NHS City and Hackney CCG Commissioning Intentions 2017/18 and - - PowerPoint PPT Presentation

Commissioning Intentions 2017/18 and 2018/19

NHS City and Hackney CCG

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Tonight is about hearing your thoughts

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Planning

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Some of the local Issues we want to address:

• Cardiovascular mortality for under 75s

high for the least 20 years, but now declining

• Obesity rates still high
• Smoking
• High A&E attendances
• Emergency admissions for over 75s still

high

• High levels of mental health need
• One year survival rate for cancer is

improving, although overall mortality still not good The NHS planning timescale this year means that the contracts for the services planned for the next two years must be signed in December 2016. Our plans reflect both national and local priorities.

Joint planning with City and Hackney

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• We are working with London Borough of

Hackney and City of London Corporation to plan health, social care and public health services together. These arrangements will become more formalised from next April.

• By doing this we want to support our

providers to also work better together and join up services around the patients’ needs.

• Examples of this more joined up way of

working include:

• Developing a care model that enables

different professionals to look after the patient together, as a team. (quadrant based model)

• Setting up a single place to contact

services when in crisis (single point of access)

Opportunities for Patient and Public Involvement(PPI)

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• We want our services to reflect our local populations and their needs which is why local

residents and patients are involved in all our decisions.

• Our plans and ideas come from talking to patients and members of public, as well as

local GPs who form our membership.

• Our PPI structures were rated ‘outstanding’ by NHS England in 2015/16.
• People can get involved in the CCG’s work through the following groups and

structures:

Where the CCG will spend its resources in 2017/18

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Homerton NHS Foundation Trust 29.7% North East London Acute Trusts 8.5% Other London Acute Trusts 10.1% London Ambulance Service 3.2% Other Acute Trusts 1.1% Mental Health Services 12.9% Community Health Services 7.4% Continuing Care 6.6% Primary Care 3.5% Prescribing 7.5% Other Programme 7.5% Property Costs 0.5% Running Costs 1.6%

Homerton NHS Foundation Trust 29.7% North East London Acute Trusts 8.5% Other London Acute Trusts 10.1% London Ambulance Service 3.2% Other Acute Trusts 1.1% Mental Health Services 12.9% Community Health Services 7.4% Continuing Care 6.6% Primary Care 3.5% Prescribing 7.5% Other Programme 7.5% Property Costs 0.5% Running Costs 1.6%

Whilst the CCG is continuing to make investments in areas of local health economy needs, it continues to meet and exceed the National Mental Health Parity Of Esteem targets each

• year. £14m of non-recurrent funding

has been made recurrent to facilitate this investment.

Pooled budgets

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CCG = Clinical Commissioning Group PH = Public Health SC = Social Care

Our “Time to talk” scheme (extended consultations for people with multiple long term conditions) is a good idea Peer support is helpful

You said..

We commissioned Hackney Council for Voluntary Services to run a grant programme for local organisations to

• ffer peer support groups for people

with a range of long term conditions We re-commissioned this service and have expanded it to include people with sickle cell disease as a single condition

Long Term Conditions: You said… We did

We did

Planned Work

• More people will have access to longer consultations and

reviews with their GP practice

• People will be supported to help themselves and manage

their condition through a range of different services including peer support and education

• We will find and treat more people with high blood pressure
• People with Learning Disabilities will get enhanced support

from their GP and improved job opportunities

Long Term Conditions

“Look at other ways of

• ffering

appointments …” “as we recognise that staff are under pressure…” C&H patients said… As part of the same contract some practices are starting to try out group consultations for people with certain long term conditions Commissioned the GP Confederation to pilot on-line consultations - some practices have just started

• ffering these

Primary Care Quality - You said… We did

We did

• The NHS has an aspiration that all patients in the country

have access to weekend/evening routine GP appointments by 2020.

• City and Hackney CCG is considering how it can give

patients the opportunity to consult with their GP practice

• utside of standard practice opening times - which for

most C&H practices is 8 am to 6.30, Monday to Friday.

Planned Work

Primary Care Quality

We need more services for older people. You were concerned that our intention to keep people out of hospital may not be in some people’s best interest. Patients and carers find it difficult to know whether to call 111, or our local

• ut of hours service
• CHUHSE. Adding the

Paradoc service as another option to call would be asking people to make clinical judgments that GPs are best qualified to make. Urgent care services will continue to be managed in primary care with patients accessing GP’s telephone assessment in and out of hours. The sickest patients will be visited at home or referred to hospital, with community teams supporting patients at home where it is safe to do so. The GP contract which supports Nursing Homes will continue until January

• 2019. The Frail Home

Visiting service will have permanent funding from 2017/18.

Crisis Services (Urgent & Integrated Care) You said… We did

We used this feedback when revising service specifications for our crisis services.

We did You said

Planned Work

• Simplifying access to urgent care services through a new integrated urgent care

service (111) and the development of a single point of coordination for crisis care services.

• Ensuring patients receive joined up health and social care through better integration

and coordination of multidisciplinary teams (quadrant working).

• Avoiding long hospital stays and ensuring patient choice through improved discharge

processes.

• Ensuring that patients approaching the end of life have the opportunity to express their

wishes about future plans, and be supported to die in the place of their choice.

Crisis services

You were discharged after a procedure but couldn’t get your dressings changed and stitches removed at your GP practice You have no alternative but to go to A & E with Minor Eye Conditions because you couldn’t see anyone quickly People who communicate by Sign or can’t speak English said they were having problems with accessing health services in the City of London and Hackney

You Said

We are working with Islington CCG to commission a new service for Minor Eye Conditions to provide care in 24/48 hours at a local Opticians- starting in early 2017 A new Post-Operative Wound Care Service started in April giving City and Hackney patients access to dressing changes at their local GP practice, or one close by, 7 days a week.

Planned Care - You said… We did

We will improve community and GP Practice interpretation services by providing face-to-face interpreting for those who need it as well as greater access to telephone and video interpreting

We did

Planned Care

• Develop a photography dermatology service so local GPs can send photos for

diagnosis directly to the consultant at the hospital. This will help some patients avoid a trip to the hospital and will enable the GP to start treatments more quickly

• Improve audiology services to provide better access to hearing tests in the

community

• Reduce cancer pathway delays - Aim to improve early diagnosis by achieving

50% of patients diagnosed within 28 days by 2020. This will include supporting GPs to refer their patients straight to a diagnostic test so patients are diagnosed more quickly

Planned Work

Mental Health - You said… We did

FAMILIES Learnt behaviour from parents / carers with chaotic lifestyles. Impact of environment on child and their development including development of anxiety in young adults. DEMENTIA Improving outcomes for dementia sufferers – need improved links into

• services. Increased

people living more independently; consider use of technology to maintain at home as long as appropriate for individual. Keeping people well and prevention area very important. Investment here prevents more costly care We have secured on-going investment in Family Action to support and reduce incidents of depression, social isolation. Family Action will offer practical and emotional support for individuals as well as whole famililes We are focusing our dementia Alliance work on reviewing and improving current care pathways. This will help support people to live more independently and where appropriate, make use

• f new technology.

We are also investing in a befriending and peer support service for carers of people with dementia CHILDREN Young children (age 5 given as example) placed in PRU’s and future impact as no school place – set up to fail but underlying issues not dealt with Work in the CAMHS Alliance will improve the interfaces core mental health services have with

• schools. There will

be a key focus on exclusion rates and dealing with systemic issues in relation to children in Pupil Referral Units (PRUs) EMPLOYMENT Keeping people

• employed. Lack of

employment directly links into MH We are investing in initiatives that improve employment

• pportunities via the

Psychological Therapies Alliance improvement programme.

Mental health

Mental Health Alliances : Phase two of getting our mental health providers working together seamlessly towards shared improvement programme. Key Areas: Children's Mental Health (CAMHS), Psychological Therapies, Dementia, Primary Care, Autism. City of London and Hackney Local Authorities both active participants to ensure plans align with the needs of their residents Management of mental health in primary care: Development of primary care dashboard which will provide in-depth knowledge of system issues relating to the diagnosis and management of mental health in primary care. This information can then be used to improve services Services that help people having mental health crisis / urgent care: Invest in a CORE psychiatric liaison service and compliant Early Intervention in Psychosis (EIP) service (aim to expand EIP), build on innovative pre crisis initiatives: Service User Network (SUN) Project, Crisis Café, pilot virtual street triage as part of the Crisis Line, improve access to substance misuse services for inpatient wards. Children and Young People Mental Health: New funding will improve eating disorders, perinatal (before, after and during pregnancy) Mental Health and autism pathways, provide 24/7 crisis support and transform services to improve links with schools, children’s social care, youth justice and continue to address early intervention and family support. We increase capacity to better meet greater numbers of children and young people with mental health needs.

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Planned Work

We heard that being admitted when labour has started can take too long and there is limited space for women to labour comfortably Women suggested being assessed at home or by telephone and going straight to the birth centre if booked there. The Homerton has reviewed and audited it’s triage service and they are putting in place lots of new actions

Arriving at hospital in labour (triage service)

The Homerton are extending their maternity telephone helpline hours to help provide more phone assessments for women in labour The Homerton are changing the name of their service to ‘Emergency Obstetric Unit’ so it is really clear for patients that it is for emergencies.

Maternity You said… We did

Midwives are reviewing women at 34 weeks and identifying everyone suitable for a midwife led birth at the birth centre Homerton are introducing stickers for the front of women’s notes saying ‘Homerton birth centre’ so low risk women can bypass the triage service

We did

Planned Work

Support to breastfeed

• We will redesign breastfeeding support services to make sure services reach women

where and when they need help.

• We will also make sure services target women who are less likely to breastfeed and
• ffer tailored support that meets their individual needs.

Reducing infant deaths

• We will make sure that projects that help to reduce stillbirths and infant deaths are in

place at the Homerton.

• This includes projects that help women to stop smoking when they are pregnant and

that help to identify babies before they are born that are small, not moving as much they should and babies who are in distress during labour and birth. Improving pregnancy outcomes

• We are reviewing the support available to women who are overweight or obese before,

during and after pregnancy.

• We know being a healthy weight helps reduce the risk of things like gestational diabetes,

pre-eclampsia and miscarriage which can all affect the health of mother and baby

Maternity

All services need to work together for families whose children have special educational needs and disabilities (SEND) The voice of children, young people, parents and carers need to be heard Services are too fragmented We want services to be joined up, so we

• nly tell our

story once Our Children’s Disability Forum provides coffee mornings and subject topic sessions for parents/ carers A fantastic week of inclusive , health and well being activities, held in partnership with the Hackney Empire, were provided for young people We have identified how health information can best be shared to inform joint planning with families and professionals

Children: You said… We did

There is better joint working between GPs and Health Visitors, identifying and supporting

• ur vulnerable children

More children and young people are offered Personal Health Budgets, joining up their health and social care services

We did

Pl Plan anned W d Work

• Through our GPs we will increase the number of children being immunised. If we

reach 95% or ‘herd immunity’, we can be more confident that we will not have local

• utbreaks of diseases such as mumps and measles
• We will explore how to reduce the increasing numbers of children and families

attending A&E whose needs could be met in the community

• We will ensure that accurate information is available via the Hackney and City

Local Offer websites. These should include all health, education and social care services available to local children, young people and their families

Children

Patients should be able to ask their Pharmacists what they can expect from their drugs:10 mins with the Dr is not enough to find out about their medicines Some patients feel they get given medicines they don’t take as they should How is the CCG managing patients’ expectations of having a medicine prescribed after every GP consultation? Medication Review dates- Patients don’t understand this very well Those on many drugs – have problems having to request various medicines at different times – need system to try and ensure patient doesn’t have to make repeated trips to

• rder different meds

You said…

As part of the NEL STP plans, we are looking at

• Promoting self-care
• Supporting general practices to

reduce use of drugs that are not good clinical evidence e.g. cough & cold remedies

• Promoting community pharmacies

for supporting patients with advice for minor ailments Reducing use of GP time for minor ailments, will release appointment times for patients with who have long term conditions or who have more severe / complex conditions From Nov2015, we started a pilot Domiciliary Medication Review Service – 2 pharmacists visiting referred patients to help identify & sort out medicines issues Pharmacist(s) have worked with C&H practices & > 1,000 patients with asthma or COPD have been reviewed, improving the way patients use their inhalers

Prescribing Programme Board You said… We did

This year we have been providing training for non- clinical GP staff on the repeat prescriptions including advice to patients

We did

Planned Work Key Questions

• 1. End of life care (EoLC) medicines
• Reviewing options for improving how medicines for

EoLC are made available to patients

• 2. Continence Care
• Review of current systems for providing continence

products

• Agreeing & implementing a formulary [preferred NHS

list] of cost effective products

• Improving follow up care of patients receiving these

products

• 3. Reducing prescribing of drugs of limited

therapeutic value

• Reducing investment in interventions with low

clinical value e.g. cough & cold remedies & releasing

• pportunity costs for investment in medicines

proven to improve mortality & morbidity

• This would also help free GP appointment time for

more complex appointments

• Increasing Self-Care & use of community pharmacy

services

• 1. What problems have you or those close to

you had in relation to medicines when a loved

• ne has died at home?
• 2. If you or a close friend or relative use continence

products:

• What works well for you ?
• What problems do you have ?
• What improvement ideas do you have ?
• 3. Do you agree the NHS should prioritise

funding of drugs which have proven evidence and disinvest from products of limited clinical value?

• 4. Are you aware of the minor ailments scheme /

Pharmacy First?

Prescribing Programme Board Summary of Planned Work & Key Questions

Next steps

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• We would like to hear your thoughts on the key questions

in the hand-out.

• Your views will help shape our plans for the next two

years.

• There are lots of opportunities to have your say. For

further information about how to get involved please see below:

• Hackney devolution pilot: Emily@HealthWatchHackney.co.uk
• CCG Plans: eeva.huoviala@nhs.net