2017/18 NHS City & Hackney CCG Annual General Meeting Wednesday - - PowerPoint PPT Presentation

2017/18 NHS City & Hackney CCG Annual General Meeting Wednesday 5 September 2018 Tomlinson Centre

Annual General Meeting Panel

Jane Milligan Accountable Officer Dr Mark Rickets Chair David Maher Managing Director Sunil Thakker Chief Finance Officer Catherine McAdam PPI Lay member

Running Order

7.30: Start of AGM Presentation 7.30 - 7.35: Opening from Mark Rickets & Jane Milligan 7.35 - 7.40: East London Health & Care Partnership: Update - Jane Milligan 7.40 - 7.45: Primary Care Update - Mark Rickets 7.45 - 7.50: Summary of CCG Annual Report & Achievements - Mark Rickets 7.50 - 7.55: Summary of Financial Position - Sunil Thakker 7.55 - 8.00: Co-Production Achievements & Further Work - Catherine Macadam 8.00 - 8.10: Questions and Answers with AGM Panel 8.10 - 9.00: Community Services Discussion and Close

Key Health Challenges in City & Hackney Socioeconomic Deprivation

• Despite some improvements

in recent years, Hackney remains the second most socio-economically deprived borough in London

• Within Hackney, there is also

inequality at electoral ward level

Life Course in City & Hackney

All figures apply to Hackney and the City together Red indicates worse than the London average, amber similar, and green better. Grey indicates that the direction

• f the indicator

isn’t clear

East London Health and Care Partnership

ELHCP brings together 12 local NHS organisations (commissioners and providers) and 8 local councils to improve health and care services and

• utcomes; highlights include:

 Digital Technology - funding secured for ‘one London’ to be an exemplar of

local health and care records to raise the bar around NHS and partners sharing data to deliver better care

 Workforce:

• £400k for the international GP recruitment programme
• Maternity recruitment & retention programme: launched in May and aimed

at encouraging new talent

East London Health and Care Partnership

ELHCP Highlights (Continued):

 Urgent & Emergency Care - August 2018: Successful roll-out of the new

integrated urgent care 111 service

 Cancer – Measures being applied to increase the one year survival rate to 75%

by 2020 across all cancers by 2020

 Outpatients - Service transformation underway aimed at delivering 30% of

services in the community for outpatients

 Engagement - An online citizen’s panel established to gather the views of

patients and the wider community in shaping and driving decisions about health and care services

Challenges in City & Hackney

• Socio-economic deprivation
• Population growth
• Socio-economic deprivation
• Mental Health

Socio-economic deprivation Population growth Health inequalities Smoking Obesity Mental Health Alcohol Life expectancy

City and Hackney CCG Headlines

We achieved financial balance in 2017/18 as planned and are in a good position to

achieve our aims in the next financial year

All City and Hackney GP Practices rated by the Care Quality Commission (CQC) as

“Good” or “Outstanding”

East London Foundation Trust rated by the CQC as “Outstanding” Homerton Hospital rated by the CQC as “Good” overall, and “Outstanding” for

A&E and Medical Care

People in our area are spending less time in hospital Service delivery for 2017-18 and forward plans for Children and Young

Persons mental health highly credited as among the best in London

Primary Care Achievements

• Five extended access hubs for all

patients to use on top of what their own practice offers –

• pening hours are 4pm to 8pm

Mon-Fri and 8am to 8pm Sat and Sun

• pm to 8pm Mon-Fri and 8am to

8pm Sat and Sun

• Five extended access

hubs for all patients to use on top of what their

• wn practice offers –
• pening hours are 4pm

to 8pm Mon-Fri and 8am to 8pm Sat and Sun Five extended access hubs for all patients to use on top of what their own practice offers –

• pening hours are

4pm to 8pm Monday - Friday and 8am to 8pm Saturday and Sunday Practices are making more appointments bookable online; national money is being used to pay for making and changing appointments by phone at any time of the day and without having to speak to a receptionist and offering more online consultations

CCG has taken on responsibility with NHS England for making decisions on what happens to regular primary care. This includes developing improved GP premises and additional investment for practices serving populations for whom English is not their first language and consult via interpreters

Investments to develop Patient Participation Groups at practice and neighbourhood level and fund practice improvements that patients say they want CCG money going to practices to pay for training, support and formal quality improvement programmes

Mental Health in Primary Care Achievements

 More comprehensive depression reviews: In

2017-18, GPs reviewed 3,564 patients on anti- depressants covering physical health, medication and whether they have the right support from psychological therapies and wellbeing interventions

 A best practice site: In 2018, City and Hackney

primary care mental health services were selected by the Healthy London Partnership as a best practice learning site with findings to be shared across NHS

Primary Care Achievements

City & Hackney CCG 83% Good

Integrated Commissioning Overarching Achievements

 Extended GP hours and launch of GP Hubs  New school-based and vulnerable children’s health

services

 Redesign of services to tackle childhood obesity  Anticoagulation service to reach all GP registered

patients

 New pilot to assess long-term care at home or

community after discharge

 In urgent and emergency care, the joint procurement

with NEL partners of the new 111 service

Unplanned Care Achievements

 Neighbourhoods model agreed as strategic priority for all City and

Hackney

 New Homerton Hospital ambulatory service  Seven day hospital and social care discharge  New ‘discharge to assess’ model  Improved care planning processes  Health information exchange  Working with partners across the East London Health and Care

Partnership on services where a cross borough approach is beneficial

 In urgent and emergency care, the jointly procured new 111 service

We have expanded open door mental health crisis services, so that more people can get immediate help without needing to go through professionals first. Newly developed services at ELFT include:

24/7 Crisis line supported by a 24/7 urgent assessment

team (launched in October 2017 ahead of national target)

 Crisis Café for hot drinks and crisis support

SUN project offering crisis planning and group support

Mental Health Unplanned Care

Mental Health Unplanned Care

City of London Street Triage

 Since being launched, Street Triage has reduced the

number of people sectioned under the mental health act by the City of London Police by 46%

 Police surveys also show an improvement in working

relationships with the NHS, substance misuse and homeless services

 Street Triage workers also provide important support to

the police during suicide attempts which are particularly prevalent on the City of London's bridges

Planned Care Achievements

 New expanded anticoagulation service in the

community

 70% of blood taking services now provided in the

community cutting down on patients’ trips to hospital

 Joint budgets and closer working with local

government to improve the quality of care packages provided

 Work done to redesign Learning Disability Services to

improve opportunities and outcomes for our residents

Mental Health Planned Care

 More people with anxiety and depression are recovering

after receiving psychological therapy. City and Hackney now has the second highest recovery rate in London (out of 32 CCGs) and third highest number of people accessing treatment. City and Hackney also achieved its Quality Premium for its high BME recovery rate and older adult access rate

 Low Intensity therapy can now be accessed directly

• n-line, backed up by professional support, with or

without a GP referral

 Waiting times for psychological therapies have improved –

in 2017/18, over 90% of patients started treatment within six weeks of referral

Children, Young People and Maternity Achievements

 Midwifery performance at Homerton Hospital rated as “Good”  Highest score in England for caring about the emotional health of

• ur new mums and their families

 New services to women with moderate to severe mental health

needs and help for them to raise healthy families

 Improved, re-designed children's health services, including:

Audiology, School Based Health Services, the Family Nurse Partnership and Obesity early prevention services

 Provision of Special Educational Needs and Disability credited as

being “Good” from joint OFSTED and CQC inspections

Mental Health Children and Young People

Schools: the Children and Young People’s transformation pilot programme saw mental health clinicians in at least 50% of City and Hackney schools during the year, helping teachers identify young people vulnerable to mental health issues in order to put in place early support. We aim to extend this to all schools Access: City and Hackney’s mental health services saw more children and young people than any other borough in 2017-18

Prevention Achievements



Excellent results supporting people to manage conditions that affect their long-term health issues - 90% of people with diabetes and 98% of people with heart disease locally have good control of their blood pressure, one of the best CCGs nationally



Record numbers of people referred to preventative support services: 700+ to the Diabetes Prevention Programme; 1,200 to the Social Prescribing Initiative; and 1,400+ have quit with the help of the Stop Smoking Programme



Extra funding from NHS England to support expanded education courses for people with diabetes



A highly successful peer mentoring scheme has helped 30 children and young people better manage their sickle cell disease

Mental Health Prevention

 The Recovery College: provided by ELFT was

commissioned in 2017 to help people improve their mental wellbeing and life skills. The service is open to everyone and no referral is needed - 50 students graduated and 17 went on to become peer tutors

 Employment Pilot: City and Hackney received

Department of Work and Pensions funding to pilot employment services linked to Homerton’s psychological therapies. Last year over 300 people received employment support

Recovery college graduation ceremony

Safeguarding Children and Adults

Keeping Children and vulnerable adults safe runs like a thread through everything we and our health and care partners do. Measures include:

• Expertise and support from our Safeguarding Leads and

doctors

• Support to frontline practitioners to share best learning and

practice to support vulnerable families

• Providers being monitored for all safeguarding activities,

like staff training

• Working with local safeguarding partners through the local

safeguarding Children and Adult Boards

• Information sharing and policy development across London
• Responding to national safeguarding risks at a local level

Financial Performance

External audit issued an “unqualified audit opinion” on the 2017/18 accounts - the CCG delivered its statutory obligations and was given a clean bill of health External audit concluded that the CCG has adequate arrangements to secure economy, efficiency and effectiveness in its use of resources During the year the CCG managed and contained material cost pressures across the portfolio, delivered its programme of work and supported the wider system by releasing £3.3m of surplus A programme of one-off investments totalling £7.4m was delivered aimed at enhancing quality and access to patient care

Financial Performance

Savings and efficiencies totalling £5.0m were realised in support of the future financial position of City & Hackney CCG Underspends on running costs (E.g. CCG management costs) totalling £1.3m were realised and spent on patient care A number of known prior year disputes were resolved realising one-off benefits there were spent on patient care The CCG ended the year being well place for 2018/19, but big challenges lie ahead

Where we spend our money

Patient and Public Involvement

Highlights

 CCG green rating against NHS England

Patient and Community Engagement indicator

 Continuation of grants to support patient

voice groups to run regular events

 Working towards an involvement alliance

with funded groups and wider patient voice networks to strengthen collective voice and foster co-operation and integration Continuing to promote our PPI priorities for the CCG:

Patient and Public Involvement

Working with others across Health and Social Care Highlights Development of “Engagement Enabler Group” bringing together public reps and those working to promote patient, public and service user voice to:

 Influence decision making about

integrated commissioning

 Co-ordinate, support and develop new

ways to embed co-production and co- design of new services

 Develop and support patient and public

leaders for the future

 Adoption of Co-production Charter for

Health and Social Care in City and Hackney – first in the country

 Healthier City and Hackney Fund –

A £500k joint initiative with Hackney Council and City of London to support new ideas to increase life expectancy, reduce health inequalities and improve access to services

Questions and Answers

Questions and Answers

Thanks!

Your thoughts and opinions are important to us!

If you have concerns or questions about any other issues that we have not had time to address in this segment of the Annual General Meeting please let us know on the event feedback form or via the event feedback link on our website http://www.cityandhackneyccg.nhs.uk/have-your-say/agm-2018.htm

Community Services Discussion

Jonathan McShane Convener for City and Hackney Integrated Care Partners

Life Course in City & Hackney

All figures apply to Hackney and the City together Red indicates worse than the London average, amber similar, and green better. Grey indicates that the direction

• f the indicator

isn’t clear

Integrated Commissioning - Our Collective Ambition

By 2022, we will have a single approach across City and Hackney that supports people and their families to live the healthiest lives possible and looks to address the underlying causes of poor health. For you this will mean:  More support for you and your family to get healthy, stay well and be as independent as possible​  Easier ways for you to be involved in decisions about your care  Neighbourhoods where people and communities are actively supported to help themselves  Joined up support that meets your physical, mental  health and other needs  High quality GP practices, pharmacies and community services that offer you more support closer to home  A thriving local hospital there when you need it

Why are we doing this? What will it mean for you?

 Integrated Commissioning means that the CCG can now make decisions jointly with local authorities but services are still being delivered separately.  Neighbourhoods are being set up around groups of GP practices and they aim to deliver locally joined up services that address the specific needs of those areas.  Joining up out of hospital services should deliver a better experience and better

• utcomes, particularly for people who rely on a range of different types of

support.  This project is about developing community services designed around people not organisations

A model for the future

Community Services in the future

Community Mental Health Social Care Hospital Services Community Health Services Enhanced primary care services

Neighbourhoods

 Communities with a population between 30,000 and 50,000 with clusters of GP surgeries at the centre  A way to deliver ongoing innovation and improvement in a range of health, care and community services in future  Services that are more responsive to the needs of the local community  A real focus on the wider social and economic determinants of health for the whole population  Places where people and communities are actively supported to help themselves  Coordinating and planning services with residents around their individual needs

Community Midwives, Children's Nurses, Paediatrics and CAMHS

Current Community Health Services

37

Community Nurses providing care for people with complex needs and long-term conditions like Diabetes, COPD and Sickle Cell Community Physiotherapists, Occupational Therapists, Speech and Language Therapists, Dieticians and Podiatrists Psychological Therapies, Psychology, Psychotherapy, Counselling Rehabilitation, Stroke Care, Continence, Palliative Care, Hospices, Wheelchair Services

What do you think?

• 1. What works well with existing community services locally and

elsewhere?

• 2. What aspects of community services could work better?
• 3. How could we deliver community services differently based on the

neighbourhood model?

Community Services Feedback

Annual General Meeting Close Close and thank you