0.079m against a limit of £0.238m Yes

2017/18 Savings

Achievements

• £10.4m savings (90% of target achieved

and 4% of our funding allocation)

• Strong programme approach and clinical

buy in to support service transformation

• Focus on managing demand and

avoiding activity of low qualitative value

• Successful schemes included Early

Home Visiting and Falls Rapid Response

• Enhanced scrutiny of transactions
• Some difficult choices to limit access to

services based on stricter clinical criteria

MSK £0.5m Urgent Care £1.2m CHC/FNC £1.3m Elective Demand £0.8m Medicines £1.1m Finance & Business £1.6m Other £3.9m

Challenges for 2018/19

Funding growth

• 2.8% funding increase
• £1.9m new funding to meet key national

priorities

Key expectations

• A&E 4 hour and waiting list performance
• Mandated investment in adult & child mental health

and primary care

• Provider inflation and tariff increases
• Population and demand growth
• Other cost pressures e.g. prescribing
• Investments to deliver change and savings

Funding gap £6.2m

Review of 2017/18 and future plans

Tracey Cox Chief Officer

The NHS in the Headlines

• Brexit
• Demographic growth & Ageing Population,

Patients with long term conditions

• Health & Care Services under pressure –

“Winter”

• The monetary position is still really

challenging

• Workforce Shortages
• New Health Secretary

Some of the solutions ……..

• Integration & integrated working across health and

care providers

• Working differently and finding new ways of

delivering services

• Digital agenda & advances in medical treatment
• The Long Term Plan for the NHS

Our primary care services

• 91% of patients rate their experience of GP care as good
• All our practices are rated as ‘good’ or ‘outstanding by the

Care Quality Commission

• Our practices are starting to work closer together to ensure

resilience and sustainability and provide more services in the community

• The CCG’s Primary Care Strategy sets out our vision

Primary care is changing

• Practices merging or coming together as federations e.g.

Heart of Bath Medical Partnership and Minerva Health Group

• St Augustine’s moved to purpose-built new premises
• Developing and supporting practices to work as an integrated

team of multi-disciplinary professionals via work of Clinical Integrators

How is Integrated working developing across B&NES?

Joining up health and care services

• Closer working between the Council & CCG
• Benefits of more person-centred services,

reduced duplication, making best use of limited resources

• Pooled budgets for some areas
• Established a joint Health and Care Board in

Shadow form, first Public meeting in early 2019

Managing the needs of children with Complex health needs

• We are one of the first areas to create a pooled budget

for children and young people with multiple and complex needs

• A Joint Agency Panel meets every month to decide how

to use this budget to commission, monitor and review packages and placements

• Budget made up of education (45.1%), social care

(41.2%) and CCG (13.7%)

What difference has it made?

• Brings together knowledge and expertise to

improve outcomes for children

• Quicker and better decision making on

complex cases

• Improved dialogue and relationships between

professionals

• No more arguing about which organisation

pays for what

• Improved financial efficiency, sustainability

and accountability

Looking Ahead

Challenges ahead and how is the CCG responding ?

The challenges ahead

• Number of people aged 65 & over will increase

by 19·4%: from 10·4M to 12·4M

• Number with disability will increase by 25·0%:

from 2·25M to 2·81M

• Life expectancy with disability will increase

more in relative terms

We are focusing on Older People

• It crosses health and social care, so can drive

integration

• Large increases in over 65s in B&NES by 2030
• Impact on the NHS, from a greatly increased

incidence of chronic long-term health conditions, including dementia, arthritis, diabetes, stroke and heart disease

• Change needed in attitudes to ageing
• We want to support older people and those with

frailty to stay healthy and independent

Frailty Work Across B&NES

• Developing multi-disciplinary team working in

2 Residential Homes launched on 6th September (Pilot)

• Advanced Nurse practitioner seconded from

the RUH to support community staff in developing their skills in management of frailty

• End of Life Care - Advanced Care Planning

Specialist Nurse appointed until March 2019 to help with training and developing staff in End

• f Life Care

Digital Agenda

Digital developments

Fun facts Used internet in last 3 months:

• 90% adults
• 99% 16-34
• 80% 65-74
• 44% 75+

Two practices have more than 40% of their population registered with GP services

• nline. Across BaNES this falls

to 26%.

Other technological advances

Consultant Connect Paediatric HandiApp

Have your say on the long term plan

• Three key themes:
• 1. life stage (early life/ageing well)
• 2. clinical priorities (e.g. cancer, respiratory),
• 3. enablers of improvement (e.g. workforce,

primary care)

• Discussion guide with some questions to consider
• Deadline for submission is the 30 September
• Visit www.engage.england.nhs and search on

‘long term plan’

Local outcomes for 2017/18

• Cancer

Outstanding

• Mental Health

Outstanding

• Maternity

Outstanding

• Dementia

Good

Thank you and any questions?

https://youtu.be/x-B784RP800

REFRESHMENTS

The Wigan Deal Cllr Keith Cunliffe Deputy Leader Wigan Council

Confident Place, Confident People.

Different relationships between Public sector and the Citizen

Confident Place, Confident People.

• 320,000 Population. Ninth-largest metropolitan authority in

England, second largest Council in Greater Manchester.

• Local Authority responsible for an annual revenue budget of

£864m a year.

• Adult Social Care accounts for around a third of the Councils net

resource.

• Over 7,000 people supported within adult social care each year.
• Annual Health & Social Care spend across

the place - £669m.

Wigan in Profile

Confident Place, Confident People.

Confident Place, Confident People.

A Familiar Challenge: Our Response

Achieved In Progress Planned

• Opportunity to do thing differently
• Wigan one of six to be awarded

‘Creative Councils’ funding to test new ideas about how public services are delivered

• A new relationship with residents and

communities

• People at the Heart of Scholes’ - integral

to this thinking supported by NESTA and the LGA

• Work in Scholes - powerful impact and

challenged the way we work with services users and the wider community

• Commitment to invest at scale

Third largest proportionate reduction in funding across the country through Government austerity

Confident Place, Confident People.

Context – Adult Social Care:

The Ca Case for r Ch Change

• 2011/12 projected overspend of £6.9million, with rising

demand for services

• A traditional service model - care management focus
• Lack of leadership and direction
• Accountability issues throughout the service
• Dis-engaged and risk averse staff; multiple assessments;

bureaucratic processes

• Listen to what is important to you
• Support you to have more independence
• Give you support that is unique to you
• Provide you with greater choice
• Give you access to new opportunities
• Be open minded to our new approach
• Share your ideas and be honest
• Get involved in planning your care
• Think differently about what you need
• Focus on what really makes you happy

Signed Signed

Lord Peter Smith of Leigh, Leader of Wigan Council

Give you time to understand service users Relieve the paperwork pressure Provide a high level of support Give you real influence Support you to make connections Take your time to understand service users Embrace new ways of working and new technologies Be part of an innovative way to deliver care Empower people to take control Think about improving their whole lives

Signed Signed

Lord Peter Smith of Leigh, Leader of Wigan Council

Confident Place, Confident People.

The Deal - 10 Essential Components

• Strong Narrative - a simple concept

that everyone can understand but is profound in its implications .

• A belief that this is a movement not

a project - rooting the approach in public service values: “sense of vocation”.

• Leadership at every level -

commitment and senior sponsorship

• Workforce culture change - training

and core behaviours that define how we work, whatever the role.

• A different relationship with

residents and communities

• building self reliance and

independence

• Permissions to work differently -

leadership backing: ‘we will support you’

• Redesigning the system - testing our

systems, processes, ways of working against our principles: ‘do they make the culture and behaviours we want more or less likely?’

• Enabling staff with the right tools

and knowledge

• using new technology to support new

ways of working and new roles

• A new model of commissioning and

community investment - market development and new arrangements for commissioning

• Supportive enabling functions -

breaking down barriers to progress and facilitating the change

Confident Place, Confident People.

Making it happen: it’s simple but profound

• Having a different conversation
• Knowing your community better
• Attitudes and behaviours of staff
• Giving permission and freedom to redesign and innovate
• Co-location of teams and partner agencies in a place

Confident Place, Confident People.

The Deal for Adult Social Care & Wellbeing

A Relentless Journey of Reform

2012 – 2013

• Political & Senior Management sponsorship of a shift

New vision for Wigan set out – underpinned by a political appetite for risk and a formula for sustainable public service reform

• Leadership & Management Reform:

Senior Management Restructure. Director posts for Adults and Childrens established - responsible for delivering the ‘Deal’ across the Life course.

• The ‘Deal’ approach nurtured and developed in Adult Social Care
• Public Health integration – maximising synergies across population

health, social care & wellbeing

Confident Place, Confident People.

2013 - 2014 ……………

• Day Support Modernisation – 2 phased approach. £1.5m saved via shift from a

traditional building based model to vibrant community connection. 14 buildings reduced to 6

• Redesign of management capacity & internal leadership within the Directorate – to

drive cultural change and new models of commissioning

• Workforce reform at scale – new permissions and roles:
• Sustained Service Manager Leadership
• Community Knowledge Officers
• Quality Performance Officers, Lead Provider Managers
• Social Care Officer and Primary Assessor roles
• Community Investment Fund launched

July 2013. Investment NOT Grant

• Legislative Reform – Deprivation of Liberty

and preparation for the Care Act (April 2015).

Confident Place, Confident People.

2015………..

• Housing with Care - £2.3m saved through the

redesign of supported accommodation around shared models of support, community connection

• Restructure - changing attitudes & behaviours in
• perational Support & Safeguarding
• Transformation through Technology – new care

management system and 400 frontline workers equipped with agile devices. £0.8m saved.

• Leisure contract managed under Director of Public

Health – better connecting wellbeing outcomes with strategic health and social care priorities

Confident Place, Confident People.

2016

• Ethical framework – an asset based commissioning market focusing on

quality and sustainable care at home.

• Scaled Up Reablement – pump prime investment secured through

GM Transformation Funding

• Co-location of front line teams in multi service centres
• Operational reconfiguration around the customer journey.

Integrated Hospital Discharge Team established with health partners – ‘home first’ ethos

• Joint Integrated Care Organisation Director (Rebecca Murphy)

appointed – Healthier Wigan Partnership

Confident Place, Confident People.

• Integration of Housing and Adult Social Care – more joined up planning

and use of housing for health

• People Powered Technology - £1m programme of

investment in smart technology to help people remain independent at home - On-line Brochure

• Reformed model of Extra Care to deliver a more personalised, strengths

based offer of support whilst securing £0.35m of cost efficiencies (37%)

• Place Based Working – restructuring of public services around seven

service delivery footprints across the ‘place’

2017

Confident Place, Confident People.

Workforce

Job Specification Deal for your street

Confident Place, Confident People.

Care Home Reform

• Nationally 3rd most improved care home quality
• Most improved care home quality in Greater Manchester
• 88% rated good or outstanding
• Supported 3 providers to move from Inadequate to Good

within 12 months and one inspection

• Towards Outstanding Programme
• Good relationships with local CQC inspectors who have

confidence in our approach

Confident Place, Confident People.

Care Home reform

Comparison 2015 2018

• verall

Safe Effective Caring Responsive Well led

Outstanding 1 1 1 1 1 Good 26 43 44 45 48 45 42 Requires Improvement 17 6 6 4 1 4 7 Inadequate 6

Significant improvements across the market

Confident Place, Confident People.

Achievements from applying The Deal

Community Book - innovative online community matching tool for diverse range of community based activities, co-designed with the community. Reducing demand for formal services:

• 8,818 people (2013/14)
• 7,782 people (2016/17)

90% of domiciliary and 88% of care home providers rated ‘good’ or ‘outstanding’. Regional average 81% and 66% respectively. Admissions to nursing residential care have reduced 15% and at a faster rate than the England average 75% of residents supported by our

• utstanding reablement service

require no further on-going social care support 72% of residents strongly believe that they belong to their local area

Confident Place, Confident People.

Healthy life expectancy in the most deprived areas increased by seven years 3rd fastest improvement in care home quality nationally 100% of directly delivered services rated ‘good’ or ‘outstanding’ by CQC Getting people home from hospital: Wigan best in North West and 5th in country A balanced budget with growth earmarked 18/19 . £26m of cashable efficiencies simultaneous to improving services &

• utcomes

Wigan is the happiest place to live in Greater Manchester

Latest

(2014-16)

Trend* Gap Change** Wigan

62.0

24 months 26 months

61.0

25 months 22 months

Barnsley

59.8 58.6

Rotherham

55.7 59.8

Wakefield

60.3 57.4

Tameside

58.3 57.7

England

63.9 63.3

Healthy Life Expectancy

*From 2009-11 **Reduction in gap compared to England Statistical Neighbours Greater Manchester

60.6 59.4

n/a Latest

(2014-16)

Trend* Gap Change**

25 months 28 months 13 months 10 months 53 months 50 months 20 months 17 months 10 months 7 months 13 months 17 months 11 months 13 months 2 months 6 months

n/a n/a n/a

2 months 4 months

Confident Place, Confident People.

Indexed Under 75 Mortality from Cancer

↓ Lower is better

Confident Place, Confident People.

Indexed Hospital admissions for alcohol-related conditions (narrow measure)

↓ Lower is better

Confident Place, Confident People.

How

• w we del

e deliv iver er – Com

• mmunity

munity In Investment estment

£10m £10m

invested in communities by the end of 2018 Opportunity for the commu munity nity to take e contr trol l and make a di diff ffere erence nce Focus on:

• Innovat

vation

• n and bright

ht ideas

• Co

Commun unity ity driv iven en in init itiative iatives

• Re

Reducing ng demand d on public services vices

• Ca

Capacity ity building

• Flexible

ble approa

• ach

ch

Confident Place, Confident People.

How

• w we del

e deliv iver er – Com

• mmunity

munity In Investment estment

59 59 big ideas £3.9m £3.9m

external funding leveraged

£1. £1.26m 26m

recurrent savings

Soc

• cia

ial l an and e d econ

• nom
• mic

ic be bene nefi fit t of

• f £5

£5.6 .6m m

Confident Place, Confident People.

Wigan Warriors Launch

Confident Place, Confident People.

Financial Impact & Approach

• Different approach taken to the challenge of austerity and

demographic change. Invest to save mind set.

• £26m of savings delivered within adult social care since 2011/12

simultaneous to improving services & outcomes

• Strengthened investment in prevention & early intervention. Spend

in 2018 to be 100% higher in this area than in 2011

• £5m invested in local fees over the last 2 years to secure sustainability
• £2m Residential Investment Fund launched as part of a wider

package of reform to drive efficiency, innovation and capacity

• Well positioned comparatively. Genuine opportunity to invest

new allocations in accelerated reform across the place

Confident Place, Confident People.

The Partnership

Wigan Borough’s Approach to Health and Wellbeing

Asset-Based Community Development For Health Developing Leadership/ Culture change Commissioning levers Investment in health & wellbeing services Developing staff skills & confidence Staff Health & Wellbeing

Maximising Health Gain

Population of Wigan about 323, 000. Nearly 98% of Wigan's population are White British:

• 65% of the borough population are of working age.
• 23% of residents have long term illness.
• There are nearly 34,000 carers of which 3,000 are likely to be children.
• Nearly 100,000 people in the borough are living in the most deprived quintile.
• Rates of homelessness are high 3.63 per 1,000 households compared to 2.48 per 1,000 for England.
• Higher than average rates of obesity
• 16 excess cancer deaths each for women and men under 75yrs against the England rates 2012-14 (majority are lung

cancer deaths)

• Our population aged 65+ will increase by 30,000 over the 20 years.

Confident Place, Confident People.

He Healthier hier Wigan Partnersh tnership

• Healthier Wigan Partnership is a partnership of health and

care providers and commissioners bound together by an Alliance Agreement to deliver integrated health and care through the transformation out of hospital services, to improve the health outcomes of the population and ensure an affordable health care system in the future.

• Key components
• Integrated primary, community and in-reach

secondary care services

• Scaled implementation of the Start Well offer
• Public health interventions wrapped around GP

surgeries

• Increased prevention, early intervention and self help
• Shift of hospital activity (diagnostic and treatment) to

community

• Parity of physical and mental health
• Place based bringing together a full range of public and

voluntary sector services

• Asset based approach

‘We are working together to help people live healthy, happy and fulfilled lives’

Confident Place, Confident People.

Integrated Model of Working

Wider public & voluntary sector services

• Police
• Fire & Rescue
• DWP
• Housing
• MASH
• Live Well Key

Workers

• Others

Confident Place, Confident People.

Service Delivery Footprints

• 30-50,000 population
• Co-terminus GP

Clusters

• SDF Managers as

convenors

• Named capacity for

each SDF

• Schools
• Profile for each SDF
• Community Assets

mapped

• Estates Strategy by

SDF

• SDF multi-agency

huddles

• Sub SDF

neighbourhood teams in areas of greatest demand

Confident Place, Confident People.

Confident Place, Confident People.

Thank you for your time Any Questions?

Closing Remarks

Tracey Cox, Chief Officer Dr Ian Orpen, Clinical Chair

BaNES CCG Board Meeting in Public

8th November 2018 1pm – 3pm Somerdale Pavilion

All are welcome