2015/16 Annual General Meeting Welcome Dr Hari Pathmanathan tweet - - PowerPoint PPT Presentation

2015/16

Annual General Meeting

Welcome – Dr Hari Pathmanathan

tweet #ENHCCGAGM follow us @enhertsccg

Financially Healthy? 2015/16 Finance Report

Alan Pond Chief Finance Officer

Statutory financial duties

• To keep spending within resource limit
• To keep spending within running cost allowance
• Not to spend more cash than allocated
• To achieve value for money in use of resources
• To produce annual accounts and annual report
• To keep appropriate accounting records

Financial challenge facing CCGs

• Nationally 0.1% real terms growth in funding
• Increasing and ageing population = increased demand
• Improving quality and outcomes = cost pressures
• Pay and prices cost pressure
• NHSE requirement for 1% underspend on budget
• NHSE requirement 1% to be spent non-recurrently on

transformation

• NHSE requirement to hold 0.5% contingency reserve

EFFICIENCY SAVINGS NEEDED

ENHCCG’s 2015/16 financial challenge £12m Efficiency Savings (QIPP)

• 1% underspend
• Increased

demand

• Inflation
• Investment in

quality/outcomes

• Funding growth
• Tariff reductions
• Underspend

brought forward

How did we do on Statutory Duties?

ACHIEVED £7,775,000 underspent ACHIEVED £32,000 underspent ACHIEVED £7,743,000 underspent ACHIEVED £2,494,000 underspent ACHIEVED Cash underspent by 0.4% ACHIEVED unqualified audit opinion ACHIEVED draft delivered on time ACHIEVED unqualified audit opinion To achieve value for money in use of resources [14Q] To produce annual accounts and annual report [14Z15] To keep appropriate accounting records Revenue administration resource use does not exceed the amount specified in Directions [223J(3)] Capital resource on specified matter(s) does not exceed the amount specified in Directions [223J(1)] Revenue resource on specified matter(s) does not exceed the amount specified in Directions [223J(2)] not applicable; no specified matters in 2015/16 not applicable; no specified matters in 2015/16 Not to spend more cash than allocated Expenditure does not exceed sums allotted to the CCG plus other income received [223H(1)] Capital resource does not exceed the amount specified in Directions [223I(2)] Revenue resource use does not exceed the amount specified in Directions [223I(3)]

By budget heading?

Description Annual budget £000 YTD Actual £000 YTD Variance £000 Allocation 683,077 683,077 Acute Commissioning 374,999 381,452 (6,453) Non Acute Commissioning 176,060 179,302 (3,242) GP Prescribed Drugs 76,901 78,396 (1,495) Other Primary Care 18,764 15,894 2,870 Running Costs 12,334 11,196 1,138 Transformation reserve 6,311 5,458 853 Recurrent investment fund 2,546

• 2,546

Resilience funding 4,061 3,637 424 Contingency reserve 3,358

• 3,358

Expenditure 675,334 675,334 (0) TOTAL UNDER / (OVER) SPEND 7,743 7,743

How did localities do?

Description Budget £000 Actual £000 Variance £000 Variance % Allocation 683,077 683,077

• North Herts

127,228 126,892 336 0.3 % Lower Lea Valley 85,887 85,868 20 0.0 % Stevenage 103,593 104,664 (1,071) (1.0%) Welhat 121,601 120,283 1,317 1.1 % Upper Lea Valley 124,985 124,543 442 0.4 % Stort Valley & Villages 60,105 60,044 60 0.1 % Reserves & Unattributable 51,935 53,039 (1,104) (2.1%) Expenditure 675,334 675,334

• TOTAL UNDER / (OVER) SPEND

7,743 7,743

Where did we spend our money?

Changes in spending

Future cost drivers

• Increasing population
• Ageing population
• Reduced social care funding
• Reduced staff availability
• Increasing deficits in Providers
• New technology and treatments
• Patient expectations
• Drive for continuous improvement

Funding gap 2016/17 to 2020/21

£92m

Financial plan headlines for 2016/17

• Plan meets NHS England’s requirements and

carries forward the £7.8m underspend

• Plan rolls over 2015/16 funding for primary care

services

• Plan has QIPP requirement of £18m compared

to £12m in 2015/16

• Plan has a Transformation Reserve of £8m, but

this has been frozen by NHS England

• Must work with Providers to eliminate deficits

Thank you

Beverley Flowers

Chief Executive’s overview

Care at home – the rapid response service

‘Early intervention’ vehicles launched.

With 1 vehicle in

• peration -

Between 26 April to 5 August

75% of patients were able to stay in their homes

186 visit s

Improving stroke services

Recognise and act on symptoms immediately Get to a specialist stroke centre quickly Have rapid access to specialist stroke assessments and treatment Ensure a joined-up approach to patient- centred rehabilitation Review patients’ progress to identify any needs which haven’t been met

• the ambulance rings ahead to the hospital for all

suspected strokes

• stroke specialist nurses at Lister Hospital meet the

patients as they arrive, 24/7

• when in an acute hospital, patients spend the

majority of their time on the stroke unit and get there more quickly

• patients who don’t need to be in hospital can

quickly receive early intensive rehabilitation at home

• more people are able to get stroke specialist

inpatient rehabilitation in the community and receive a specialist review 6 months after their stroke.

What does this mean for patients?

About our hyper acute stroke services – on a Sunday in February 2016. “my world upside down in a second. I had had an acute and severe stroke. I received fantastic and state-of-the art treatment very rapidly…which is what saved me from permanent paralysis.” About our community stroke services “He left in a taxi, no ambulance ,no wheelchair , a walking stick and dignity……..the reason she can walk again is due to the dedication and expert treatment every day.”

What our patients say …

• improve public awareness that the risk of

stroke can be reduced

• increase the detection and treatment of people

at risk of stroke

• ensure we act on the emotional wellbeing

needs of people who have a stroke and their families

• increase the uptake of 6 month reviews and self

management opportunities

• better understand and meet the needs of

families and carers of people who have had strokes

What next?

Transforming care for adults with learning disabilities

Our plan continues to focus on:

• Piloting community based, preventative

services, to reduce avoidable admissions

• Improving the wellbeing and successful

discharge from hospital of people who need inpatient beds or secure health services

• Services that support social inclusion
• Developing an all-age care pathway
• Training the wider workforce in Hertfordshire to

meet changing needs

Kooth: Online counselling for young people

• Free online support for children and

young people aged 10-25 years

• Counsellors online until 10pm, 365 days

a year

• Top presenting issues: anxiety/stress;

family relationships; friendships; and depression

• More than 700 users signed up already

What young people are saying: “Hi, the advice that some of your team have given me is amazing. It has helped a lot.” “Thank you so much I love this site, it’s really helpful, one of my teachers recommended it to me I’m really glad my teacher showed me this.”

Youth Mental Health First Aid Training

• 12 Hertfordshire professionals

qualified as instructors to train

• thers in Youth Mental Health

First Aid

• Instructors now training staff

in schools, Public Health, Youth Connexions, Herts for Learning, colleges, the School Nursing Service

• Mental health first aiders can

support 8 to 18 year olds showing signs of mental or emotional distress

Time period Type of service Monthly average patient numbers April – September 14 A&E at the former QEII 1837 October 14 – May 15 Urgent Care Centre based at the former QEII 1482 June 2015 – Nov 15 Urgent Care Centre based in New QEII Hospital 3176 Dec 2015 – April 16 Urgent Care Centre in New QEII 3360

“Peter was there a few months ago and he was in and out, X- dddddd ray etc. in less than half an hour. Great service QEII keep it up. up. “Went in with my stepson was seen in less then 20 minutes. X-rays

• etc. all done and out in less then 1 hour. Great Service;)

Workforce - our most valuable asset

We are promoting General Practice as a career through:

• Creating fellowship schemes for GPs
• Investing in practice nurse training

and 12 practice nurse mentors

• Appointed GP leads and nurse tutors

to lead on developing the workforce across the area Next steps:

• Host careers events for all clinical

specialisms

• Offer general practice

apprenticeships

• Offer general practice ‘taster’

sessions for student nurses & foundation doctors

• Focus on training of practice staff

Your questions and feedback

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Hertfordshire and West Essex Towards a healthier future

Jacqui Bunce – Associate Director

Who we are: The Hertfordshire and West Essex health and care planning footprint has a population of 1.5 million people. There are over 160 GP Practices, 2 county councils, 2 Health & Wellbeing Boards, 2 Healthwatch, 13 district and borough councils, 3 acute hospitals, 2 mental health providers, 2 community providers, 1 ambulance trust and a significant number of other partners. Patients travel for a range of services outside of the footprint.

The challenge …

Our population is changing:

• Birth rates are increasing, and people are living for longer
• Public demand for specialist treatments is increasing and

expectations of services are high

• Patients with complex conditions are supported to live on

into old age We currently spend £4.5m per day on health care alone.

By 2021 we would have to spend £5.8m per day to keep

up with demand, and if we continue to provide services in the same way In addition: There will not be enough skilled health and social care staff Our acute hospitals will not be able to meet demand Deaths from preventable illness will increase

Our Ambition – By 2021 we will have integrated primary and community and social care services wrapped around local communities, alongside sustainable acute hospital services, which deliver the right care at the right time and at the right place within the financial resources available.

What do we want our plan to deliver?

Our plan puts the patient at the heart of a high quality, sustainable health and social care system, which emphasises the importance of personal responsibility, preventative care and partnership working.

“I have the expert advice and tools I need to manage my long term condition” “I know that the care I receive follows best practice advice and guidance” “I will be cared for at home, or close to home, whenever possible” “I am empowered and motivated to look after my health and the health of my family” “When I need expert help, I can go to a specialist centre with skilled staff” “I know where to go for health and care advice and support” “Simple treatments, procedures and consultations are available in my local area”

How will we get there?

Prevention and self-care

Working with people & communities to keep as healthy and as well as possible More patients are supported to live well with their conditions: » personal health budgets » use of voluntary sector » supporting carers

Starting Well Developing Well Living and Working Well Ageing Well

Improving the health of NHS staff nationally could reduce sickness rates by a third, the equivalent of adding almost 15,000 staff to the national workforce, saving 3.3 million working days a year. Source: NHS Five Year Forward View

How will we get there?

Community and primary care

• Continue to bringing care closer to home – physical and

mental health and social care support provided in the community, by multi-speciality teams.

• Work with our localities and GP Practices to support primary

care services

• Making better use of community pharmacists
• Continue to work with the voluntary sector to deliver joined

up community based services

How will we get there?

Acute services

We have already made significant changes in

• ur area but we can do more:
• Standardised pathways of care
• Going to hospital for specialist
• pinions only when required
• Looking after people in the

community will reduce the demand for hospital care

• Closer working between hospitals
• Improve our cancer care

How will we get there?

Bridging the financial challenge…

• Right staff, right skills, right places
• Improving prevention and supporting self

care

• Standardised pathways of care
• Coordinating care and supporting people to

avoid crisis

• Going to hospital for specialist services only
• Reducing demand on hospitals with

effective local services

• Efficiencies in how we do things including

administration

Making the best use of medicines

Pauline Walton, Associate Director Pharmacy & Medicines Optimisation

Medicines – what’s the problem?

• around 7% of hospital

admissions are attributed to or associated with adverse drug reactions

• two thirds of these admissions

are preventable

• up to 50% of patients take

medicines incorrectly

• inappropriate use of antibiotics is a

significant and growing problem

What are the costs?

Medicines are the NHS’ most frequent health care ‘intervention’ In 2015/16:

• we spent £77.7M on primary care

prescribing - 12% of total budget

• GPs prescribed 5.5% more items

and costs grew by 3.5%

• hospital prescribing increased by 15%.

Medicines optimisation…

Emphasises:

• patient engagement
• safety
• professional collaboration
• governance

So that patients get the maximum benefits from their medicines.

The aim: right patients get the right choice of

medicine, at the right time. The goal is for patients to:

• improve their outcomes
• improve medicines safety
• take their medicines correctly
• avoid taking unnecessary

medicines

• reduce medicines waste

Medicines optimisation can help encourage patients to take ownership of their treatment.

A dedicated CCG pharmacy team work in care homes:

• reviewing individual residents’

medication

• working with GPs and staff to make

changes to improve residents’ health & wellbeing

• reducing avoidable hospital

attendances

• reducing the risk of falls
• making medicines safer, reducing

waste www.enhertsvanguard.uk

Medicines in Care Homes

Antibiotics – vital life-savers

• Antibiotics treat infections caused by bacteria
• Routine and life-saving treatments rely on
• antibiotics. For example caesarean sections,

hip replacements or treatment for cancer.

• Antibiotics cannot kill other microscopic
• rganisms that may also cause infections e.g.

viruses and fungi

• Antibiotic resistance is a growing problem …

46

47

48

Common Misconceptions

• Many people believe

they are resistant to the antibiotic, whereas it is the bacteria that are resistant

• ‘I’m not feeling any better after 3 days so I

must need an antibiotic’

• Getting antibiotics is proof you’re ill
• Parents want the best for their children and

think ‘gold standard’ treatment means antibiotics

What is the CCG doing to tackle antibiotic resistant infections?

• Guidance for treating common infections
• Educational sessions to GPs and patient groups
• Review and monitor GP prescribing
• Issuing prescribing targets
• Promoting the Antibiotic Guardian campaign

Reduction in total antibiotic GP prescribing

• Nationally total oral antibiotic consumption* stable

between 2011 and 2014

• G.P. prescribing of antibiotics in our CCG reduced

by 4% between March 2015 and June 2016

1.1 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.2 Items per oral antibiotic*

Antibiotic consumption 2015/16

What can you do?

• Don't ask your GP for antibiotics for cold and flu
• Take antibiotics exactly as prescribed. Always

finish the course

• Encourage family and friends to sign up to the

Antibiotic Guardian Campaign and tell them about antibiotic resistant infections

• Take the pledge! Become an Antibiotic Guardian.

antibioticguardian.com

Repeat medicines

• In Hertfordshire we estimate around

£3.5M is wasted on unused or unnecessary medicines

• This could be used on other

valuable treatments such as expensive cancer drugs, hip replacements or more nurses

• Returned medicines cannot be

recycled or reused

Ordering repeat medicines

• Only tick the items you really need
• Remember to tell your GP or pharmacist if you

do not need a medicine at that time

• Open the bag! Check when you collect your

medicines that you still need them. Only take those that you will use

• Don’t stockpile medicines
• Be clear about how you can

avoid wasting medicines and save money save NHS money.

Thank you Questions?

Pauline Walton Associate Director Pharmacy & Medicines Optimisation

Time for a break …followed by your workshop sessions

Welcome back

?

Any questions or feedback?

Thank you – have a safe journey home Please complete and return your feedback form