Annual General Meeting 6 October 2020 Welcome to Hammersmith and - - PowerPoint PPT Presentation

Hammersmith and Fulham CCG Annual General Meeting 6 October 2020

Welcome to Hammersmith and Fulham CCG’s Annual General Meeting

2

Today’s agenda:

Welcome and AGM

James Cavanagh, CCG Chair

Achievements 2019/20

James Cavanagh, CCG Chair Janet Cree, CCG Managing Director

2019/20 Annual Reports and Accounts

Jenny Greenshields, Chief Finance Officer

NW London plan 2019/20:

Janet Cree, Managing Director

Finance

Jenny Greenshields, Chief Finance Officer

Quality

Diane Jones, Director of Nursing & Quality

CCG Covid-19 Response

CCG Governing Body Members

Questions

James Cavanagh, CCG Chair

Who We Are and What We Do

Dr James Cavanagh Chairman

Who we are and what we do

4

• NHS Hammersmith and Fulham CCG plans and buys healthcare

services for the borough and ensures these are of good quality and value for money.

• We work with clinicians, patients and carers to make sure your

health and social care services are effective and coordinated.

• We have 29 GP member practices for a population of over 250 000
• We don’t commission alone but as part of an Integrated Care

Partnership and in accordance with the NHS’s long term plan

• We are part of the North West London collaboration of clinical

commissioning groups along with Ealing, Harrow, Hillingdon Hounslow, Central London, West London and Brent

2019/20 Some Key Achievements

Dr James Cavanagh Janet Cree Chairman Managing Director

Achievements 2019/20

6

Primary Care

• Primary Care Networks (PCN) were established and

commenced delivering population-based care in line with national service specifications

• Completed the procurement and roll out of the online

consultation offer to complement existing access channels

• PCNs have recruited new roles building the pharmacist and

link worker staffing base to provide population-based care

• Agreed joint working principles with PCN Clinical Directors

and the GP Federation to support the development of PCNs and deliver on shared priorities

• Pride in Practice programme was rolled out across general

practice to provide training and support to strengthen and develop primary care services’ relationship with their LGBT patients.

Achievements 2019/20

7

Perinatal Mental Health

• Received a positive CQC report highlighting consistently good

practice across the board including examples of outstanding practice

• Positive feedback from peer review including: “There is a clear

sense of strong leadership, coordination and organisation in the service, as well as a strong ethos.” Early intervention in Psychosis (EIP)

• Expansion of service to treat all people between the ages of

14-65 with a first episode of psychosis

• Royal College of Psychiatrists audit puts us as one of the top

performing EIP services for Cognitive Behavioural Therapy, employment support and support for carers .

Achievements 2019/20

8

Children’s Mental Health

• Successful application to NHSE to be a trailblazer site for the

implementation of mental health support teams in schools.

• Established Dynamic Support Register and multi-agency oversight

for children and young people with ASD and/or Learning Disability at risk of admission to inpatient mental health or residential settings

• Agreement to jointly commission an Intensive Behaviour Support

Team for children and young people with behaviour that challenges.

Achievements 2019/20

9

Patient and Public Engagement

• Maintained a strong and effective Patient Reference Group
• ​Continued to increase the number of groups and individuals
• n our stakeholder list
• Undertook a full consultation on the proposed overnight

closure of Hammersmith Hospital Urgent Treatment Centre

• Established a Patient Participation

Group support programme with Healthwatch Central West London

• Provided support to SOBUS to help

facilitate community involvement

Annual Report and Accounts 19/20

Jenny Greenshields Chief Financial Officer

Fin inancia ial Posit ition 2019/20

The below table shows that the CCG delivered its planned deficit of £6.7m in 19/20. The CCG also achieved its financial duties with regards to Running Costs.

How we sp spent your r money – £352.9m in in 2019/20

The pie chart below shows a breakdown of CCG expenditure by programme area.

NW London plans 2019/2020

Janet Cree Managing Director

14

Our vision for NW London Integrated Care System (ICS) is to reduce inequalities and achieve health outcomes on a par with the best global cities. Care will be integrated within a single system, focused on the needs of the individual and unhindered by organisational boundaries. We will combine our collective resources, clinical expertise and local knowledge to build a fair, effective and accessible health service for all.

In 19/20 we started working towards our vision for NW London:

This meant that key focuses for the year were:

• The development of our five year (Long Term Plan)
• Working towards a single CCG and building relationships as part of
• ur Integrated Care Partnership and local borough partnerships
• The Covid19 pandemic changed accelerated our focus and joint

working.

Our five year plan

15

• We developed a five year strategic plan with our partners, public and

stakeholders.

• This plan was developed to meet the new national requirements set out in the

NHS Long Term Plan, to improve the quality of patient care and health

• utcomes, while focusing on building an NHS fit for the future.
• It also focuses on reducing local health inequalities and variation in services

across NW London.

• To deliver our ambitions set out in the plan, throughout 19/20, we have focussed
• n seven interconnected areas:

Clinical and care strategy

16

In conjunction with our five year plan we developed our clinical and care strategy. The clinical strategy has nine clear priorities for delivery in 2020/21:

• Access to specialist opinion
• Frailty/last phase of life
• Care planning
• Long term conditions
• Early detection of cancer
• Social isolation
• Safer care – maternity
• Proactive urgent care
• High intensity users

17

A single CCG for NW London

As part of merging the eight CCGs we are making the following six commitments:

1. Move resources across NW London and within boroughs to reduce inequalities over the next four years 2. Increase our proportion of investment in out of hospital services, as a first step we will level up investment in primary care services outside the core contracts 3. Ensure consistency in services across NW London 4. Ensure equity of access to services, to enable our providers to improve outcomes for patients and reduce health inequalities 5. Patients and GP member practices will continue to be involved in the single CCG and at local level 6. We will devolve decision making on delivery and integration

• f services to neighbourhood and borough level as our

integrated care partnerships develop.

In September 2019, the CCG agreed that a single CCG for NW London was the right direction of travel. It was also agreed that 20/21 would be a transitional year focused on financial recovery, developing a single CCG operating model and working through financial implications.

Our system’s financial challenge

Jenny Greenshields Chief Financial Officer

Financial position

19

2019/20

• The year ended with a deficit of £50.9m

for the NW London CCGs – this is in line with our plan.

• Five CCGs reported a deficit (Brent,

Central, Ealing, Hammersmith & Fulham and Harrow).

• The major pressure in 19/20 was acute

spend.

• Achievement of the 19/20 plan was

largely through non-recurrent measures, therefore our underlying deficit has not improved significantly. 2020/21

• A new financial regime was put in place

for 2020/21 following the Covid19 pandemic.

• For the first six months of the year we

are expecting to receive a resource allocation that matches both our Covid and non-Covid spend.

• NHS providers receive a block payment

to meet their costs and the opportunity to claim for a ‘top-up’ of this block payment is insufficient to cover their costs.

• We are awaiting guidance on what the

funding arrangements will be for the second half of the year.

20

Reduction of the deficit

• Whilst we achieved the planned deficit target,

the underlying position remains broadly the same at the end of the year at just under £100m

• We have continued to reduce our

management costs under-spending by £6m against budget

• Towards the end of the financial year we did

start to see a reduction in acute (hospital) activity growth, which should impact on future costs

System alignment

• Our five year plan is a combined plan for

providers and commissioners

• Introduction of new payment regime moving

from purely costs and volume for acute contracts to agreed contract values with marginal rates for over and under performance

Controls established

• Vacancy freeze and review of interim staff

continued through 19/20

• Investment Scrutiny Panel imbedded to review

every proposed contract change or new business case

System recovery

• System recovery linked to five year plan and

key programmes of work

• Development of ICS (Integrated Care System)

recovery work streams

• Focus on schemes that will deliver system

wide savings

What we have achieved

21

Returning to financial balance as a system

Covid-19 has significantly changed the way we are working as a health system in NW London with activity from both providers and commissioners being refocused on the Coivd-19 response and recovery. Therefore our original 20/21 commissioner and provider cost recovery plans have not started to deliver or be monitored in the normal way. However there are areas where transformation across the system has been accelerated beyond our plan and areas that are currently on hold that may or may not restart after Covid-19 activities have been normalised. The focus for the immediate future in order to return the system to financial balance will be to:

• Reset 20/21 commissioner and provider cost recovery plans
• Alignment with ICS recovery work streams
• Determine gap to financial balance and
• Determine further ICS Recovery work stream opportunities.

Quality

Diane Jones Chief Nurse and Director of Quality

Quality in 2019/20

The CCG has a statutory duty to report on the performance of services as defined in the NHS

• Constitution. In addition, it has a remit to improve quality within the services that it commissions

The CCG uses three domains to monitor quality of services and measure quality improvement: – Patient experience – Patient safety – Clinical effectiveness

During 2019/20 the Quality Team has:

– Undertaken quality assurance support visits to primary and secondary care as well as care homes to support quality improvements – Been a central resource for all clinical quality issues e.g. supporting robust systems for sepsis management in a trust – Undertaken and reviewed Quality Impact Assessments (QIA) and Equality Health Impact Assessments (EHIA) for pathway changes in commissioned services – Worked with providers of care and the Care Quality Commission (CQC) where there are quality concerns (and good practice) to support system learning and improvement – Supported the GP quality alert process to highlight quality concerns to trusts for their investigation and resolution.

Patient experience

Engagement The CCG work with and talk to patients and the public about our services feedback is shared and discussed at CCG Committees and Governing Body meetings. Complaints The CCG analysed trends and themes relating to complaints received during 2019/20 with key themes being:  Delays within the Continuing Health Care process (CHC) claims  Disputes about the outcomes of CHC assessments and nursing home placements  The NWL CCGs’ IVF policy  The introduction of a new policy relating to injections to treat patients suffering from lower back pain  Introduction of Prescribing Wisely and NHS England’s guidance relating to medicines that should not be prescribed routinely in primary care. – ensured lessons learned were disseminated for wider learning, e.g. through discussion at team meetings or multi-disciplinary professional meetings, incorporated in to training Continuing Health Care (CHC) – Ensuring that individuals are appropriately assessed to identify if they have a “primary health need” – If need is determined then a package of care was commissioned by the CHC team and reviewed in line with national guidance – As a result of complaints received our systems and processes have been strengthened

Patient safety

Serious Incidents (SIs)  Our service providers reported 933 serious incidents (Sis) in 2019/20, Imperial was the highest reporter as they report all 12 hour breaches in A&E as SIs.  Treatment delay, maternity and diagnostic incidents are the top three types of incidents reported.  Maternity cases are high due to the number investigated by the Healthcare Safety Investigation Branch which would not normally meet SI criteria.  In the majority of cases, providers identify learning and create actions to address the learning which is monitored locally.  The CCG is developing new ways of reviewing and closing SIs with wider involvement of provider partners. Safeguarding

• The CCG has worked with partners to ensure effective arrangements are in place to

meet the safeguarding framework requirements for Children & Adults

Clinical effectiveness

Medicines management – CCG pharmacists worked with GPs and other providers to:

• Identify opportunities for quality improvements
• Increase effectiveness of joint working with secondary care
• Find and investigate any medicine incident related harm

Infection Prevention and Control (IPC) – Worked with providers to ensure that appropriate systems and processes are in place to ensure the risk from healthcare associated infections is minimised – Ensure outbreaks are managed and lessons are learnt/shared across the system – Identified the preparedness required for the COVID-19 outbreak Clinical effectiveness – NW London’s Policy Development Group worked with healthcare providers across the system to develop evidence-based polices – We undertook an analysis of CQC quality ratings for providers and set out a plan to support improvements in areas assessed as below good.

Local response to COVID-19

Governing Body Members

Covid-19 pandemic

28

• February and March 2020, saw the focus of the organisation shift to

support and react to the Covid19 pandemic.

• The CCG worked as part of the NW London health and care

partnership to change ways of working and staff were redeployed to support the emerging situation.

• A lot of work happened in a short space of time

and the development of our NW London system ensured that we had a united response in terms

• f implementing national

guidance, sharing resources and ensuring that as a system we provided the best possible outcomes for all patients through the crisis.

An overview of the 19/20 response

29

February

• Community testing centres and services were set up - the Heathrow isolation hotel was also opened.

March onwards

• Rapid expansion of intensive care capacity
• Hospital and community services were changed to reduce the spread of the virus
• Outpatient appointments were provided virtually
• Across London, emergency powers were put in place

to maintain urgent cancer and cardiac care in hubs and the private sector were brought in to resume elective surgery

• In our GP practices video and telephone appointments

were set-up and hot clinics were then launched to provide dedicated sites to see patients with symptoms

• f Covid19
• A dedicated programme of support for

care homes, including greater GP support, infection control guidance and dedicated point of contact with the CCG. The NHS is now working on the recovery, and ensuring services can be safely maintained in the event of a second wave this winter

Joint working / mutual support & at scale working New model – total digital triage, home visiting, escalated care clinics Recovery focused on priority groups based

• n those most

affected by COVID Shielded patients – mutual aid groups & link workers Additional support to care homes

Covid-19

Response

Primary Care

Triage and streaming of patients during first wave Self assessment of readiness for reopening of services in relation to IPC Virtual and physical visits from NWL IPC Lead to help provide 1:1 advice where needed NWL checklist to ensure compliant with obligations as employer and health care provider Online training re IPC provided to all practices and guidance shared

Covid-19

Response

PPE support throughout and

• ngoing

Infection Prevention Control

4 CQC registered nursing care homes in H&F GP clinical lead in each care home PPE champions identified in each care home to support ongoing correct use of PPE and infection prevention and control Care home clinical advice provided by *6 111 out of hours service Pharmacy and medication support put in place to facilitate medication supply

Covid-19

Response

All nursing home residents tested weekly as part of a pilot with Dementia Research Institute and Imperial.

Care Home support

Additional support 8am- 12 midnight 7 days per week from Imperial (ICHT) frailty team

Use of digital technology has accelerated since the start of the pandemic Feedback and evidence tells us that there is digital poverty, with inequality in access and ability to use the technology Working with local and NWL partners to reduce the digital inequalities that have become more apparent since the

• utbreak of

Coronavirus

Covid-19

Response

Focus on digital

We continually raise awareness that digital is just one option and face- to-face appointments will be offered to those who need them Between May and July, 78 per cent of people who use eConsult say they are either very satisfied

• r satisfied with the

service

Promptly send all of the latest Coronavirus information to

• ur patients and stakeholders

Maintain a strong two- way conversation through monthly PRG meetings Working with a new Healthwatch and others to address patient concerns and co- design patient involvement

Covid-19

Response

Patient and public engagement

We are well- represented on the NWL EPIC steering programme which has a focus on Covid recovery

Questions

Dr James Cavanagh Chair