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
Croydon in numbers… 406,000 GP registered population Population growth 1% per year Over half of Croydon population are from a black or minority ethnic background 17% of adults smoke 65% of adults are overweight and obese 1 in 4 children are overweight and obese
Who we are and what we do • 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 organisation of 57 GP practices across six clinical networks • Budget of £488 million for services
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 out 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; o Reduction in the average waiting time for a routine appointment from 104 weeks to eight weeks o 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 over 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 outreach 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 own 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 £4.2m deficit £10.8m deficit NHSE (Cumulative) (£47.9m deficit) (£54.5m deficit) QIPP Savings Target NHSE £18.4m £14.5m Revenue Resource Limit £10.8m deficit Stat. £Nil (Cumulative) (£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 “True and Fair View” Unqualified Opinion Qualified : “expenditure incurred as Regularity Opinion Expenditure exceeded intended by parliament” resource limit Securing economy, Qualified: Value for Money efficiency and Did not meet NHSE target Assessment effectiveness deficit
Looking forward … In 2017/18, Croydon CCG received £12.0m (2.62%) allocation growth - now only 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 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 25
Any questions?
Out of Hospital Rachel Soni Alliance Programme Director
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“Look at Me Now!” A Case Study Sylvarani Nair Personal Independence Coordinator
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 of 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 only afford an electric heater and air purifier
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