Annual Report 2016/17 Helen Shields Chief Officer Summary This - - PowerPoint PPT Presentation

Annual Report 2016/17

Helen Shields Chief Officer

Summary

• This has been the most challenging year for the CCG to date
• There have been performance issues across the system with some NHS

Constitution targets missed all year

• There have quality issues including a highly critical CQC report where special

measures was imposed on the IW NHS Trust

• The CQC also inspected Earl Mountbatten Hospice which was rated outstanding

and all of the GP practices have been rated good

• The CCG together with system leaders put in place a Transformation Programme

through the Vanguard

• The CCG achieved all of its statutory financial duties but with difficult decisions

required

Summary (cont…)

• The first year of delegated commissioning of primary care has been successful with

a new Primary Care Strategy published.

• A Sustainability Transformation Plan across Hampshire and IOW has been

established.

• A reconfiguration of Mental Health services has commenced.
• A redesign of acute services is in progress.
• The CCG achieved all of its statutory financial duties but with difficult decisions

required

Our Objectives

• To support system transformation and sustainability

– We received vanguard funding to support My Life a Full Life Projects. – We appointed to a new senior post to lead the integration of commissioning across health and social care – We agreed the Sustainability Transformation Plan for Hampshire and the Isle of Wight – We worked closely with NHS England to make the case for additional funding to support the island

• To meet finance, quality, commissioning and performance targets

– We achieved our financial targets – We did not achieve all of our performance targets – There were challenges with the quality of services we commission

Our Objectives

• To implement and deliver delegated commissioning of Primary Care

– We published our Primary Care Strategy – We achieved our financial targets in relation to primary care – We have not yet agreed a quality framework for primary care – We have not yet finalised the performance dashboards for primary care

• To evolve the culture and governance of the CCG to deliver transformation

– We did not make the progress we hoped in relation to organisational development across the system – We have agreed to review the Governance of the CCG. – We have reviewed and recommissioned our communications and stakeholder engagement support

Future Challenge

• The CCG remains 10% above target allocation
• There is increasing demand on all healthcare services, inflationary pressures and

demographic growth

• There is a significant financial deficit at IW NHS Trust
• Primary care is increasingly under pressure in relation particularly to workforce

and demand

• The Island continues to experience significant workforce issues including

recruitment and retention in all parts of health and care sector

Future Focus

• System leadership – establishment of the IOW Local Care Board
• Local Care Plan – clear priorities for delivery and transformation
• Delivery of savings in year
• Supporting improvement in quality of services at IW NHS Trust
• Delivery of 7 day services in primary care

Performance 2016-2017

8

Andrew Heyes

Head of Performance and Contracting

NHS Constitution T argets (1)

9

The CCG met 8 of the 15 key National NHS Constitution Standards. Key problem areas were the A&E 4 hour waits, Ambulance responses , 18 week Referral to Treatment (RTT) target and cancer waiting times.

Achieved Not Achieved

Indicator

Target Actual

Diagnostic - Patients waiting for test waiting less than 6 weeks from referral

>99% 99.48%

Cancer – Max 2-week wait for first appointment for patients referred by GP urgently with suspected cancer

93% 97.03%

Cancer - Max 2-week wait for first appointment for patients referred by GP urgently with breast symptoms

93% 96.24%

Cancer - Max 31-day wait from diagnosis to first definitive treatment for all cancers

96% 98.64%

Cancer - Max 31-day wait for a subsequent treatment where the treatment is surgery

94% 95.51%

Cancer - Max 31-day wait for subsequent treatment where that treatment is an anti-cancer drug regime

98% 99.38%

Cancer - Max 31-day wait for subsequent treatment where the treatment is a course of radiotherapy

94% 98.76%

Cancer - Max 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers

90% 90.82%

Indicator Target Actual

RTT - Patients on incomplete non-emergency pathways (yet to start treatment) waiting no more than 18 weeks from referral

92% 87.29%

A&E - Patients should be admitted, transferred or discharged within 4 hours of their arrival at A&E

95% 85.74%

Cancer – Max 62-days wait from urgent GP referral to first definitive treatment for cancer

85% 81.71%

Cancer - Max 62-day wait for first definitive treatment following a consultants decision to upgrade the priority of the patient (all cancers)

86% 80.00%

Ambulance - Category A calls (Red1) An emergency response arriving within 8 minutes

75% 63.16%

Ambulance - Category A calls (Red 2) An emergency response arriving within 8 minutes

75% 70.03%

Ambulance - Category A calls (19) An ambulance arriving at the scene within 19 mins

95% 91.87%

NHS Constitution T argets (2)

Improvement plans, with target dates, have been put in place for the indicators that were not achieved.

10

Indicator Action Expected date achieved

Referral to Treatment within 18 Weeks

• Improving capacity – beds and theatres
• Recruitment to certain specialties
• Improve scheduling - booking efficiency
• Promoting patient choice to mainland providers

March 18. (90% by Sept) A&E 4 hour Waits

• Improving internal operational processes and latest

best practice guidance– ECIST / CQC

• Roll out of ambulatory Care
• Improving internal patient flow and discharge
• Recruitment plans

March 18 (90% by Oct) Ambulance call out times (3 categories)

• Improved hospital handover (Turnaround)
• Efficient use of Community First Responders
• Workforce Rotas re-design
• Recruitment and role development
• Implementation of Nature of Call (NoC) and

Dispatch on Disposition (DoD) initiatives

Red 1 March 18 Red 2 June 17 Red 3 July 17 Cancer 62 Day to treatment

• Closer working with mainland cancer centres
• Weekly patient tracking reviews.
• Working with the Wessex area cancer alliance

November 17

Isle of Wight NHS T rust CQC (1)

1 1

The Isle of Wight NHS Trust, who the CCG commissions most of its services from, was recently put into special measures following a CQC inspection. In response: The Trust, working with the CCG and other health and care partners and receiving advice from expert bodies, has developed an extensive improvement plan. T

• monitor progress and achievement, target dates for step- change

improvement have been set. The CCG will be working with the Trust’s regulators (NHS Improvement) to support delivery of the improvement plan.

Isle of Wight NHS T rust CQC (2)

1 2

In response: The action being taken by the CCG includes:

• Strengthening quality management, including: thematic reviews,

quality visits, and “deep dives” into service areas;

• Setting a clear vision for mental health services and

strengthening commissioning arrangements;

• Working with the Hampshire and Isle of Wight Sustainability and

Transformation Partnership (STP) and the Acute Care Alliance (University Hospitals Southampton, Portsmouth Hospitals and Isle of Wight NHS Trust) to ensure sustainable acute services for Islanders and visitors.

Finance 2016-2017 Loretta Outhwaite

Chief Finance Officer

How we spent our allocation

2016/17 funding of £239m

• Programme(healthcare) £217m
• Running costs £3m
• Delegated primary care £19m

The funding included:

• Growth funding of £2.8m (1.4%);
• Non-recurrent investment from

the national New Care Models programme of £4.9m, to support service transformation.

Financial Performance Highlights

All statutory financial duties achieved:

• Expenditure did not exceed income;
• Cash balance £127k, within cash limit;
• Running costs were within the allocation of £3.1m;
• Audit Letter: Financial Statements – unqualified;
• Audit Letter: Income & Expenditure – unqualified;
• Audit Letter: Value for money conclusion: identified a weakness in

planning finances effectively to support sustainable delivery of strategic priorities and maintaining statutory functions. CCG delivered a surplus of £2.3m, which was £2.3m above target, due to a national requirement to retain the 1% risk reserve. The Quality Innovation Productivity and Prevention (QIPP) plan delivered £6.5m (2.7%) savings in 2016/17.

Planning 2017/18

service transformation in 2017/18 is likely to be c£3.3m.

• Allocation for 2017/18: £233m;
• Programme costs: £21

1m

• Running costs: £3m
• Primary Care: £19m
• 10% (c£19m) above target, therefore received minimum growth of

£0.3m (0.16%: average national growth 2.14%);

• In line with NHS business rules the CCG plans to:
• Achieve an in-year break-even position;
• Hold a 1% £2.3m risk reserve, 50% of which is un-committed;
• Hold a 0.5% £1.2m un-committed contingency;
• QIPP savings target of £12.9m (5.6%) is required to deliver a

break-even position; currently estimating a delivery risk of £2m;

• Additional non-recurrent New Care Models funding, to invest in

Financial issues

Financial pressures on the Health & Social Care system

• CCG has an underlying deficit (c£2.9m);
• Minimum growth funding for the CCG forecast to 2020/21;
• Significant pressure on Social Care budgets;
• Isle of Wight NHS Trust in significant financial deficit.

Actions

• Partnership working through Local Care Board/Plan, with IW Council and IW

NHS Trust;

• Partnership working within the Hampshire and Isle of Wight

Sustainability and Transformation Partnership (STP);

• Service transformation through the implementation of the Isle of Wight

My Life a Full Life Care Model; integration, care closer to home, prevention

Isle of Wight population

Source: https://fingertips.phe.org.uk Source: IOW Public Health

Increasing net migration to the Isle of Wight by people in the older age groups. Public Health will not have an impact on preventing conditions in these populations.

Health Needs – Multiple chronic conditions by age

– The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more conditions – More people have 2 or more conditions than only have 1 – More people have one or more condition than have none – 58.1% of patients have at least one condition Source: ACG Risk Stratification tool, June 2017

Activity Benchmarking – NHS Outcomes T

• ol

Unplanned hospitalisation for chronic ambulatory care sensitive conditions, 2015-16 Emergency admissions for acute conditions that should not usually require hospital admission, 2015-16

T

• tal savings opportunity per

1,000 registered population

Source: RightCare Where T

• Look Packs, Jan 2017

Disease area savings opportunity per 1,000 registered population

Circulation Endocrine, Nutritional and Metabolic Mental Health Respiratory

Source: RightCare Where T

• Look Packs, Jan 2017