Annual General Meeting 2016 Dr Neville Purssell, Chair Annual - - PowerPoint PPT Presentation

Annual General Meeting 2016

Dr Neville Purssell, Chair

Annual General Meeting Wednesday July 13 2016

Time Topic Presenter 18:30 Open forum with CCG & partner organisations 19:00 Introductions & Scene Setting Dr Neville Purssell, Chair 19:05 Overview and achievements in 2015/16 (i) Mental Health (ii) Homelessness (iii) MSK Dr Neville Purssell, Chair 19:25 Working in Collaboration across North West London Clare Parker, Chief Officer 19:40 Quality & Safeguarding Jonathan Webster, Director of Quality and Patient Safety 19:50 Annual accounts & 2016/17 Budget Deputy Chief Financial Officer: Helen Troalen 20:00 Priorities 2016/17 Jules Martin, Managing Director 20:25 Question and Answer Session 20:55 Last thoughts and Close of Meeting 21:00 Close

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Central London CCG?

We commission hospital care, urgent care, community & mental health services 2015/16 was

• ur third year

as a fully authorised CCG The patient is at the centre of all we do This is our third Annual General Meeting We have 35 member practices and a population of around 200,000 Patients and GPs at the heart of everything we do CCG Council of Members and Governing Body The CCG Chair is elected by the Governing Body members GB consists of GPs, practice staff, lay members, a secondary care consultant and CCG officers

Part of a larger system

Central London CCG Tri-borough CWHHE CCGs Collaborative North West London CCGs Collaboration Whole London

4 Five year forward view

Overview & Achievements 2015/16

Year of achievement and challenge

• Vision: personalised, localised, integrated and specialised care for local people

This means

• Making it easier to book weekday, evening, and weekend GP appointments
• Providing better staffed specialist hospital units 24/7
• Focus on mental health services
• Coordinating your care better across the NHS
• Moving more healthcare services closer to your home

Year ahead promises to be one of challenge and opportunity

• Increasing demand for mental and physical health problems
• Pressures on financial position
• Important CCG focuses on clear transformational plans that are achievable

Mental health and wellbeing

Clinical lead: Dr Paul O’Reilly Delivery Manager: Robert Holman

Mental health in Central London

National context

• Mental health affects all of us
• Significant social costs of mental ill

health

• Lower life expectancy for people with

serious mental illness

• Historically under-funded

Local context

• Population increasing
• Ageing population
• High incidence of mental ill health
• High homeless population

PERSONALISED LOCALISED INTEGRATED CENTRALISED I know how to lead a healthy lifestyle and can manage my own care. I feel in control

• ver my care

because decisions are taken with me and consider my lifestyle and individual choices My care is now more convenient because the services closer to my home are more accessible. I know I will be provided with a wider range of high quality care within my community for all of my health and wellbeing needs. I’m not treated ‘in parts’, but as a whole person in a coordinated way. Whoever I see, knows me and my preferences, and I no longer have to repeat my details each time. I have a positive experience which helps me feel confident in the quality of care provided to me. I am (in hospital) no longer than I need to be, and am able to receive effective care sooner rather than later.

I can manage my health and have positive relationships, secure housing, financial security, etc

I am involved in planning my care and support. I can access support near to where I live or work.

My needs are met in the least restrictive setting – in the community where possible. My mental and physical health needs are met together.

I don’t have to tell my story to lots

• f different

people. I can access excellent support quickly when I am in crisis.

I get the right support to help me recovery from a crisis and live independently.

NWL priorities

Successes

• Developed high quality, responsive services for people in

crisis

• Diagnosing dementia early, to support people to live well
• Improved access to evidence based therapies for people

experiencing psychosis for the first time

• Improving access to psychological therapies which help

people with anxiety and depression to recovery

• Commissioned partnership to manage Primary Care Mental

Health services

Successes

• Developing better mental healthcare for women

during and after pregnancy.

• Rolling out innovative suicide awareness training
• Joint leadership across West London & Central

London.

Challenges

• Need to ensure our investment in mental

healthcare delivers good outcomes for patients and value for money for the taxpayer

• Are we doing all we can to treat mental and

physical health in an integrated way?

• How do we reduce reliance on hospital care and

specialist (secondary) care?

• How do we promote resilience within the

population?

Intermediate Care Network for Homeless Health Partnership

Clinical lead: Dr Paul O’Reilly Delivery Manager: Sophia Malik

Background

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25% of all rough sleepers in England and Wales are in Westminster, accounting for 50% of rough sleepers in London. Homeless People:

• Access A&E 7x more than the general population.
• Tend to have more co-morbidities than the general population.
• 1 in 5 rough sleepers who had contact with hospitals had 3 or more

diseases

• Are 40x less likely to be registered with a GP
• Are likely to die much younger than the general population.
• Are over 9x more likely to commit suicide than the general

population

Our Response

Following on from various Department of Health pilots, in October 2015 Central London CCG launched the Integrated Care Network (ICN) for Homeless Health. 14

Integrated Care Network

Hostel Beds GP Leadership and street

• utreach

Homeless Health Team Redesign Care Coordination

The GP Perspective

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• Elderly street homeless woman
• Critical lung issues
• ICN stay meant she was able to engage with health service
• Resulting in health improvements and in accommodation

Patient Case Study

Impact

Health Outcome assessed by clinician during patient’s final week with the service Wellbeing measured with EQ5D (a measurement tool) at start and end of patient’s term with the service

Even in these early days the results are extremely promising.

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Impact

Community MSK Service

Clinical lead: Sheila Neogi Clinical partners: Nick McGrath and Neil Cook Senior Delivery Manager: Will Reynolds

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Service Model

• Clinical triage of all referrals
• Community-based multi-disciplinary team: Orthopaedics,

Rheumatology and Pain clinics

• Non-Surgical Rehabilitation Sports and Exercise Consultant and

specialist GP clinics

• Ultrasound Guided Injections on-site in the community
• Condition management class rehabilitation programmes

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Innovation

• Innovative patient self-referral approach: web-portal and

telephone (demonstrated at our Planned Care stall!)

• Consultant-led primary care education
• Developing patient empowerment, health-literacy and self-

management

• Pioneering e-consultation with Primary Care
• Acute Rheumatology and Pain Consultant joint clinics now

provided in the community

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Sites

• New purpose-built clinical space is being developed at a hub

site in the North - due to open in August ’16!

• Delivery from SWC in the South continues as well as across a

range of GP premises across the locality

• Local leisure centre site for non-medical setting of

rehabilitation class programmes

Convenient, friendly and welcoming local services!

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Patient Satisfaction

Patient numbers 1,200/month, 20% surveyed

Working in Collaboration across North West London

Chief Officer: Clare Parker

Shaping a Healthier Future overview

Two distinct parts to these plans: local service improvements, which includes primary care transformation and whole systems integration to better coordinate health and social care; and changes to our hospitals. Our plan was to:

• make progress in local services as quickly as possible to improve care for

patients and take pressure off hospital services, especially A&E

• at the same time, there were a number of key hospital changes that needed to

take place on safety grounds

• we would then move to secure the capital funding needed to modernise our

hospital and primary care facilities, through the ImBC. Local services will be in place before changes to hospital services are made. 27

Local service improvements: NW London-wide

• NWL GP practices offer extended opening weekday hours (8am-8pm) and

weekend access to over a million people in NW London

• Investment in new technology at 80 GP practices means they now offer online,

email, video or telephone consultations to over half a million patients

• Eleven primary care hubs are already providing access to primary care and

social care services in one place

• A single discharge agreement in place across NWL to get patients home

quickly and safely reducing stays by up to three days

• Nearly two-thirds (250 of 389) of NWL GP practices have signed up to an

information sharing agreement 28

Maternity

The implementation of new ante natal and post natal pathways, and the closure

• f Ealing Hospital’s maternity services took place in July 2015. A review of the

changes found:

• a complex service change was managed safely, with clear benefits to mothers

and babies

• an improved midwife to birth ratio now meets on average the London Quality

Standards minimum staffing ratio of one midwife to thirty births

• 122 hours of consultant cover against pre-transition average of 101
• 100 new midwives have been recruited
• 79% of women now receive their postnatal care from the same hospital trust

that provides their antenatal care, up by 21% The review was endorsed by the Royal College of Midwives and recognised by Baroness Cumberlege as it aligned with the national maternity review. 29

Paediatrics

In order to improve children’s care across the whole of NW London the closure of Ealing Hospital’s paediatric inpatient services went ahead as planned on 30 June 2016. It has led to:

• Far better access day and night, seven days a week, to more specialist children’s

doctors

• 27 new beds are opening at West Middlesex, Hillingdon, Northwick Park, St Mary’s

and Chelsea and Westminster hospitals, 11 more than at Ealing Hospital

• An extra 48 paediatric nurses and 10 paediatric consultants have been recruited
• Four new paediatric assessment units opened to reduce admissions
• A new rapid access clinic has been introduced at Ealing Hospital so GPs

can access paediatric consultants for advice and same day patient appointments, reducing the need for a child to attend A&E

• Over three-quarters of existing children’s services will remain at Ealing Hospital,

including a 24/7 urgent care centre, day time clinics and outpatient services.

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Mental health update

• To improve mental health and wellbeing across NW London, we’ve

established a new strategy called ‘Like Minded’, which is all about working in partnership to deliver excellent, joined up services that improve the quality of life for individuals, families and communities.

• A new 24/7/365 single point of access was introduced for support, advice and

information for people with mental health illness and carers and professionals received 4,700 calls, reducing A&E attendances and providing right and fast support for people in crisis

• New specialist assessment, treatment and support service started for

perinatal mental health services for pregnant women or women who have given birth in Ealing, Hounslow and Hammersmith and Fulham

• New services for children and young people affected by eating disorders

launched in June.

• a coordinated approach to decriminalising mental health detention to help

keep people out of police custody. 31

Sustainability & Transformation Plans (STP)

Chief Officer: Clare Parker

• STPs were introduced by NHS England to support delivery of

their Five Year Forward View strategy

• The STP is an opportunity to radically transform the way we

provide health and social care

• 44 STP areas (footprints) across England
• Main focus on how as a system we close the three main gaps

identified in the Five Year Forward View:

• Health and wellbeing – preventing people from getting ill and

supporting people to stay as healthy as possible

• Care and quality - consistent high quality services, wherever

and whenever they are needed

• Finances and efficiency - making sure we run and structure
• ur services as effectively as possible

What is the STP?

Health & Wellbeing

• Adults are not making healthy choices
• Increased social isolation
• Poor children’s health and wellbeing

Care & Quality

• Unwarranted variation in clinical practise and outcomes
• Reduced life expectancy for those with mental health

issues

• Lack of end of life care available at home

Finance & Efficiency

• Deficits in most NHS providers
• Increasing financial gap across health and large social

care funding cuts

• Inefficiencies and duplication driven by organisational not

patient focus.

• 20% of people have a long term condition
• 50% of people over 65 live alone
• 10 – 28% of children live in households with no adults in employment
• 1 in 5 children aged 4-5 are overweight
• Over 30% of patients in acute hospitals do not need to be in an acute setting and should be

cared for in more appropriate places.

• People with serious and long term mental health needs have a life expectancy 20 years less than

the average.

• Over 80% of patients indicated a preference to die at home but only 22% actually did.

Health and social care in NW London is not sustainable

Current Population

Health and social care in NW London is not sustainable

Future Population (2030) % Increase

• NHS and six of the eight local authorities across NW London

working together to deliver a better health and care system

• Development has included patient groups, and we are keen to

engage more widely with the public later this year Who is working on the STP?

The NW London Vision – helping people to be well and live well

Our vision of how the system will change and how patients will experience care by 2020/21

How we will close the gaps – 5 delivery areas

T riple Aim De live ry a re a s (DA)

DA 1 Radically upgrading prevention and wellbeing DA 2 Eliminating unwarranted variation and improving LTC management DA 3 Achieving better outcomes and experiences for older people

Improving health & wellbeing Improving care & quality Improving productivity & closing the financial gap

DA 4 Improving outcomes for children &adults with mental health needs DA 5 Ensuring we have safe, high quality sustainable acute services

• Enabling and supporting healthier living
• Wider determinants of health interventions
• Helping children to get the best start in life
• Address social isolation
• Specialised commissioning to improve pathways from primary

care & support consolidation of specialised services

• Deliver the 7 day services standards
• Reconfiguring acute services
• NW London Productivity Programme
• Improve cancer screening
• Better outcomes and support for people with common mental

health needs,

• Reducing variation
• Improve self-management and ‘patient activation’
• Whole systems approach to commissioning
• Implement accountable care partnerships
• Implement new models of integrated care services
• Upgraded rapid response and intermediate care services
• Single discharge approach
• Improve care in the last phase of life
• New model of care for people with serious and long needs
• Address wider determinants of health
• Crisis support services
• Implementing ‘Future in Mind’ to improve children’s mental

health and wellbeing

Pla ns

What next with the STP?

• The latest STP draft was submitted to NHS England on June 30 for

review

• We have a date in mid-July to discuss their views on this version.
• We will engage with the public and stakeholders over the next 3 months

to inform the final version

• Please do get involved, have your say and spread the word.

Quality & Safeguarding

Director of Quality Nursing and Patient Safety: Jonathan Webster

Annual Accounts and 2015/2016 budget

Deputy Chief Financial Officer: Helen Troalen

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Financial Duties

Revenue resource allocation and running costs allocation Most of our income comes from the Department of Health (DH) Costs can be recurrent or non recurrent We have a statutory duty not to spend more than we are given We are not allowed to borrow money

• r go
• verdrawn or

hold cash at year end

Financial position 2015/16

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The Clinical Commissioning Group met or surpassed its statutory requirements in

2015/16, as follows: The financial position of the CCG is set out below:

Duty CCG Performance Expenditure must not exceed allocation Achieved Capital expenditure must not be above allowance Achieved Surplus target Achieved Running cost allocation not exceeded Achieved

How we spent our allocation

The CCG’s budget for 2015-16 was £301m. We spent £270m of this on services directly commissioned for our patients, and £4.5m on administration. In addition, we host £25.6m of expenditure on behalf of NWL CCGs to implement our joint strategy for transforming services.

Changing Financial Position

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2015/16: The CCG planned to deliver and achieved a surplus of £8.6m, in 2015/16. This is a good financial position, however, it should be noted that the way in which we delivered that surplus was not through sustainable means as the CCG received £10m of non-recurrent financial support. This would mean that if we did nothing to address the financial challenge the CCG would effectively be starting 16/17 with an underlying deficit of £1.4m. 2016/17: In the year ahead we have a budget £280.2m. We have to achieve a surplus of £5.8m. Our budget increased by 1.4%, but the pressure of growth in demand and rising costs is 6% . This means we have to make savings of 4.6% (£12.8m) to live within our means.

Financial strategy

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Our high level financial strategy is:

• The CCG has historically received more funding per person than other parts of the
• country. There is a national policy of equalising funding levels, and this means we will
• nly receive minimum levels of growth over the next 5 years.
• The CCG needs to generate sufficient savings to offset the growth in demand for

services over the next five year .s. Our current planning assumption is for a 4.6% (£12.8m) savings target in 2016/17. We will need to make comparable annual savings over each of the next five years.

• The CCG needs to strengthen its underlying financial position, by only committing

reserves non recurrently where possible and using them to pump prime new services that will lead to reduced costs (i.e. investing to save).

• Supporting the NWL Financial Strategy to enable the 8 CCGs across NW London to invest

in out of hospital and primary care services, to deliver the Shaping a Healthier Future programme.

What we plan to deliver in 2016/2017

Managing Director: Jules Martin

We plan to deliver in 2016/17

We plan to deliver in 2016/17

Any Questions?

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