Hounslow CCG Annual General Meeting 2019/20 Thank you for joining - - PowerPoint PPT Presentation

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Hounslow CCG Annual General Meeting 2019/20

Thank you for joining us. The meeting will begin at 12.30pm.

Welcome to Hounslow CCG AGM

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TIPS: Questions can be posted in the MS Teams question and answer section and will be responded to towards the end of the presentation.

Welcome to Hounslow CCGs AGM

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Today’s agenda:

Welcome and AGM

Jo Ohlson, Accountable Officer Annabel Crowe, CCG Chair

NW London plan 2019/20:

• Changing the way we work

a single CCG for NW London

• Our five year plan
• Covid19

Jo Ohlson

Finance

Jenny Greenshields, Chief Finance Officer – NWL CCGs

Quality

Diane Jones, Chief nurse/Director of Quality NWL CCGs

Questions

Jo Ohlson, Jenny Greenshields, Diane Jones

Achievements 2019/20 Local Covid-19 update Patient Engagement

Annabel Crowe Dilo Lalande/Judith George, CCG Engagement

Questions

Annabel Crowe

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Annabel Crowe

NW London plans 19/20

Jo Ohlson Accountable Officer North West London Collaboration of CCG’s

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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

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• In 19/20 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 T erm Plan, to improve the quality of patient care and health outcomes, 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.

• T
• deliver our ambitions set out in the plan, throughout 19/20, we have

focussed on seven interconnected areas:

Clinical and care strategy

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In conjunction with our five year plan we have also developed our clinical and care strategy. Setting out our expectations of care – as professionals, as stakeholder organisations accountable to our communities, and as patients, carers and residents in our local areas. 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

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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.

Covid-19 pandemic

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• 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

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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

Our system’s financial challenge

Jenny Greenshields Chief Finance Officer NWL CCG’s

Financial position

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2019/20

• Accounts have been closed and

show a deficit of £50.9m in line with

• ur 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 Covid pandemic.

• For the first six months of the year

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

• NHS providers receive a block

payment to meet their costs and the

• pportunity to claim for a ‘top-up’ if

this block payment is insufficient to cover their costs.

• We are waiting guidance on what the

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

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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

begin to see a reduction in acute activity growth, which should impact on future costs

System alignment

• 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 embedded 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 have we achieved since last year?

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Returning to financial balance as a system

Covid-19 has significantly changed the way NWL are currently operating as a health system, with many of the normal activity of providers and commissioners being refocused on the Coivd-19 response. 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.

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Financial Position 2019/20 – Hounslow CCG

The below table shows that the CCG achieved breakeven in 19/20. The CCG also achieved its financial duties with regards to Running Costs.

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How we spent your money – £425m in 2019/20

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

Quality

Diane Jones Chief nurse/Director of Quality North West London Collaboration of CCG’s

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.

Questions

Key achievements

2019/20

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Achievements 2019/20

Cancer

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• 5th most improved CCG for adult cancer

survival rates (since 2002) in the country.

• Hounslow GP practices signed up to the

CtheSigns pilot.

• Improved cancer screening rates from

18/19 to 19/20

• New test (FIT) available in primary care

since May 2019 to support the early detection of bowel cancer in low risk patients.

• Secured funding for a Macmillan cancer

GP to support primary care education.

• Increase in Learning Disability health checks to 77% - 19/20 position

62%

• Increase in Mental Health physical health checks which has led

NHSE Improvement to identify Hounslow national as an area of good practices and improvement

• Receptionist to Health Care Assistant programme
• Primary Care Networks have been developing over the year, with 5

networks across Hounslow established in July 2019

• Supportive partnership working between PCNs and Community Trust
• Link worker (social prescriber) and pharmacists recruited by PCNs.
• Increased access to routine appointments in hubs evenings and weekends

Primary Care

Achievements 2019/20

Mental Health – children and young people

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• Established a third Mental Health Support Team for early

interventions in schools,

• Wellbeing Practitioners in place and offering variety of

support to children and young people with mild to moderate mental health needs, in a group or class basis, and training and consultation to school staff.

• Significant investment in autism assessment pathway to

meet waiting time growth.

• Produced an advice and support guide to signpost

families and professionals to a range of resources in the community.

The map is designed to help young people access advice and support.

We have coproduced a Mental Health and Wellbeing Map and a Wellbeing Charter for schools. This was coproduced with young people from Hounslow Y

• uth

Council and the CAMHS Y

• ung

People’s Panel.

Achievements 2019/20

Mental Health – adults

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• Increased investment in crisis care – larger

liaison team at West Middlesex Hospital, 24/7 community crisis team, crisis café,

• New Mental Health Integrated Network Teams

(MINT) - increased resource and staffing with West London Trust linked to each Primary Care Network.

• Phased implementation beginning in

2020/21. Three new residential services opened during 2019/20 for local residents with serious and long-term mental health needs, all with 24-hour staffing, providing a total of 29 places.

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NEW SERVICES

24hr

ST AFFING

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PLACES

Achievements 2019/20

Learning Disabilities

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• Increase in Learning Disability health

checks to 77% from 62% in the previous year.

• The number of people with a learning

disability residing in specialist hospital settings has reduced from six in 2018 to three in 2019.

• Improved outcomes for people - engaging

in community activities and being as independent as possible.

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PEOPL PEOPLE WIT WITH A LEARN RNIN ING DISABI BILIT LITY RESIDIN RESIDING IN A SPECIALIST SPECIALIST HOSPI HOSPIT A L SETTING SETTING

Achievements 2019/20

Bristol Court opening

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• In September 2019,, a new 94-unit extra

care scheme opened in Feltham.

• Delivers care for adults with learning

disabilities and dementia alongside support for adults who have a physical disability or are frail due to age.

• Daily activities are run on-site.
• Residents receive enhanced primary care

from their local GP, who work with the care provider to create Coordinate My Care records and Health Passports.

“[Resident’s] son has expressed his happiness since his Mum moved to Bristol Court. He has found that she is engaging in more conversations with him and she has not responded to him like that in a very long time. He said he was so grateful that [his mum] had social activities to look forward to, as it was doing wonders for his mum’s wellbeing.”

Achievements 2019/20

LIFE Supported Housing Services

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• LIFE Supported Housing Services is a scheme to

develop two single-bed self-contained flats to support individuals who are, or are going in to crisis.

• These units will be used to reduce the need for hospital

admission and help manage any issues locally wherever possible.

• The two units were completed in March 2020 and will be
• ccupied in November 2020.

• The Integrated Care Partnership (ICP) is a collaboration of

NHS organisations, local councils and other health and care partners, taking collective responsibility for managing resources, delivering effective health and care services, and improving the health and wellbeing of the population it serves.

• Good progress in working across organisational

boundaries both before and during Covid period. Examples such as :

– The hospital discharge hub, – COVID hot hubs, – system level planning for winter and second wave of Covid.

• We also made our commitment to integration explicit

with an ICP alliance agreement.

Integrated Care

Achievements 2019/20

Integrated Care Partnership (ICP) working groups

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There were key workstreams in 19-20 that were signed up to by all partners under the Health and Care

• Partnership. These included:

Support to High Intensity Users Improving Urgent Care services for both adults and children Identifying rising risks in the local population and implementing initiatives to population health improvements Falls pathway Integrated home visiting models

Public Engagement

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• We strive to put the patient’s voice at the heart of everything we

do.

• We have continued to build on the successes of previous years by

strengthening our innovative approach to public engagement

• On August 3, 2019, and October, 24, 2019, the CCG held road show

events where we spoke to 400 people about their views on the flu immunisation, new roles within GP practices and about ways in which people were trying to be healthier

• We have given 23 presentations to community groups, had stalls at

17 events, conducted 25 one-on-one interviews with members of the public, attended 20 public meetings, held 13 focus groups, attended 15 community and voluntary sector meetings, held six Patient Committee meetings and held two roadshows

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Patient and Public Involvement - Outcomes

Here are some examples of the outcomes of patients engagement.

• The launch of the Maternity Voices Partnership in June 2019 and a further

five sessions have happened since with mums/mums-to-be and dads/dads- to-be via activities or breastfeeding sessions taking place in Hounslow GP practices

• A closer understanding of the Trans community in Hounslow. Through a

very specific piece of engagement we were able to interact with five Trans patients, offering valuable feedback, advice and suggestions

• Engagement with healthcare professionals, children, young people and their

families was used to inform a new service specification for Child and Adolescent Mental Health Services (CAMHS)

Achievements 2019/20

Black, Asian and minority ethnic (BAME) engagement

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• Healthcare engagement with Black,

Asian and minority ethnic (BAME) young people at West Thames College during Black History Month in 2019.

• Diabetes awareness roadshow with

the BAME community

• NW London Workforce Race

Equality Standard (WRES) report published with recommendations for 2020/21.

We have also been engaging in a dialogue with our membership regarding improvements to services through:-

• Neighbourhood meetings.
• Practice visits.
• CCG events.
• Clinical leads meetings.
• Ran and managed Network Patient Participation Group meetings
• Established five Primary Care Networks across Hounslow
• Re-launch of the Integrated Care Patient Participation Committee
• Right to Sensory Equalities Partnership Group
• Tobacco Control Plan Workshop
• Carers Week at the Treaty Centre
• Dementia Steering Group
• Representation at Healthwatch Hounslow Mental Health Workshop for

Residents of Hounslow

Integrated Care engagement and better partnership working & routine engagement events

Local covid-19 update

Dr Annabel Crowe Chair Hounslow CCG

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Discharge Hub to manage patients coming out of hospital Primary care support for shielded patients Virtual consultations and mobilisation of E- Consult Antigen and Antibody testing for staff and public

Covid-19

Response

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Communication Channels

Questions

How can I get involved?

We want Hounslow residents, patients, carers and health, care and voluntary sector professionals to be involved. We are committed to developing services together with patients, the public and staff. We want to hear from you: get in touch by emailing HOUCCG.communications@nhs.net

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