Annual General Meeting 29 September 2016 Welcome Dr. Jonty - - PowerPoint PPT Presentation

Annual General Meeting

29 September 2016

Welcome

• Dr. Jonty Heaversedge

CCG Chair

CCG Annual Report and Key Achievements 2015/16

Andrew Bland CCG Chief Officer

Patient Stories: Personal health budgets

Patient Stories: Personal health budgets

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Annual Report 2015/16 and key achievements

• NHS England annual rating for CCGs: Southwark is one of only two

CCGs in south London to receive the overall rating of good for 2015/16.

• The following were Identified as strengths during our annual

assurance for 2015/16:

• our vision and leadership
• robust approach to planning, contracting and service

development across health and social care

• a nationally recognised Sustainability and Transformation Plan
• our approach to continuing healthcare, involving patients and

the public in our work

• our safeguarding arrangements and approach.

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Transforming the health and care system in Southwark

• Extended Primary Care Service launched at Bermondsey Spa in

April 2015 and available 8am-8pm 7 days-a-week to all patients registered at GP practices in north Southwark.

• Use of the Extended Primary Care Service continued to increase.

From April 2015 to February 2016, a total of 40,435 additional appointments were offered at the two sites.

• One of very few CCG areas nationally to offer 100% coverage for

8am-8pm 7 day access.

• Completed a procurement for improved IAPT services for people with

anxiety and depression.

• Local Care Record went live in January 2016. It is a new secure way
• f sharing information electronically between hospitals and GP

practices in Southwark and Lambeth. Over 1,000 primary care and 2,200 KHP staff are now active on the new system (August 2016).

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• Leading a NHS Diabetes Prevention Programme in south London -
• ne of the first areas in the country to have a programme in place to

find people at risk of diabetes and work with them to prevent the disease.

• Adults eligible for NHS continuing healthcare offered a personal

health budget.

• CCG commissioned self-management courses – Self Management

for Life – accessible to patients with a range of long term condition. The courses help patients learn new skills to help them manage their health more effectively. Approximately 163 patients registered to access these courses in 2015/16. Transforming the health and care system in Southwark

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• A leading partner in the development of the South East London

Sustainability and Transformation Plan – recognised as a national exemplar.

• Agreed a pooled Better Care Fund budget of £21 million with

Southwark Council and invested in services to help support people in the community, reduce emergency admissions to hospital and improve timely discharge. One of only six areas nationally to be fully assured.

• Development of shared system-wide incentive (CQuIN) to deliver

person centred and coordinated care for people with high complexity. Implemented in 2016/17 contracts.

• Progress on the engagement and design of a new health centre for

Dulwich and the surrounding area. The Dulwich hospital site will in future house a secondary school and the new health centre. Transforming the health and care system in Southwark

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Further development of GP federations including:

• Primary Care Development Programme (leadership development

and practice engagement in both federations).

• Population health contracts delivered by federations (NHS

Vascular Health Checks; Smoking Cessation advice, prescribing and support; Ambulatory Blood Pressure Monitoring; Holistic Health Assessments for over 65s; and early identification and management

• f Long Term Conditions).
• North and south Southwark GP federations and local care network

partners participated in a Care Navigators pilot with Age UK Lewisham and Southwark (AULS), the CCG and other local partners.

• NHS Lambeth CCG and NHS Southwark CCG, in partnership with

Health Education South London (HESL), have recruited six newly qualified GPs as part of a Population Health Improvement Fellowship Scheme. Transforming the health and care system in Southwark

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Performance achievements

• 94.6% of patients were seen by a specialist within 2 weeks of an

urgent GP referral for suspected cancer

• 96.0% of patients received their first treatment within 31 days of a

cancer diagnosis

• Low level of delays in hospital discharge compared to other boroughs
• No patients admitted to mixed-sex wards
• Worked with trusts to reduce the number of MRSA infections compared

to previous years

• IAPT services in Southwark provided the greatest number of

appointments of all CCG areas in London

• More residents with dementia are now known to the NHS, ensuring

they can access the treatment and services they need.

Quality, Safety & Performance of Commissioned Providers

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Quality, Safety & Performance of Commissioned Providers

Performance challenges Locally and nationally NHS organisations have faced challenges in meeting some of the national standards. We worked with other parts

• f the NHS, local CCGs and the hospital trusts to address

performance challenges in 2015/16 in the following areas:

• A&E 4 hour waiting standard
• Ambulance response times
• RTT waiting times - % of patients waiting to start treatment who

have been waiting less than 18 weeks

• Long waiters – patients waiting more than 52 weeks for treatment
• Diagnostic waits - % of patients waiting 6 weeks or more for a

diagnostic test

• IAPT recovery rates – the % patients deemed to have to improved

against the requisite scale following a course of treatment.

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• On-going quality review with providers; local authority;

regulatory agencies (e.g. CQC, Monitor); NHS England and people in Southwark to identify and address issues relating to care quality.

• Robust arrangements are in place to support effective

safeguarding for adults and children.

• CCG contributed to the CQC inspection reports at SLaM; KCH;

and GSTT. We are involved in supporting delivery of post- inspection action plans.

Quality, Safety & Performance of Commissioned Providers

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• Assessed as outstanding by NHS England for engagement work.
• In December our work to involve local people in creating a new

healthy weight service was recognised by Guy’s and St Thomas’ NHS Foundation Trust. We won the ‘Involvement to Impact’ award.

• Spoke to local people about the Dulwich development; Our Healthier

South East London programme; Extended Primary Care Service; and to young people about their experiences of local health and care services.

• CCG member practices each run Patient Participation Groups

(PPGs), which meet as locality PPGs once a quarter.

• Highest response rate in London and the third highest in England

for Annual 360º stakeholder survey led by Ipsos-Mori. Engaging patients, local people and stakeholders

CCG Annual Accounts 2015/16

Malcolm Hines Chief Financial Officer

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Key Financial Performance Duties

Duty 2015-16 Target £000s 2015-16 Performance £000s RAG Expenditure not to exceed income 415,379 407,706 Capital resource does not exceed the allowance N/A N/A Revenue resource does not exceed the allowance 400,621 392,948 Capital resource use on specified matters does not exceed the allowance N/A N/A Revenue resource use on specified matters does not exceed the allowance N/A N/A Revenue administration resource use does not exceed the allowance 7,083 6,890

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• Met all the statutory financial performance duties in 2015/16.
• The CCG demonstrated a strong financial performance, achieving a

surplus higher than originally planned: £7,673k against plan of £7,277k:

• £193k on running costs. The CCG received £511k Quality Premium

funding in 2015/16 - the spend was incurred within programme

• costs. This was offset by a provision for redundancy of £252k;
• £202k on programme costs – due to underspends on Acute and

Better Care Fund, which were partially offset by overspends in

• ther areas.
• No capital resources allocated in 2015/16.
• CCG accounts audited by Grant Thornton UK LLP. The auditors

signed-off the CCG accounts. 2015/16 Annual Accounts

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2015/16: Where the money went

A&E (£15m) London Ambulance Service (£12m) Hospital: Outpatients (£37m) Hospital: Emergency Admissions and Critical Care (£57m) Hospital: Planned Admissions (£41m) Hospital: Maternity (£21m) Hospital: Other (£37m) Corporate Costs (£19m) Mental Health, Client Groups and Continuing Care (£69m) Community Contract and Primary Health Services (£33m) Prescribing (£33m) Better Care Fund (£19m)

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5 year financial forward view 2016-17 2017-18 2018-19 2019-20 2020-21 Allocation £k 393,667 403,327 413,452 424,011 439,530 Growth % 3.0% 2.5% 2.5% 2.6% 3.7% Primary Medical Growth % 3.6% 2.5% 3.6% 3.8% 4.6% Specialised Growth % 8.4% 5.4% 5.1% 5.0% 5.5% Population Projection 316,773 320,977 325,127 328,967 332,668 Savings required estimate 3% 6,659 12,385 12,628 12,950 13,450

Questions and Answers

Southwark AGM Forward View Into Action

September 2016

Michael’s story is an illustrative account, showing how a holistic, whole person approach which considers health, social and economic needs could make a real difference. Michael is 62. He moved to Southwark ten years ago for work, but has recently been made redundant. He lives alone in rented

• accommodation. Since losing his job Michael

sees fewer people. He worries about his rent, and growing debt. Michael has insulin-dependent diabetes, hypertension and depression. He knows he should eat better and exercise more, but it feels hard; going to a gym is another expense and it’s quick and easy to eat take-away food. Michael feels things are out of control, and his only real comfort is alcohol.

Fragmentation means that services often don’t take a holistic view of a person’s needs and this can lead to poor care, poor outcomes and avoidable medical interventions

The police have taken Michael to A&E four times in the past six months, after he collapsed in the street following particularly heavy drinking. His diabetes is a problem; he has called an ambulance twice in the past month and been admitted into hospital with hypoglycaemia because he hadn’t eaten enough. In hospital Michael met other people with

• diabetes. One person had had a heart attack

related to diabetes. She had also had an amputation last year as her leg ulcers refused to heal. She told Michael that she wished someone had helped her before it was too late. When Michael was discharged he was very worried; he didn’t want to have a heart attack or end up needing an amputation but he didn’t know what to do.

Why?

Kate’s ‘Web of Care’ For people like Kate we need to do more to simplify and coordinate care across health and social care and to address mental and physical needs

Why?

Emphasize populations rather than providers Focus on total system value rather than individual contract prices Focus on the ‘how’ as well as the ‘what’ We are changing the way we work and commission services so that we:

Arranging networks of services around geographically coherent local communities Moving away from lots of separate contracts and towards population-based contracts that maximize quality outcomes (effectiveness and experience) for the available resources Focusing on commissioning services that are characterized by these attributes of care, taking into account people’s hierarchy of needs

Our strategy is to maximize the value of health and care for Southwark people, ensuring

• ur services exhibit positive attributes of care

What?

We will begin to address the fragmented arrangements of commissioning & contracting, by: We will begin to address the fragmented arrangement of

• rganisations and professions, by:

We will begin to address the need to empowering residents and service users, by We are trying to maximize the total value of health and care for Southwark people, ensuring that commissioned services exhibit positive attributes of care (services respond to a person’s mental and physical health needs; they are proactive, preventative, and empowering; and they are well coordinated) a) Restructuring our internal programme boards b) Creating a joint commissioning resource with the Council through the BCF c) Creating a joint Commissioning Partnerships Team with the Council d) Creating a formal alignment of contracts through a shared incentive to develop and deliver coordinated care e) Appraising options to move to full delegation of primary care commissioning f) Supporting the development of multi- specialty models of service delivery through Local Care Networks g) Supporting the development of at scale working in general practice h) Supporting the development of new pathways and delivery models across South East London i) Increasing the involvement of residents within the formation of commissioning intentions j) Continuing to invest in self- management support k) Ensuring that our commissioning requires providers to involve people in care planning and self- management

• We will establish a local Strategic Partnership of commissioners, statutory providers and residents to ensure alignment of
• rganisational strategies and to coordinate and enable the delivery of our shared transformation programme

1 2 3 4

We want to develop local care so that it is more integrated, coordinated and so that it is financially sustainable now and for the future…

How? Plan on a page

We have begun to address the fragmented arrangements of commissioning & contracting, by: We have begun to address the fragmented arrangement of

• rganisations and professions, by:

We have begun to address the need to empowering residents and service users, by We are trying to maximize the total value of health and care for Southwark people, ensuring that commissioned services exhibit positive attributes of care (services respond to a person’s mental and physical health needs; they are proactive, preventative, and empowering; and they are well coordinated) a) Establishing joint population-based commissioning development groups and a Joint Committee b) Creating fully assured BCF plans c) Recruiting to an Assistant Director for Joint Commissioning, and launching consultation on the joint commissioning team structure d) Establishing a shared system incentive (with alternative arrangements for general practice) e) Starting formal options appraisal and engagement to determine if we will submit an application for delegation f) Establishing two Local Care Network Boards in Southwark, with consistent multi-agency representation, and funded LCN chairs – additional resources are being agreed to support further development g) Putting into practice two ‘at scale’ Extended Access Hubs, developing GP federations, and orienting adult social care around neighbourhood and LCN geographies h) Agreeing our local Sustainability and Transformation Plan (STP) and launching a consultation on an elective orthopaedic centre model i) Holding public meetings about our GP contracts (the PMS Review), and involving local residents in the development of a new pathway of care for people with complex needs (through ethnographic research, patient stories and experience-based co-design) j) Successfully bidding to be a pilot site to embed Patient Activation Measures in our local services k) Requiring providers to include collaborative care planning and self- management in the pathways for people with chronic conditions

• We have established a local Strategic Partnership of commissioners, statutory providers and residents to ensure alignment
• f organisational strategies and to coordinate and enable the delivery of our shared transformation programme

1 2 3 4

…and we are making practical progress in all areas of our plan

How? Plan on a page

The practical progress we’re making

COUNCIL OF MEMBERS

We have established joint population-based commissioning development groups and a Joint Commissioning Strategy Committee

• 1. Contracting &

commissioning

We are recruiting to an Assistant Director for Joint Commissioning, and launching consultation on the joint commissioning team structure in September

• 1. Contracting &

commissioning

• The Council and the CCG are together recruiting for an Assistant Director for Joint

Commissioning to lead the Partnership Commissioning team with interviews to be held in early October.

• The Assistant Director will report jointly to the Council’s Director of Commissioning and the

CCG’s Director of Integrated Commissioning.

• A staff consultation on the changes needed to establish the Partnership Commissioning Team

commences at the end of September and will run through October 2016.

• The intention is that following consultation and implementation of resulting changes, the

new team will be fully operational in Quarter Four of 2016/17.

• The direction of travel will be towards greater integration of commissioning budgets and we

will look to agree a shared plan for future financial and risk arrangements by March 2017.

We have put into practice two ‘at scale’ Extended Access Hubs, we are developing GP federations…

The Extended Primary Care Service (EPCS) improves access to general practice by delivering healthcare treatment and advice 8am – 8pm, 7 days a week. Our two Extended Primary Care Access hubs operate from Bermondsey Spa Medical Centre in the north of the borough, and the Lister Primary Care Centre in the south. From April 2015 to February 2016, a total of 40,435 additional appointments were offered at the two sites. Utilisation rates for both services have increased over the year. As the utilisation rates increase practices’ resources will be freed to focus on other tasks, for example on developing and then delivering new models of coordinated care for people with complex needs.

Challenge Fund and 8am-8pm 7 Day Primary Care Access Supporting the development of at scale working in general practice

• 2. Organisations

& Professions

…and we are working with the local authority to shape adult social care around neighbourhood and LCN geographies

• 2. Organisations

& Professions

• (Non-urgent) Physical Disability & Older People’s

teams will be structured around Local Care Networks geographies covering the north and the south of the borough

• This place-based approach aligns assessment,

allocation and case management functions alongside neighbourhood teams; it supports greater integration of social work and OT professional (alongside community services teams)

• The design principles for this work are to: provide

a safe service; to deliver on the Care Act

• bligations; to streamline pathways (avoiding

duplication, reduce assessments & handovers); to increase integrated and coordinated working; to ensure skills bases are retained and respected; to align with other partners as part of the two Southwark Local Care Networks

Examples of practical changes on the ground

We have supported the development of care navigators in general practice

• Since September 2015, three SAIL Care Navigators

have been hosted by GP practices across the north

• f the borough (QHS) and the south of the borough

(IHL), taking referrals directly from practice staff.

• Care Navigators attend clinical meetings and Patient

Participation Groups, follow up on social needs identified by Holistic Assessments, and take cases to Community Multidisciplinary Team meetings.

• Bringing social prescribing and navigation into

primary care is expected to improve outcomes by

• ffering a more holistic approach to care helping

people to access support for non-medical needs.

• The results so far have been really positive and we

look forward to seeing the role develop across other participating GP practices. Alice‘s GP noticed she had become low in mood and

• tearful. She desperately wanted her hair cut but was

housebound, and she felt ashamed of her neglected garden. The Care Navigator arranged for a mobile hairdresser to come that afternoon for a wash, cut and blow dry. They also found an affordable gardening service to clear Alice’s garden ready for summer. Meanwhile Alice’s mobility was improving with physiotherapy, so the Care Navigator referred her for befriending to ensure she had someone long term encouraging her to keep walking. On the Care Navigator’s last visit Alice, who had always dropped her keys down from the window, actually came down the stairs herself to open the door! She feels more like her old self again.

“[In] many cases where social issues are tightly entangled with medical problems…we can't resolve the latter without improving the

• former. I have been often frustrated by the limitations of what GPs

can offer in terms of social support, and thus I am excited and delighted with the SAIL project.”

• 1. Source: SAIL Impact Report 2015-2016, available at:

http://www.ageuk.org.uk/brandpartnerglobal/lewishamandsouthwarkvpp/documents/independ ent%20living%20services/sail/impact%20report%202015-2016%20pdf%20finished.pdf Changes on the ground

Care Navigators

We have supported the development of a Wellbeing Hub for people who would benefit from personalised mental health support…

A Wellbeing Hub and satellite have been set up in Southwark. Provided by ‘Together for Mental Wellbeing’ (a UK charity organisation) access is via:

• the outreach hub (in Peckham)
• a number of pop-up services (including in GP practices)
• at home or provided over the phone / on-line.

Peer Supporters (volunteers) use their own experiences of mental distress to support

• thers towards:
• better wellbeing on a one-to-one basis or Self-Management Groups which focus on

coping strategies and setting goals

• information about organisations, services and activities available in the community,

as well as information/ tools to help manage wellbeing

• time to talk and understand peoples problem and provide practical support with day-

to-day concerns like debt, housing, loneliness or applying for and manage a ‘Personal Budget’.

• a programme of workshops that provide information on mental health conditions (and

can help to develop skills to improve health and wellbeing) The hub provides coordinated care by supporting people to manage their health and wellbeing via the support of a named professional

Changes on the ground

… and this type of support blends input from volunteers and other teams to improve people’s wellbeing and health outcomes

• Karen is a 59 year old woman who was referred to the

Southwark Wellbeing Hub because she experiences chronic anxiety and depression. She was unable to leave the house on her own, and felt highly anxious leaving the house assisted. She had no motivation to look after her home, and felt no satisfaction from completing everyday tasks.

• Katie, the Wellbeing Hub Worker, initially met Karen outside her
• house. On the first visit, they walked around her block several

times and got to know one another. On the second visit, they walked a bit further up Southwark Park Road. By the fourth visit, Karen was opening up about her anxieties, and was gaining some confidence to be outside on her own.

• At 12 weeks on, following weekly visits, Karen is now attending

a sewing and knitting group at the Blackfriars Settlement every Thursday alone, for which she obtained a personal budget. She has also attended numerous appointments with the Community Mental Health Team (CMHT) on her own, and has used public transport on several of these occasions.

• It has been noticed over the weeks that Karen has flourished

under the joint support from both The Southwark Wellbeing Hub and the CMHT. To avoid regression at this stage, Karen now has a Peer Supporter in place to continue to support her recovery.

“I find Katie easy to get along with, friendly, understanding and she is also very helpful. She has helped me to get my discretionary housing payment and helped me to make phone calls to

• ther services. Since working with Katie I don’t

feel so anxious to go out. I feel good when we meet, and I feel good afterwards. I have someone to talk to. I would recommend this service to others; I can see that the person I worked with was well suited to my own mental health issues as she had experienced similar issues in the past so really understood the processes I go through”.

Changes on the ground

What next?

One in five Londoners are living with one or more complex conditions. Other people go through periods of severe, complicated, health problems which may last months or years before they are resolved. Changes to the GP contract focus on the over-75s, but in London it is often younger people who live with complex health problems which may be harder to manage because of drug or alcohol dependence, mental health problems or financial and social pressures. Many Londoners, young and old, will be receiving care from several different services, which can become confusing and frustrating if the services don't work in close collaboration. Firstly we need to identify the patients who would benefit from this approach. Many will be elderly and suffer from multiple chronic conditions while others may suffer from mental health issues or have a set of social circumstances and lifestyle issues which are best addressed though coordinated care.

• Dr. Rebecca Rosen (Greenwich GP)

C1 Case Finding C2 Named Profession C3 Care Planning C4 Self-Management C5 MDT Working

Healthy London Partnership

• 1. Source: https://www.england.nhs.uk/london/wp-content/uploads/sites/8/2015/03/lndn-prim-care-doc.pdf

The service specification sets out five core processes that define good care coordination

By focusing on improving care coordination, our Local Care Networks are developing pathways that will empower service users and give much greater opportunity for VCS involvement

What next: Clinical change

We are working with local general practices to understand the needs of people with three or more long term conditions, so that we can co-design more coordinated services (1/3)

What next: Clinical change

Opportunities for better care coordination

• Undertake Holistic Assessment of Need
• Community matron as named professional
• Case discussed at CMDT
• Consultant geriatrician to provide advice

when required

• Advance care plan and crisis plan

developed and shared with Barbara, her daughter and the teams involved in her care (e.g. through Coordinate My Care)

• Admissions avoided
• Care plan reviewed regularly

We are working with local general practices to understand the needs of people with three or more long term conditions, so that we can co-design more coordinated services (2/3) Barbara is 84 years old She lives alone and is bedbound upstairs She has HF, COPD, depression / early dementia, diabetes and pain Daughter is very anxious about Mum Services to support Barbara

• Daily district nurses
• 4 carers visits daily
• Frequent GP home visits
• @ Home team
• 3/12 admission in 2015 – doesn’t want

to go back again!

• Geriatric medicine at KCH
• 1. Source: Based on work undertaken at Crown Dale Practice, South East Lambeth

What next: Clinical change

Opportunities for better care coordination

• GP named professional
• Undertake Holistic Assessment of Need
• Case discussed in LTC virtual clinic
• Council OT referral home adaptations
• Age UK Befriending service
• Strength and balance classes
• Care plan developed with Colleen
• Referred to DESMOND self-management

and structured education for diabetes We are working with local general practices to understand the needs of people with three or more long term conditions, so that we can co-design more coordinated services (3/3) Colleen is 79 years old She was widowed last year and has no close family She has diabetes, kidney disease and arterial fibrillation Colleen is independent but beginning to struggle Services to support Barbara

• Recently Colleen has fallen resulting in

an AAU admission with fracture in her elbow

• Rapid response were involved but she

has now been discharged

• Colleen has poor diabetes control
• Seen at GP surgery regularly for INR

blood tests

• 1. Source: Based on work undertaken at Crown Dale Practice, South East Lambeth

What next: Clinical change

We will continue to develop our Local Care Networks to support better and more coordinated care…and we will help providers to explore new contracting flexibilities to work in new ways

What next: Organisational change

Questions and Answers

Closing remarks

Dr Jonty Heaversedge CCG Chair

Thank you