NHS Croydon CCG Annual General Meeting Thursday 28 September 2017 - - PowerPoint PPT Presentation

NHS Croydon CCG Annual General Meeting

Thursday 28 September 2017

A very warm welcome to our Annual General Meeting 2017

Dr Agnelo Fernandes Clinical Chair

Introduction

Councillor Toni Letts OBE The Worshipful the Mayor of Croydon

Governing Body Members

Governing Body Members

406,000

Over half of Croydon population are from a black or minority ethnic background

17% of adults smoke

65% of adults are overweight and

• bese

Population growth 1% per year 1 in 4 children are

• verweight and obese

Croydon in numbers…

GP registered population

• Our vision is for: Longer, healthier

lives for all the people in Croydon

• We plan and buy most health

services in Croydon, including hospital, community and mental health services

• Clinically-led membership
• rganisation of 57 GP practices

across six clinical networks

• Budget of £488 million for services

Who we are and what we do

Andrew Eyres Accountable Officer

www.croydonccg.nhs.uk

Improving performance and quality Areas where we have performed well:

• Access to cancer diagnosis and care
• Identifying people with dementia
• Early intervention in psychosis
• Supporting people with learning disabilities

Improving performance and quality Areas where we need to improve:

• Waiting Times in A&E
• Referral to Treatment and Diagnostic Waiting

Times

• Improving Access to Psychological Therapies

Meeting our significant financial challenge

• We have a statutory obligation to live within our means and remain

under financial special measures as part of our recovery process.

• Croydon CCG overspent by £10.8m in 2016/17 against a planned

deficit of £4.2m.

• We are planning for a deficit of £6.9 million in 2017/18 with a

savings target of over £29 million

• Resolving our 3% historical challenge and around 3% per annum

added value is required for the next three years, if we are to address the needs of a growing and ageing population and live within available resources

Improving out of hospital support

• Commissioner and provider led programme to

transform health and social care services to over 65s

• The aim is to support older people in Croydon to stay
• ut of hospital and remain as independent for as long

as they can

• Partners include Age UK, Adult Social Care

Services, Croydon Health Services NHS Trust and South London and the Maudsley NHS Foundation Trust.

• More on this later!

Transforming urgent care

• During 2016/17 we designed new approach to treating

urgent care. Commenced from April 2017.

• New approach providing high quality urgent care 8am –

8pm, 365 days a year

• Three ‘GP Hubs’ are now open across the borough

to treat both minor injuries and illnesses.

• The Hubs also offer walk-in services, but

‘phone before you go’ to ensure residents access the best service

• Health Help Now app has over 4,000 downloads

across Croydon and Sutton

Improving access to mental health services

• £1.1m invested in Child and Adolescent Mental Health Services;
• Reduction in the average waiting time for a routine appointment from 104

weeks to eight weeks

• Roll out of Single Point of Access into Mental Health and Well Being

Services across Croydon, involving specialist CAMHS, and the Local Authority Early Help service

• Support people to stay well in the community, working with third sector

partners such as The Mind Hub and Imagine Drop In.

• No Health without Mental Health training

delivered to 250+ members of the public and professionals

• Piloted nurse-run physical health checks and smoking

cessation advice on a twice weekly basis

Together for Health: Helping people to help themselves

• Piloted successful group consultations in six GP

practices

• Rolled out support for clinicians to engage with

patients and involve them more in decisions about treatment

• Improved use of voluntary sector resources and

increased evidence of ‘Making Every Contact Count’

Engagement and consultation

We have run two engagements and one consultation

• ver the year about IVF/ICSI, routine prescribing and

women’s mental health facility, Foxley Lane. We have also forged links with the wider community to support our work:

• Worked with Healthwatch Croydon volunteers to help us

disseminate information about the Financial Recovery Plan

• Partnered with agencies such as Croydon Voluntary Action,

Croydon Asian Consortium and the Croydon BME Forum to

• utreach and engage with seldom heard communities

Working with our partners within Croydon

• We are working towards a better integrated health and

care system in Croydon

• We want to ensure services are coordinated around the

needs of individuals and communities

• We want to work to prevent ill health

and sustain independence

• Where care is needed, we want

it to be accessible, high quality and to support recovery

Working with our partners across SW London

• SW London Sustainability and

Transformation Plan to be refreshed later this year with a new focus.

• Approach to planning across NHS and

Local Authority partners focusing on the needs of local people and involving them.

• Support people to stay healthy and

independent – “the best bed is your

• wn bed”

Thank you to everyone involved in improving health and providing care in Croydon

Financial Performance

Mike Sexton Chief Finance Officer

We spent £489m on the following care:

We are funded £1,182 per person (£478m) We spent £1,208 per person in

• Croydon. Our key providers of

healthcare are:

• Croydon Health Services NHS Trust
• South London & Maudsley NHS

Foundation Trust (FT)

• St George’s University Hospitals

NHS FT

• Kings College Hospital NHS FT
• Epsom & St Helier NHS Trust
• London Ambulance Service

Financial Performance in 2016/17

Description Source Target Actual Achieved Target Expenditure Deficit (Cumulative) NHSE £4.2m deficit (£47.9m deficit) £10.8m deficit (£54.5m deficit)

 

QIPP Savings Target NHSE £18.4m £14.5m



Revenue Resource Limit (Cumulative) Stat. £Nil £10.8m deficit (£54.5m deficit)

 

Capital Resource Limit Stat. £0.2m £0.1m



Administration Costs Stat. £8.3m £8.0m



Maximum Cash Drawdown NHSE £488.7m £487.6m



Cash at Bank on 31/3/17 NHSE £0.5m £0.3m



Public Sector Payment Policy DH 95% 93.0% - 99.3%



External Assurance on Financial Performance

Type of Opinion Description Opinion Achieved Financial Statements Opinion “True and Fair View” Unqualified



Regularity Opinion “expenditure incurred as intended by parliament” Qualified: Expenditure exceeded resource limit



Value for Money Assessment Securing economy, efficiency and effectiveness Qualified: Did not meet NHSE target deficit



Looking forward …

In 2017/18, Croydon CCG received £12.0m (2.62%) allocation growth - now

• nly 3.69% below target funding.

Above average funding only available if more than 5% below target – expectation is now that the CCG must simply live within its allocation. Target performance is £6.9m deficit (17/18) and breakeven (18/19) – need to deliver £44m QIPP across the two years. There is significant challenge in 2017/18. CCG to deliver a sustainable breakeven position from 2018/19.

Financial Recovery Approach

25

The CCG will need to deliver savings of £29.3m through:

• Continued delivery of our QIPP Programme – clinical based service

redesign

• Ongoing delivery of longer term transformational schemes; Planned Care

Transformation, Out of Hospital Strategy, Together for Health, Transforming Adult Mental Health

• Releasing ‘management cost’ savings
• Enforcing compliance with treatment policies and criteria
• Working with partners and providers to deliver better value from contracts

and release savings

Any questions?

Out of Hospital

Rachel Soni Alliance Programme Director

28

Sylvarani Nair Personal Independence Coordinator

“Look at Me Now!”

A Case Study

Background

Robert is 77 years old

• He lives alone
• Same rented accommodation for 30 years
• His wife was bed bound and he cared for her
• He used to be a professional magician
• His daughter lives in Wallington

In January 2016 he experienced shortness of breath and rapid weight loss

• Admitted to hospital where he stayed for 11

months on and off

• Discharged in November 2016
• Wife passed away in that period
• He did not return to work

What was the situation

• Robert was confined to the top floor
• f his home
• He could not climb his stairs and

relied on paramedics to move him up and down to attend outpatient appointments by ambulance

• He was supported by carers three

times a day, relying on them for his meals

• Medication for panic attacks, COPD

and vasculitis

• He had no central heating, he could
• nly afford an electric heater and air

purifier

How the PIC service has helped

• Identified goals to increase Robert’s independence in his home
• Assess the risks and discuss them with Robert and put prevention

measures in place

• Set small, achievable targets – like walking downstairs once a week
• We also arranged for:
• a volunteer to visit him every week to talk to Robert, encourage

him and supported him to plan and make light snacks and easy meals himself

• heating to be installed at his home through his letting agent
• a local school horticulture tutor does some gardening for Robert
• an application for attendance allowance to be submitted to

Croydon benefits adviser service

• Age UK Croydon Healthy Living Project to visit him at home and

successfully advise him of a weight gain diet

Robert says:

“When I was returned to my home in November 2016 I was fearful as to what would happen to me particularly as I would be on my own for the first time in 40 years, and living with support three times a day. “When I was first contacted and met SN from AUKC I was sceptical of programme planned and the support I was promised but “look at me now!” “With the help of SN, my carer, the volunteer and my family I am able to go up and down stairs 2 or 3 times a day and undertake minor tasks that require minimum effort in order to preserve my respiratory rate. “I am now eating three meals a day and have gained weight. I am planning to take up driving again, with the approval of my doctor, have regained my personal confidence and look forward to the continuation of my progress. “All this is down to the encouragement and support received from AUKC and SN.”

Outcomes achieved

• Attendance allowance granted
• More independence at home
• Heating installed in some rooms
• Garden work done
• House clean
• Healthy living and gained weight
• Started driving again

Trip to Knole House in wheelchair Home-made cakes Road trip to Italy with his grand daughter

Robert’s GP says: “I think the PIC involvement with this patient has had an incredibly positive impact with respect to his holistic needs. The patient engaged well and appears to be more independent inside and

• utside of his home.“

Any questions?

Rapid Response Team

Dr Chris Bell Community Geriatrician Nicola Gass Rapid Response Matron

Community Rapid Response

Croydon Health Services NHS

NHS Trust

The Rapid Response Service is an admission avoidance service available 24 hours a day, 7 days a week. We are a team of nurses and therapists, with on-call consultant support. Categories of patients NOT accepted

• Medically unstable
• Sudden onset of acute delirium
• Acute Mental health
• Head injury
• Acute urine retention
• Substance misuse
• For requirement of package of care and respite

Rapid Response

The aim of the rapid response team is to:

To prevent inappropriate A&E attendances by providing rapid intervention and support

The rapid response team:

• Provides expert advice and signposting on the appropriate community pathways

available

• Provides clinical triage role within the admin centre
• Reduces the risk of inappropriate readmissions
• Works with staff in care homes

All healthcare professionals can refer to the Rapid Response Team. Members of the public cannot self refer.

2014-2018

Rapid Response Case Study 1

Background

• Referral made by London Ambulance Service for patient following a fall

Rapid Response Actions

• Oral fluids encouraged as likely dehydrated
• Full set of bloods taken
• Antibiotics prescribed for a unitary tract infection (UTI)
• Deemed too unsafe to remain at home so patient transferred to a Step Up Bed

at a care home that day for medical supervision and therapy input

Background

• Referral received from GP
• 96 year old lady with recent discharge from hospital with catheter.
• Patient was independent before being admitted to hospital

Rapid Response Actions

• The team identified that the patient would benefit for a trial without her

catheter, once her chest infection had cleared.

• Patient has reduced her package of care and is completely mobile
• Discharged with a higher level of independence

Rapid Response Case Study 2

Any questions?

Thank you

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