Operating Plan 2015/16 (Draft April 2015) A Response to The Forward - - PowerPoint PPT Presentation

Wandsworth CCG Operating Plan 2015/16

(Draft April 2015)

A Response to “The Forward View into Action: Planning for 2015/16”

Wandsworth Clinical Commissioning Group

Contents

Introduction – Wandsworth Population and Strategic Priorities 1. Delivering Outcomes 2. Improving Health – Commissioning Programmes 3. Reducing health inequalities 4. Quality - Responding to Francis, Berwick and Winterbourne View 5. Constitution Standards 6. Operational resilience 7. Alignment with the Local Health Economy (LHE) 8. Empowering Patients 9. BCF - Extending the integrated community model

• 10. Delivering value – QIPP
• 11. Finance
• 12. Planning Assumptions

2

Wandsworth Clinical Commissioning Group

Wandsworth - Our Population

Source: 1 Estimates of resident population (2011 Census based) from ONS.gov.uk, 2 PCT registered list of patients (Extracted from Exeter System September 2011) from HSCIC, 3 JSNA leaflet 2001, What are the health and care needs for Wandsworth?

7.07% 5% 4% 4% 7% 15% 14% 10% 7% 6% 5% 4% 3% 3% 2% 2% 1% 1% 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Population in Wandsworth compared to the rest of South West London1

Wandsworth SW London

Wandsworth has 50% more 20 to 40 year olds, but 33% fewer older people than other South West London

• Boroughs. However, the older population in Wandsworth is more likely to have poor health, and live in deprivation, than in other areas of SW London.

3

Wandsworth Clinical Commissioning Group

Wandsworth Population –key JSNA messages

49% 8.7 years lower

The difference in life expectancy between most and least deprived areas

6.8 years lower

• Wandsworth has 50% more 20 to 40 year olds, but 33% fewer older people than other South West

London Boroughs. However, the older population in Wandsworth is more likely to have poor health, and live in deprivation, than in other areas of SW London

• The resident population is projected to reach 363, 256 by 2025
• There were 375,000 patients registered with Wandsworth GP practices at 31 December 2014
• The population is remarkably young – nationally Wandsworth has the highest proportion of population

aged 30-44 and second highest aged 25-29

• Transient –Wandsworth has the third highest annual migration from all London boroughs at 25% between

2012 and 2013

• The majority of working age adults are comparatively affluent, well educated, healthy and in work
• However, there are areas of significant deprivation – around 30% of children come

from deprived households and 25% of over 60s are in receipt of pension credits

Health Inequalities

4

Wandsworth Clinical Commissioning Group

Wandsworth Strategic Priorities

• Doing core business well – delivering better care and a healthier future for Wandsworth through our clinical

leadership, robust commissioning processes and excellent staff, focussed on delivering quality services and improved outcomes for patients.

• Transforming primary care – optimising impact and outcomes for patients through delivery of excellent primary

care to all people registered with a Wandsworth GP.

• Commission prevention and social care services– where it will generate an increased health benefit for our

population.

• Reducing health inequalities – the CCG will commission differentially to address specific population need where it

will reduce health inequalities.

5

Wandsworth - Strategic Priorities into Commissioning Programmes 2014/15 2015/16

Older People WCCG Response:

• Planning All Care Together enhanced primary

care contract

• Transforming Community Adult Health

Services – seven day service

• Integrating health and social care

Working Age Adults CCG Response:

• Sexual health clinical lead
• Joint commissioned alcohol liaison services
• Increased investment in IAPT

Children CCG Response

• Redesigned CAMHS services
• Pilot project on admission avoidance

Preventing Ill Health Learning Disabilities Primary Care Children Mental Health Older People Urgent Care Planned Care Improving services, outcomes and value for money

6

Wandsworth Clinical Commissioning Group

Seven Outcome Ambitions

• 1. Securing Additional Years of Life for

treatable illness (E.A.1)

Five Domains – National Outcome Frameworks (NOFs)

Domain 1 – Preventing people from dying prematurely

Delivered through Intervention

• 2. Improve Quality of Life for people with

LTCs (E.A.2)

• 3. Reducing the amount of time people

spend avoidably in hospital (E.A.4) Domain 2 – Enhance Quality of Life for people with Long Term Conditions (LTC)

• 4. Increase older people living

independently (post discharge) (E.A.S.3) Domain 3 – Help people to recover after ill health

• 5. Improve patient experience in hospital

(E.A.5)

• 6. Improve LTC patient experience in all

care settings (E.A.7) Domain 4 – Ensuring patients have a positive experience of care

• 7. Eliminate avoidable deaths in hospital

(E.A.8) Domain 5 – Ensure a safe environment, protect from harm

• Out of Hospital Strategy
• Integrated Falls Service
• Integrated Carers Service
• Transformation of Adult Community Services

(Care for Doris)

• Rapid Response Care Packages
• Out of Hospital Strategy
• Integrated Falls Service
• Transformation of Adult Community Services
• Rapid Response Care Packages
• Clinical Reference Groups/patient

engagement programmes

• Transformation of Adult Community

Services

• Care Homes Programme
• Quality Strategy
• Clinical Quality Review Meetings
• 1. Delivering Outcomes (2015/16)

1.1. Ambitions for Improving Outcomes

E.A.1 Potential Years of Life Lost (PYLL) from Causes Considered Amenable to Healthcare

Better

Orange Bar = Current Position

Worse

Supporting Commissioning Programmes & Clinical Reference Groups  Mental Health  Children  Learning Disability  Cardio Vascular Disease (CVD)  Chronic Obstructive Pulmonary Disease (COPD )  Substance Misuse  Cancer

Wandsworth Clinical Commissioning Group

WCCG in comparison to England

E.A.2 Improving Health Related Quality of Life for People with Long-Term Conditions

Worse Orange Bar = Current Position Better

Supporting Commissioning Programmes & Clinical Reference Groups  Telehealth  Cardio Vascular Disease (CVD)  Chronic Obstructive Pulmonary Disease (COPD )  Neuro-Rehab  Dementia  Falls & Bone Health  Mental Health  End of Life Care  Dementia  Self Management  Learning Disability  Community Services Transformation

1.2. Ambitions for Improving Outcomes

Wandsworth Clinical Commissioning Group

WCCG in comparison to England

E.A.4 (Better Care Fund Metric 4) Avoidable Emergency Admissions

Better Orange Bar = Current Position Worse

Supporting Commissioning Programmes & Clinical Reference Groups  Out of Hours  Telehealth  Cardio Vascular Disease (CVD)  Chronic Obstructive Pulmonary Disease (COPD )  Neuro-Rehab  Dementia  Falls & Bone Health  Mental Health  End of Life Care  Dementia Supporting Initiatives

• Out of Hospital
• Community Services

Transformation

• Better Care Fund

1.3. Ambitions for Improving Outcomes

Wandsworth Clinical Commissioning Group

WCCG in comparison to England

E.A.5 Increasing the Proportion of People Having a Positive Experience of Hospital Care Better Orange Bar = Current Position Worse

Supporting Commissioning Programmes & Clinical Reference Groups  Out of Hours  Mental Health  End of Life Care  Children’s  CQRG (St Georges

1.4. Ambitions for Improving Outcomes

Wandsworth Clinical Commissioning Group

WCCG in comparison to England

E.A.7 Increasing the Proportion of People Having a Positive Experience of Care Outside Hospital Better Orange Bar = Current Position Worse

Supporting Commissioning Programmes & Clinical Reference Groups  Out of Hours  Mental Health  End of Life Care  Children’s

WCCG in comparison to England

1.5. Ambitions for Improving Outcomes

Wandsworth Clinical Commissioning Group

Wandsworth Clinical Commissioning Group

1.6 Ambitions for Improving Outcomes

E.A. 8 Making significant progress towards eliminating avoidable deaths in our hospitals

Wandsworth CCG has commissioned a Care Coordination Centre (a partnership between Trinity Hospice, Marie Curie and St George’s Healthcare NHS Foundation Trust) to provide a central point of contact to arrange services for patients who have end of life care needs so they can be cared for in their own home or care home. Initially commissioned on a 2 year pilot basis, many of the KPIs relate to how the Centre is supporting patients to remain at home if that is where they wish to be or getting them out of hospital if they don’t wish to be cared for or to die in hospital. The Care Coordination Centre can:

• provide a central point of contact for end of life services – so referrers and patients don’t need to contact different care providers separately.
• plan and coordinate service - arranged on behalf of the referrer/patient from Trinity Hospice, Marie Curie, the community nursing team, and from other providers of care.
• support discharge from hospital – the Coordination Centre team will arrange a package of care so that patients can be discharged promptly to their preferred place of care.

Wandsworth CCG (recurrently) invests in both medical and nursing resources within the Specialist Palliative Team at SGH to support the Fast Track Discharge Home Scheme. This dedicated scheme supports the timely and effective discharge of end of life care patients with a short prognosis; Wandsworth CCG has invested in the development of the Gold Standard Framework and other good practice (including use of Coordinate my Care) across primary and community services to support the early identification of end of life care patients and then to pro-actively support their care, including advance care planning; End of Life Care patients are specifically identified as a vulnerable group who should be included within Planning All Care Together (PACT) consultations. This supports pro- active care to ensure preferred place of care/death are known and can be supported through advance planning. The End of Life Care Clinical Reference Group and Commissioning Team have had discussions about how they can support the improvement of end of life care within SGH, particularly in relation to education opportunities for staff outside of the palliative specialists. 13

• 2. Improving Health: WCCG Commissioning Programmes
• Following a refresh of the JSNA in 2014 and the current review of the Health and

Wellbeing Strategy the CCG and Local Authority have worked in partnership to develop a joint model of delivery against our shared key priorities.

• Taking a programme approach 10 programmes of work have been identified,

delivered through joint working with the Local Authority Commissioners, the Local Authority Public Health Team and the South West London Collaborative.

14

Wandsworth Clinical Commissioning Group

Joint Commissioning Programme SEXUAL HEALTH Joint Commissioning Programme DRUGS AND ALCOHOL Joint Commissioning Programme OLDER PEOPLE Joint Commissioning Programme CHILDREN Joint Commissioning Programme MENTAL HEALTH Joint Commissioning Programme LEARNING DISABILITY CCG Commissioning Programme PLANNED CARE CCG Commissioning Programme URGENT CARE CCG Commissioning Programme PRIMARY CARE CCG Commissioning Programme PREVENTING ILL HEALTH

Commissioning Health for the population of Wandsworth

Joint CCG and Public Health Joint CCG and Local Authority CCG Programme – aligned with SW London collaborative

15

Wandsworth Clinical Commissioning Group

JCE Joint Commissioning Programmes

• Finance and activity

monitoring by programme

• Performance Dashboard
• Project Management KPIs

Joint Commissioning Programme – Reporting and Governance CCG Board WBC Wandsworth HWB Health and Social Care Integration Steering Group

Wandsworth Clinical Commissioning Group

17

WCCG Commissioning Programmes 2015/2016 Executive Summary

Preventing Ill Health

Learning Disabilities

Primary Care

Children

Mental Health

Older People Urgent Care Planned Care

Community Empowerment

Voluntary Sector Reducing Inequalities Prevention Initiatives

Carers

Complex Disabilities/CHC Adolescent Transition Access & Equity Winterbourne View Placements Complex Community Placements Education & Care Planning to 25+

Commissioning Levers & Financing (including BCF) Stakeholder Engagement and Communications Aligning with the South West London Collaborative Commissioning Strategy

These key enablers support all

• f the

programmes

IT, Capital Planning, Estates & Medicines Management

Primary Care Strategy Primary Care Delivery Primary Care Quality Complex Disability CAMHs Prevention initiatives Children's Community therapies Acute Paediatrics EHCP CMHT Prevention initiatives IAPT Complex family therapies Perinatal Mental Health Acute inpatient Reablement Dementia Care Homes Frailty pathway EOLC Intermediate Care OOH/111 Non elective pathways Admission avoidance Trauma COPD CVD Diabetes MSK Diagnostics Ophthalmology /Dermatology

Delivering the London Health Commission recommendations Social Care

Voluntary Sector Cancer

Wandsworth Clinical Commissioning Group

Mental Health

Key JSNA messages

• Poor mental health directly impacts other health and care needs and is a particular inequality for black ethnic groups.

 Maternal mental health: there is a significant impact from poor maternal mental health during pregnancy and in the first two years of life, on infant mental health and future adolescent and adult mental health  The JSNA notes the high number of people that may have a mental health disorder (48,500 people),  The JSNA notes the high cost associated with care  The impact on other conditions or areas of life, particularly for black ethnic groups, make this a significant issue.  The Mental Health Joint Commissioning Plan, 2013-16 includes a specific and detailed Needs Assessment

National Targets 2015/16 Current Performance (Dec)

IAPT Access 8% IAPT Recovery Rate 45.8% IAPT Waiting Times TBC Percentage of people experiencing a first episode of psychosis treated with a NICE approved care package within two weeks of referral In Development Percentage of acute trusts with an effective model of liaison psychiatry (all ages, appropriate to the size, acuity and specialty of the hospital) In Development Mental Health Measure – Care Programme Approach (CPA) 97%

Opportunities & Threats

• The SW London & St George’s MH Trust consultation on estates, SWL financial modelling and the move to tariff all demonstrate high level
• f uncertainty for costing and impact on planning.
• Operating Plan guidance requires an increase in overall Mental Health spend of 1.94% (equal to £1.5M)
• Sustained delivery of the IAPT targets through 2015/16 and into 2016/17 will be a key area of focus and a competitive procurement is being

considered

• QIPP opportunity within a redesign of rehabilitation services may be realised in 2016/17 rather than 2015/16.
• SWL Collaborative commissioning priorities in tariff proposals.

QIPP Investment

Review of adult rehabilitation services (c.£400K tbc) Enhance contract & cost management for Individual Placements (£tbc)

• Investment in and transformation of

Community Mental Health Teams/Crisis & Home Treatment Team (c.£600K)

• System Resilience Group - Psychiatric

Liaison (c.£400K)

• Earlier Intervention in Psychosis

(c£132K)

• Service User Network (SUN) Project

(c.£62K)

• Additional investment to ensure

adherence to the IAPT access targets for 2015/16.

Performance awaiting update

Wandsworth Clinical Commissioning Group

Mental Health

• Earlier Intervention in Psychosis
• Early Intervention in Psychosis (EIP) – total £216K (subject to evaluation of existing projects and consideration of extension). Wandsworth projects include

a pilot of street triage £42K [increasing community access & reducing acute demand]]; pilot enhanced discharge support, £26K [crisis support]; Early Intervention Service increased resource, £29K [waiting time access standard]; Crisis & Home Treatment Team increased resource, £29K[access, support in crisis]; Social Care Assessment & Review Team (SCART) increased resource, £79K [reduce numbers of out of area placements.

• Crisis Concordat – see EIP actions above. The CCG has had extensive engagement with a Cross Stakeholder Forum lead by Local Authority. The Action

plan considers the baseline assessment, gap analysis, multi-agency forum establishment, procedural guidance, IAPT & substance misuse pathways, explore S136 triage, delayed admissions, support to GPs, monitor AMHP levels and reviews 2010 guidance.

• Remodelling of Community Mental Health Teams and Home Treatment/Crisis Teams
• The CCG has been working through investment proposals to deliver a new model of enhanced community and crisis intervention services that will support the

reduction in acute mental health beds planned as part of the SW London and St George’s Mental Health NHS Trust estates modernisation plan. It is anticipated that this increase in capacity and specification will be the majority investment arising from the Operating Plan guidance on an increase in investment to the level of increased allocation (1.94% for Wandsworth CCG, equating to additional investment of £1.5M)

• IAPT
• The CCG has a clear commitment to delivering all the IAPT targets through 2015/16 and will be working with the current providers to ensure that there is an

agreed trajectory in place and robust performance management to ensure commitments are achieved. The CCG will consider open competitive procurement to deliver an increased marketplace and segmented specification for IAPT services from 2016/17. 19

Wandsworth Clinical Commissioning Group

Learning Disabilities

Key JSNA messages

• By 2020, the number of people with a learning disability in Wandsworth is projected to increase by10% from an anticipated population of 5,500

in 2012. This may be partly due to the increase in numbers with complex conditions surviving through to transition to adulthood

• The health status of people with learning disabilities (that have been recorded) show that this group is in poor health compared to the general

registered population and die up to 25 years earlier than the rest of the population.

National Targets 2015/16 Current Performa nce (Dec) Percentage of Identified Patients with a Learning Disability have an Annual Health Check Total number of patients in in-patient beds for mental and/or behavioural healthcare who have either learning disabilities and/or autistic spectrum disorder (including Asperger’s syndrome) 6 Numbers of planned transfers to community (or other more appropriate) settings – Winterbourne View 2 Number of learning disability patients without a named care coordinator. The number of current in-patients that are not recorded on the commissioner’s learning disability register. The number of current in-patients with a learning disability who have not had a review in the last 26 weeks. 2

Opportunities & Threats

• There is comprehensive picture of the learning disability need in Wandsworth
• Services for people with learning disabilities are generally well resourced in Wandsworth
• Change in national policy for people with learning disability will improve outcomes and patient experience through the development of Personal Health Budgets
• People with learning disability are living longer and are in poor health
• Increase in numbers coming through transition will increase demand for services
• Gaps in our knowledge about local service capacity to respond to current and future service demand

QIPP Investment

• Funded Specialist Learning

Disability Social Worker Wandsworth Department of Education and Social Services

• New primary care interventions
• Review of LD services details

recommendations for transforming care through 2015/16. 20

Performance awaiting update

Initiatives

Implementation of tiered care model and coordinated care across four localities - Battersea West Wandsworth Balham, Tooting and Furzedown Central Wandsworth Proposal to integrate Health and Social Care Community Learning Disability Team Development of Commissioning Programmes including:

• Further develop local arrangements for reducing and repatriating people with learning disabilities from inpatient to the community

– Winterbourne View

• Offer of Personal Health Budgets to people with Learning Disability by April 2016
• Standard Contract 2015/16 will contain provisions requiring all providers of NHS funded services for people with learning disability

and/or autism to comply with standards for admission and discharge.

• CCG assurance process will include monitoring specific learning disability performance indicators and outcomes
• Commissioners will be expected to move away from non-specific block contracts and towards contracting for specific outputs or
• utcomes
• Implementation of integrated education, health and care plans (EHC) for 0 - 25 year old
• Devolution of budget and responsibility for commissioning services from NHS specialised commissioning to Clinical

Commissioning Groups.

Learning Disabilities

Wandsworth Clinical Commissioning Group

21

Preventing Ill Health

Key JSNA messages Lifestyle - prevalence of smoking, being overweight and lack of physical activity is relatively good in Wandsworth, but at 16%, 50% and 23% respectively, but there is still an issue with geographical inequalities Obesity - relatively good performance against peers but a national concern and local inequalities between schools. Care of Vulnerable families - Particular issues for children including support for children with caring responsibilities and children with disabilities Transition- There are approximately 13,200 children aged 0 to 15 in income deprived families - the focus is to ensure a positive parenting experience for children.

Existing QIPP Investment Aim (5 years)

• Secondary Falls prevention delivered in

acute services

• Wandsworth Wellbeing Hub
• Wandsworth CCG Patient Self

Management Courses.

• Various initiatives across the Voluntary

Sector and community groups to support commissioning programmes through non medical interventions. Joint Procurement with the Local Authority on a single specification of support for Carers: seeking better services and value for money as part of an integrated Health and Social Care approach

• Health Inequalities –developing targeted smoking cessation

services in key localities/communities

• Joint Appointment of a Health Economist with Public Health

to help develop the Joint Health and Well Being Strategy and to ensure that investments represent the best value both in terms of service delivery and target groups.

• Support for Performance and Evaluation framework to enable

the voluntary Sector and Community groups demonstrate the value of their services. This will lead to better and more targeted commissioning and evidence for future funding.

To close the gap in life expectancy between the and least affluent areas Current Performance Gap of 7 years

Preventing Ill Health

Initiatives

Continuation and Development of Existing Initiatives There is approximately £3 million investment in the voluntary Sector and community groups. The scope of work is shown on the next page. In addition to this there will be a continuation of other supporting services such as; Parenting, families and children.

• Parenting programmes and therapeutic support for children. Domestic abuse
• Troubled Families in conjunction with the LA

Mental Health and Parity of Esteem

• Workplace group CBT (Confidence building Workshops to reduce stress

related

• sickness)
• Suicide Prevention – early intervention in primary care – screening and risk
• management
• Community Network of Families (Pastors Network) - Black & Minority Ethnic

Representation in MH Services

• Surviving to Thriving (including Community Champions)

Older People Community Resilience – which is the development of a collection of co-produced services Men’s Health Forum The focus for 15-16 will continue to be prostate cancer. The forum is open to all male residents and hosts both information and social events in a variety of community settings We will continue to work with the Local Authority to find ways of commissioning services that improved quality, better value and increased integration. Programme Development Smoking Cessation Further initiatives which will be developed during the course of 15-16 include Quality Premium monies were used to provide smoking cessation training for primary care staff. To follow on from this there will be increased promotion and provision of stop smoking services. This will be done in conjunction with public health and will include greater use of resources in primary care (GP practices and community pharmacy) and Mental Health The mental health programme will have additional significant investment during 15-16. Some of this investment will be used to develop preventative interventions and services. These may include;

• Expansion of Catch 22
• SW London & St George’s MH Trust (SWLStGMHT) community links
• Welcome pack and peer audit - develop within existing SWLSTG

Equality & Diversity

• Diversity training and trans-cultural expertise -develop within existing SWLStGMHT
• Working with CCG stakeholders to ensure people with protected characteristics have equal

access to health services Health & Wellbeing Strategy The refresh of the joint Health and Wellbeing Strategy with the Local Authority will result in closer working and further joint commissioning of preventative services. A particular emphasis will be placed on addressing health inequalities and this will be supported by a joint health economist resource. Support of the Voluntary Sector and Community Groups The CCG recognises the additional value non-medical interventions bring to health and well being. In order to demonstrate this value better we are working with Kingston University to support voluntary and community service providers in the development of outcome evaluation tools and subsequent evaluation of services. This will assist us to make more informed commissioning decisions and provide group with evidence to support applications for funding from a variety of sources.

Voluntary Sector circa £3 million Mental Health circa £700k

Sound Minds Rethink Big White Wall Homelands

Children circa £300k

Th@W Place2be Children with disorders

Older People including EOL Circa £1.231 million Prevention & Wellbeing Circa £530k

Wandsworth Care Alliance The Stroke Association Wandsworth Carers Centre Paul’s Cancer Centre Connect Cross Roads South Thames Katherine Low St Michael’s Day Centre Alzheimer’s Society Age UK Trinity Hospice Marie Curie Furzedown WARF Thomas Pocklington Trust

Advice and Engagement circa £238k

Family Action

Wandsworth Citizen’s Advice Bureau Age UK Lifetimes

Wandsworth Bereavement Service

Working with the Voluntary Sector

Wandsworth Clinical Commissioning Group

Primary Care

Key JSNA messages

• It is likely that with a more mobile population, there will be relatively more limited opportunities for intervention.
• There will be a requirement for more flexible appointment times and locations.
• Symptom and risk awareness services will also need to be comprehensive and immediate.
• There will also be an increased demand for walk in services, as people may not be registered with a GP practice and patient follow up will be more difficult.

National Targets 2015/16 Current Performanc e (Dec)

Composite indicator comprised of i) GP Services and ii) GP Out of Hours

88.7% GP 52.09% OoH

Satisfaction with the Quality of Consultation at a GP Practice

422/500

Satisfaction with the Overall Care received at the Surgery

88.3%

Satisfaction with Accessing Primary Care

80.7%

Opportunities & Threats In January 2015 the Wandsworth CCG Board agreed to take on joint responsibility for co-commissioning primary care services with other CCGs in South West London and NHS England. These arrangements will go live in April 2015. Co-commissioning of primary care is a significant opportunity for the CCG, enabling us to streamline patient pathways and support quality improvements across General Practice. However, it can also be viewed as a threat, entailing a number of risks that will need to be carefully managed and mitigated i.e. the CCG will need to take an increasingly robust approach to managing conflicts of interest within our member practices, whilst maintaining existing levels of clinical leadership and engagement

QIPP Investment 2015/16

• Planning all Care Together (PACT) Enhanced

Contract

• Referral Management Programme (RMP)
• Pathology Projects:
• Incentive Scheme
• Pathway Redesign
• Review of Diagnostic Enhanced Services: to

ensure delivery for whole Wandsworth population and reflect national guidance and best practice - …

• Redesign of Pathology Pathways: roll out of new

testing techniques which are more accurate and reflect national guidance and best practice 25

Primary Care

Initiatives - The nature of the CCGs work in Primary Care over the next year will be focused on two main fronts:

• 1. Clinical service delivery via a number of enhanced contracts
• Planning all Care Together (PACT) – Enabling GPs to spend more time

with their most vulnerable and at risk patients, supporting them proactively and holistically to remain healthy at home for longer.

• Improving Access to Primary Care – Practices can extend their opening

hours during the evenings and at weekends, allowing patients to see a primary care clinician when convenient.

• Diagnostic Enhanced Services – ongoing review to ensure patients

across Wandsworth have access to local diagnostic services, which meet their needs and are in line with national guidelines.

• 2. A number of practice-based/borough wide schemes aimed at

quality improvement

• The Members Development Programme supports practices to improve

the quality of their services, increase patient satisfaction (as set out in the Operating Plan) and helps them work towards requirements such as the Primary Care Strategic Commissioning Framework.

• The Practice Support Team provides targeted support to practices, using

a multidisciplinary team of staff with experience of primary care, education and embedding quality.

• A programme of workforce training and development will be scheduled

as a result of the annual primary care training needs analysis

• Roll out of newly procured Referral Management software DXS, will

support GPs to make better referral decisions together with their patients

• Roll out of a pathology incentive scheme, which uses education and

peer review to support GPs to improve their testing behaviour. In addition a number of alternative tests will be commissioned, which are more accurate and will save unnecessary outpatient appointments. 26

Wandsworth Clinical Commissioning Group

27

Children

Key JSNA messages

• 64,000 children in Wands worth. Birth rate due to increase by 15% by 2018 increased demand for services
• Breastfeeding Rates 6- 8 Weeks maintain Target 75%
• Reducing Childhood Obesity
• Improving Mental Health outcomes for Children-Improving Waiting times
• Children with Disabilities and Special Needs – SEND Legislation 2014
• Reducing A&E Admissions non –Emergencies 0-5 year olds
• Reducing Minor Illness Reducing Accidents in children .
• Improving Health Outcomes for Looked After Children

Opportunities and Threats

• QIPP opportunities for 2016/17 for CABIN Project which could prevent hospital admissions for

minor infections.

• SW London Collaborative Commissioning priorities for children services and Wands worth CCG

could lead to reduced A&E and hospital admissions

• SW London Collaborative presents opportunities for economies of scale and sharing of best

practice

• Birth Rate increase could lead to increased demand on Health and Social Care services
• Reviews of Therapy /Nursing services Children in Special Schools – Opportunity to commission

differently

QIPP Investment

• CABIN Project £93k
• £633k Recurrent
• £207k non recurrent

National Targets 2015/16 Current Performance Emergency Admissions Children With Lower Tract infections 234.9 Antenatal Assessment <13weeks 84.3% 84884888 Maternal Smoking at Delivery 3.8% Breastfeeding Prevalence 6-8 weeks 91.9%

Children

Programme Areas of Work Children Services agreed with LA / CCG children Services Programme Clinical Reference Group work plan / South West London Commissioning Collaborative Initiative Developing services Children with Disabilities in Special schools . The Special Educational Needs Reform 2014. Places statutory responsibility on the CCG to improve services for children with complex needs and Disability Project to review the needs of Children in Special schools( in phase 2 stage) will provide recommendations for future commissioning for all special schools in Wands worth. Reducing Obesity in Children High rates of obesity in children 684 children diagnosed as obese in 2012/13 and the highest rates are in the areas of deprivation . There is an initiative in wands worth Initiative- Measure BMI in children receiving pre-school immunisation booster (Wandle locality piloting) using this info to target parents at an early stage – Improving access and waiting times for children and Young people to Mental Health Services . In response to the growing demand for child and Adolescent mental health issues there is a need to improve access and reduce waiting times for children Expansion of counselling services to a further 12 primary schools is an early intervention approach to mental health proposed for future investment. CAMHS Access service has significantly reduced waiting times to 2-4 weeks from 14 weeks Reducing admissions to A&E for non – emergencies for 0-5 year olds Paediatric Phlebotomy service initiative to reduce the need for hospital A& E admission. Community Paediatric Review ensuring services for children with complex needs and Young People with ASD / ADHD are NICE compliant , Locally there has been a significant rise in the number of children diagnosed with ASD and ADHD in Wands worth Additional investment in clinical staff has ensured that assessments are completed in 3 months are NICE compliant. Initiative to increase the number of community nurses to facilitate discharge from hospital and provide support in the community Review of continuing care nursing team and Implementation of Personal Health budgets for children . The Special Educational Needs Reforms have given parents the right to apply for a personal budget if their child is eligible for continuing care Project to review the process of assessment for care packages in the Continuing care Nursing Team and to develop a mechanism to administer personal budgets in Wands worth . The project will provide key recommendations for future commissioning . Joint planning monitoring and Review of Health Visiting Services developing new models of service and new commissioning arrangements in 15/16. Transfer of lead commissioning responsibilities for Health Visiting to LA in 2015 from NHSE. CCG has a role to ensure that changes in referral from GP to Borough registration is effectively managed in 2015.

28

Children

Programme Initiative

Prevention initiatives South West London Commissioning Collaborative . Enhanced community Services reducing the need for A&E hospital admission and the need far a consistent approach and standards across South West London. The collaborative will be working on programmes in 15/16 in the following areas as part of a 5 year strategic plan.

• Well Child 0-5
• Children With Long term Conditions
• CAMHS

Procurement of school Nursing Service in 15 /16 Developing new models of service delivery and the procurement of School Nursing service in 15/16. School Nursing commissioned from April 13 by the LA . CCG will be involved in ensuring that the service specification and model links effectively with Health Services to develop a multi – agency approach to schools . Positive health intervention and prevention in Early Years improving immunisation and breastfeeding rates. Health Visiting services now commissioned by NHSE and will be transferring to LA in 2015. CCG will be a member of the joint commissioning partnership to ensure targets for immunisation and breastfeeding are met Reducing Accidents and injuries to young children reducing A&E admissions. Wands worth has a higher than average 13% higher emergency admission rates for children . Safety equipment initiative provides safety equipment e.g. Stair gates for families in deprived areas. The CABIN (Child Admission Bundle for Infection) project treats minor infections in the community reducing the need for hospital admission

29

Wandsworth Clinical Commissioning Group

30

Older People

Key JSNA messages Older Carers: A vulnerable group and potentially isolated group with increasing numbers. Care Homes: An ageing population with complex needs; a necessity to ensure the provision of appropriate, co-ordinated and equitable services are available in the Borough Hospital admissions and continuing care: Poor relative performance and increasing costs for continuing care. Dementia: A known population, with increasing prevalence. There is a greater programme of awareness and training needed to increase the timely diagnosis of dementia and improve access to appropriate post diagnostic support to live well for longer in the community National Targets 2015/16 Current Performance (Dec)

Estimated diagnosis rate for people with dementia 56.37% Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services 86.6% Permanent admissions of older people (aged 65 and

• ver) to residential and nursing care homes, per

100,000 population 269 / 100K Popn. Delayed Transfers of care per 100,000 population (attributable to NHS, social care or both) 998

Opportunities & Threats Enhanced model for care homes QIPP opportunity to redesign/transform OA CMHT functions may realise in 2016/17 rather than 2015/16. Extension of BACS model in the community in 2015/16 with cost savings realised across system from 2016/17 QIPP Investment

• Redesign OACMHT model (tbc)
• Review MAS (tbc)
• BACS model reducing Continuing

Healthcare (£x)

• Develop In reach to care homes model (£x)
• Frailty pathway redesign, a significant

programme of work across CCG, LA and Trust

• Recurrent funding for BACS (£282k)
• Specialist dementia training (£50k)
• Implement Care Homes programme (£x)
• Dementia Self management (£75k

pending approval)

• Mapping of Voluntary Sector provision

(£10k)

Older People

Initiatives

Memory Assessment Service (MAS) Review in year (£302k). Consider remodel for 2016/17 The MAS is the single point of access for adults of all ages with suspected dementia redesigned in October 2013 following extensive consultation has delivered : Higher than forecast number of referrals and subsequent diagnosis and treatment of people newly diagnosed with dementia Exceeded the target to achieve 75% of all new diagnosed cases of dementia receiving an individual, accessible and personalised care plan. The plan is a single comprehensive assessment of the patient and carer addressing physical, mental health and social care needs and is undertaken as an additional session, after medical feedback (i.e. at diagnosis of dementia), by a member of the Memory Assessment team. The assessment focuses on what is important to the individual with goal setting and provision of information and support for self-care to achieve these goals. Qualitative feedback from patients and carer’s benefits/outcomes have been positive and mirror some of the quality

• utcomes for people with dementia: building on the work of the National Dementia Strategy (DH, Sept 2010)

Undertook an audit on ethnicity using the service referrals against Wandsworth demographics to inform changes to increase accessibility to all Borough residents

Older Adults Mental Health & Dementia Clinical Reference Group work programme priorities

Behaviour and Communication Support Service (BACS ) on to recurrent footing from April 2015 (£282k) and consider costs and benefits of extending model. Review MAS, including the current costs pressures against actual cost of service and remodel from October 2015. Review delivery, performance and effectiveness of the Older Adults Community Mental Health Team function, (specialist support for people with dementia and for older people with functional mental health needs).Redesign models of care, service delivery and specification based on local needs, gaps and consultation with partners and stakeholders. Link with the frailty pathway and development of integrated pathways of care. Implement the Dementia Clinical Nurse Specialist team within the community to enable people to live well for longer and within their own homes and avoid crisis and unnecessary hospital admissions Delivery of long term Dementia training plan for priority group 1 – people with dementia, their carers, primary care and care homes Map and redesign the provision of non-clinical support required for people with dementia post diagnosis (£10K) Mapping and redesigning EOLC pathway for people with dementia

31

Initiatives

Behaviour and Communication Support service (BACSS) Review BACS model in year (£282k) and consider extension into the community. Consider recurrent footing in year for April 15 to ensure service continuity, quality and clinical leadership BACSS provides specialist support to staff, residents and families in reducing distressed reactions in our local care homes and in 2014-2015 has: Rolled out to 7 Wandsworth care homes with positive feedback across sites Identified carers seldom heard from both in the community and relatives of people with dementia in care homes and have developed peer support groups to operate within care homes and the community. Received national recognition from DH Deputy General following a visit to a site on National Care homes Day and winning a regional recognition award from South London Membership Council for Service Improvement Delivered successful specialist dementia education sessions alongside the Old Age Psychiatrist Consultant, to GPs

Care Homes

As part of the frailty pathway work programme, develop a Wandsworth enhanced health in reach care home model, building on the successes of the BACS team, to improve the coordination, quality of person centred care and outcomes among people living in care homes in Wandsworth. Review and appraise options of delivering enhanced proactive clinical support to care homes and reliable access to consistent and familiar professionals who have an understanding of both the needs of this cohort and the challenges of delivering person centred care within a care home environment to support homes in the provision, improvement and maintenance of quality care for their residents.

Frailty pathway

Developing a work programme to deliver integrated care for the frail older population in Wandsworth and identifying the key changes needed to deliver better and more joined up care for this vulnerable group. Developing a comprehensive frailty pathway is a key objective across health and social care over the coming year

Joint Review of step up and step down provision / pathways

Opportunities exist both in short and longer term for the CCG and WBC to jointly make improvements in current pathways and the maximisation of existing capacity. Review including benchmarking and detailed analysis of existing costs and activity and gap analysis to inform future commissioning

Community resilience

The CCG is supporting building community resilience for older people in the Borough by commissioning Age UK Wandsworth to provide a Coordinator to develop and coordinate all activity. Age UK will work with voluntary organisations in the borough to identify 4 suitable community wellbeing centres. The aim would be that these wellbeing centres each pilot the delivery of specific activity funded by the CCG that helps people to maximise their independence and remain living at home for as long as possible

32

Wandsworth Clinical Commissioning Group

33

Urgent Care

Key JSNA messages

• The JSNA does not reference urgent care services specifically but it is noted that deprived populations are higher users of unplanned care than the rest
• f the population.
• The CCG is committed to improved performance across providers in delivering key urgent care targets for the Wandsworth population.

National Targets 2015/16

Current Performance (Dec) A&E Waiting Times – Total time in the A&E department 88.8% Composite measure on emergency admissions 926.1 Ambulance clinical quality – Category A (Red 1) 8 minute response time 59.3% Ambulance clinical quality – Category A (Red 2) 8 minute response time 47.6% Ambulance clinical quality – Category A 19 minute transportation time 84.8% A&E – 12 hour waits for admission Ambulance handover times 77.6% Ambulance Crew Clear No Data, but linked to above Urgent Operations Cancelled for a second time

Opportunities and Threats

• Multiple workstreams in place around urgent care including – System Resilience

Group, Better Care Fund (Older People Programme/development of the Frailty Pathway), 111 and Out of Hours services procurement, St George’s SLA Joint Investigation/Contract Query Notice.

• Only 50% of the 2014/15 system resilience funding in the 2015/16 baselines:

work ongoing through the System Resilience Group to determine priorities

• Demand and capacity modelling being undertaken with St George’s to ensure a

shared view of the drivers for and impact of any growth in non-elective activity.

• Additional investment agreed through the pan-London SLA with the London

Ambulance Service to improve performance for key indicators in 2015/16

QIPP Investment

There is no QIPP planned in urgent care services in 2015/16

£2.09 System Resilience funding in 2015/16 baselines

Wandsworth Clinical Commissioning Group

Urgent Care

• The SW London Collaborative Commissioning Urgent Care Clinical Design Group will evolve into the Urgent Care Network to enable

better future planning and testing of new models of care

• The System Resilience Group (SRG) around St George’s Healthcare NHS FT (SGH) to continue to focus on performance

improvement and “whole systems” working.

• Pathway Redesign SRG Sub-Group developing better ways of working to improve flow through the hospital and support discharge
• A number of SRG schemes have been extended into 15/16 from the ring-fenced allocation and will be monitored through SRG:
• Weekend therapy provision at SGH to support seven day working
• Additional off-site bed capacity for SGH
• Departure lounge at SGH to facilitate faster discharge
• Increased psychiatric liaison support and home treatment
• Extended hours in primary care
• Additional social care capacity for Wandsworth, Merton and Lambeth Local Authorities
• Capacity remodelling exercise in place between Trust and commissioners to identify and close any gaps in capacity
• 111 and OOH procurement will support community response and will strengthen 111 capacity through closer involvement as an SRG

partner

34

Wandsworth Clinical Commissioning Group

Planned Care

Key JSNA messages National Targets 2015/16 Current Performance (Dec)

Referral to Treatment Pathways (18 weeks) (Admitted) 88.4% Referral to Treatment Pathways (18 weeks) (Non- Admitted) 96.1% Referral to Treatment Pathways (18 weeks) (Incomplete) 91.5% Number of 52 week Referral to Treatment Pathways 15 Diagnostic Test Waiting Times 99% Patient experience of hospital care 75.3 Cancelled Operations 19.6%

Opportunities and Threats

• Five Year Forward View and New Models of Care guidance.
• Co-commissioning primary care – opportunity to streamline whole patient pathway.
• New contracting models which allow integrated services to be commissioned more

effectively.

• Better Care Fund – opportunity to join up health and social care to address

patients needs holistically.

• Increase awareness, diagnosis and survival rates for cancer.

QIPP Investment

• Shift of Care
• Referral Management Programme
• Pathology Incentive Scheme
• Pathway Redesign
• RTT Initiatives

One-year survival from all cancers

68.64%

Cancer two week waits

97.2%

Cancer 31 day waits

98.1%

Cancer 62 day waits

95.4%

35

Planned Care

Initiatives

• Shift of care projects – redesign of Dermatology, MSK, Ophthalmology, COPD, CVD, Falls and End of Life Care, pathways to ensure that patients are seen

in the right place and at the right time, by a professional who has the skills to meet their needs

• Referral to Treatment Time (RTT) initiatives – ensuring that all patients can receive treatment in secondary care within 18 weeks of their referral.
• Planning All Care Together – enabling GPs to spend more time with their most vulnerable patients, supporting them to manage their health pro-actively and

holistically so that they can remain safely at home for as long as possible.

• Patient Self-Management Programmes – helping patients to manage their own conditions effectively and access the wide range of voluntary sector and

community support networks available across the Borough

• Improving the rate of uptake of bowel screening within Wandsworth. To increase early detection of colorectal cancer and therefore a reduction in mortality

and an improvement in morbidity for those diagnosed.

• Extended yearly holistic Cancer care review for those within 5 years of a diagnosis of cancer. Offering a holistic yearly review in a long appointment as part of the PACT

scheme, as for other patients with a Long Term Condition (LTC), for patients up to 5 years after diagnosis would allow full assessment of all the needs of the patient with appropriate treatment or signposting to available services.

• General Practice Engagement/Education and Macmillan GP Facilitator
• Practice Lead for Cancer - A designated, Named Cancer Lead in GP practices to co-ordinate engagement by other GPs to focus on early diagnosis of cancer.
• Best Practice Pathway for Ovarian Cancer - The best practice commissioning pathway suggests that both Ca125 and TVUS should be carried out simultaneously and

referral made if either is positive in order to increase the rates of cancer diagnosed at an earlier stage.

• Best Practice Commissioning Pathway for Colorectal Cancer - The best practice commissioning pathway for early detection recommends that, for patients with the

appropriate symptoms, the lower age limit of referral should be reduced to 45 years old by 2015 and that referral should be made by GPs to a ‘Diagnostic service’ – a designated referral centre which will then triage referrals to the most appropriate diagnostic test which will be booked directly.

• Self-management for Patients with cancer - To provide people with cancer and carers of people with cancer a structured way of developing the skills to cope with the stress
• f cancer via modalities including CBT, Mindfulness, self-hypnosis, relaxation and visualisation
• Macmillan Physical Activity Programme for patients with a diagnosis of cancer - Patients within 5 years of a diagnosis of cancer would be offered referral for exercise ,

behaviour change programme This would be offered by the GP in a general review or as part of the Holistic yearly cancer .

36

• 3. Reducing Health Inequalities

There is significant variation in the life expectancy for Wandsworth residents between the most and least deprived

• areas. The JSNA highlights the following areas as the main contributors excess mortality for residents in more

deprived communities under the age of 75:

• Cancer
• Cardiovascular disease,
• Multiple long term conditions including complications arising from diabetes, and respiratory diseases.

It is recognised that there are areas of significant deprivation in Latchmere, Roehampton and Queenstown.

37

8.7 years lower

The difference in life expectancy between most and least deprived areas

6.8 years lower

Reducing health inequalities

• The CCG has recognised that there are a number of disadvantaged residents in the Borough. Each will have particular contact

points with services (health or social) and therefore there are existing opportunities to help these groups. The particular groups identified include isolated elderly, carers, people with a learning disability, looked after children, the unemployed and the homeless.

• Using the Wandsworth Health and Well Being Strategy as a catalyst for change, these groups will be jointly targeted by the CCG

and Local Authority. A joint service specification for carers has recently been approved and will be contracted within 15-16. A full review of children’s services is underway. Work has begun on developing a frailty care pathway and the CCG has begun preliminary discussions for the joint procurement of voluntary sector services for older people.

• Reducing health inequalities is the golden thread that runs throughout our commissioning programmes; this will be driven

through the programme for Preventing Ill Health which is currently under development.

• The CCG will commission differentially to address specific population needs and areas of deprivation where it will reduce health

inequalities; making links with initiatives such as the Roehampton positive programme of regeneration.

38

Wandsworth Clinical Commissioning Group

Local Authority

• Public Health

preventative services – screening, smoking cessation etc.

• Alcohol & Drugs

services

• Sexual Health

services

• Child and adult
• besity
• Exercise and lifestyle

programmes CCG

• Secondary Falls

Prevention

• Wandsworth Well

Being Hub

• Self Management

Programme Joint Commissioning and Work Programmes

• Joint Commissioning of Carers Services
• Joint Health & Wellbeing Strategy

(HWS)

• Joint appointment of Health Economist

to support HWS

• Joint commissioning of Integrated Falls

Services

• Joint working - Smoking Cessation

Initiatives

• Joint working - Review of commission
• pportunities for non-medical

interventions and services from the voluntary sector and community groups Joint Commissioning Programme – Preventing Ill Health (draft – example)

Wandsworth Clinical Commissioning Group

• 4. Quality - Responding to Francis, Berwick and Winterbourne View

The CCG’s first priority is to commission services that offer quality for local people. At its simplest, “quality” is defined as care that is safe, effective and provides as positive an experience as possible. This definition of quality sets out three dimensions:

• Patient Safety - Commissioning high quality care which is safe prevents all avoidable harm and risks to the individual’s

safety; and having systems in place to protect patients.

• Clinical Effectiveness - Commissioning high quality care which is delivered according to the best evidence as to what is

clinically effective in improving an individual’s health outcomes. Making sure care and treatments achieve their intended

• utcome.
• Patient Experience - Commissioning high quality care which looks to give the individual as positive an experience of

receiving and recovering from the care as possible, including being treated according to what the individual wants or needs, and with compassion, dignity and respect. It’s about listening to the patient’s own perception of their care. Through delivery of our Quality Strategy our ambition is to:

• Establish a shared understanding of quality for all CCG staff, commissioned services and key stakeholders.
• Place the established understanding of quality at the heart of everything it does to commission high quality services.

40

Wandsworth Clinical Commissioning Group

4.2 Quality – Patient Experience

The CCG has developed a quality tracker for Primary Care, which uses a rag system to compare practices against a variety of national and local indicators including patient experience scores (NHS Choices, QOF, General Practice Outcome Standards, Friends and Family Test). The Friends and Family Test (FFT) is an important feedback tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. It is monitored nationally and published on the NHSE website and on NHS Choices. The FFT has been implemented in GP practices across England from 1 December 2014 and in all NHS-funded mental health and community health services from 1 January 2015. As part of the operating plan trajectory setting process, we have set ambitions for an improvement in scores to three satisfaction measures from the GP survey. This and FFT data will be part of the quality monitoring schedule as we move forward to co- commissioning of Primary Care.

41

Wandsworth Clinical Commissioning Group

4.5 Seven Day Services

Servi Service De Develo lopment Imp mprovement Plans ar are in n de develo lopment wi with al all ac acute pr provid

• iders. As

As the the lead ead Co Commis issio ioner WCC CCG has has neg negot

• tia

iated the the SDI SDIP belo below wi with St St Geor Georges Fou

• und

ndatio ion Trus rust to

• sup

uppor

• rt deli

delivery of

• f the

these ini nitia iativ ives.

SDIP Indicator SDIP Description Agreed Milestones Agreed Timescales Expected Benefit Method

2014/15 National Guidance sets out a number of clinical and operational standards associated with 7 day working. In 2015/16, updated National Guidance mandates that commissioners work with Trusts to implement 5 of the 10 clinical and

• perational standards, albeit

recognising no additional resources have been given directly to address implementation. Trust to internally review all components of 7 day working guidance and to produce a stock take assessment. Jointly agreed priority actions for 2015/16 to be identified and action plans completed, with clear milestones identified. Development of a (jointly agreed) action plan to implement at least 5

• f the 10 clinical and operational

standards of 7 day working End of Q1 internal, self assessment to be completed for discussion with commissioners. End of July 2015, joint agreement on priority areas and, jointly agreed Action Plan to be completed and signed off, with milestones agreed for full implementation of each agreed clinical/ operational standard (minimum standard being full implementation of 5 standards by end March 2016) CSU to receive and review the trust’s self assessment CQRG to review implementation progress at end Q2 and end Q4. Specific actions to be monitored and managed via Systems Resilience Group Improve access, flow and discharge through hospital settings. Improved productivity and efficiency (noting pace of change will also need to be considered against affordability and cost considerations). Delivery of action plan subject to General Conditions 9 (Contract Management).

42

Wandsworth Clinical Commissioning Group

• 5. Constitution Standards

E.B.1-3: Referral to Treatment Pathways (18 Weeks) performance provided by NHSE to Sept –awaiting update

• Total completed admitted pathways based on 2013/14 outturn

plus monthly 2-year average by working day for 2015/16. This avoids skewed performance caused by Autumn / Winter waiting list initiative in 2014/15.

43

Target: 90%

Green

APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH 2013-14 Completed pathways < 18 weeks 1111 1100 939 1132 1032 1050 1150 1105 937 1121 994 1104 Total Completed Pathways 1213 1184 1009 1227 1125 1155 1276 1208 1006 1215 1083 1214 % 91.6% 92.9% 93.1% 92.3% 91.7% 90.9% 90.1% 91.5% 93.1% 92.3% 91.8% 90.9% 2014-15 Completed pathways < 18 weeks 1048 1045 1147 1180 1042 1200

• Total Completed Pathways

1167 1155 1278 1363 1219 1356

• %

89.8% 90.5% 89.7% 86.6% 85.5% 88.5%

• 2015/16 Plan

Completed pathways < 18 weeks 1071 976 1100 1163 1031 1157 1149 1152 928 1018 975 1068 Total Completed Pathways 1190 1084 1222 1292 1145 1285 1276 1279 1031 1131 1083 1186 % 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.1% 90.0% 90.0% 90.0% 90.1%

Admitted Pathways

Wandsworth Clinical Commissioning Group

Table awaiting refresh

Admitted Patients (RTT) 90%

44

100 GENERAL SURGERY, 84, 20% 101 UROLOGY, 41, 10% 110 TRAUMA & ORTHOPAEDICS, 123, 29% 120 ENT, 75, 18% 150 NEUROSURGERY, 1, 0% 160 PLASTIC SURGERY, 46, 11% 320 CARDIOLOGY, 31, 7% Others, 19, 5%

ACTIVITY

100 GENERAL SURGERY, £144,680 , 16% 101 UROLOGY, £46,955 , 5% 110 TRAUMA & ORTHOPAEDICS, £439,422 , 48% 120 ENT, £112,147 , 12% 150 NEUROSURGERY, £4,750 , 1% 160 PLASTIC SURGERY, £71,477 , 8% 320 CARDIOLOGY, £69,901 , 8% Others, £16,862 , 2%

COST (£) Pressure

2013/14 2014/15 FOT 2015/16 Plan Not within 18 weeks 1,140 1,813 1,416 Within 18 weeks 12,778 13,125 12,788 Total volume 13,918 14,938 14,204 % Trajectory 91.8% 87.9% 90.0%

Day case + Elective admissions

Wandsworth Clinical Commissioning Group

E.B.1-3: Referral to Treatment Pathways (18 Weeks) performance provided by

NHSE to Sept –awaiting update

• Total completed non-admitted pathways based on extrapolated
• utturn for 2014/15 and then the monthly 2 year (2013/14 and

2014/15) average by working day for 2015/16. Non-admitted pathways were not subject to the same level of distortion by the waiting list initiative,

• therefore this method is more appropriate.

45

Target: 95%

Green

Non-Admitted Pathways

APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH 2013-14 Completed pathways < 18 weeks 6298 6354 6034 6520 5548 6086 6561 6553 5523 6602 5692 6278 Total Completed Pathways 6468 6473 6160 6696 5665 6240 6738 6726 5660 6789 5864 6447 % 97.4% 98.2% 98.0% 97.4% 97.9% 97.5% 97.4% 97.4% 97.6% 97.2% 97.1% 97.4% 2014-15 Completed pathways < 18 weeks 5714 5832 5963 6262 5094 6275

• Total Completed Pathways

5888 5991 6144 6507 5277 6547

• %

97.0% 97.3% 97.1% 96.2% 96.5% 95.8%

• 2015/16 Plan

Completed pathways < 18 weeks 5871 5481 6269 6267 5070 6224 5980 6287 5721 5685 5670 5811 Total Completed Pathways 6179 5769 6598 6596 5336 6551 6294 6617 6021 5984 5968 6116 % 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

46

2013/ 13/14 2014/ 14/15 5 FOT 2015/ 15/16 6 Plan an Not within 18 weeks 1,878 2,676 3,693 Within 18 weeks 74,048 70,426 70,336 Total volume 75,926 73,102 74,029 % Trajectory 97.5% 96.3% 95.01%

110 TRAUMA & ORTHOPAEDICS, 125, 71% 120 ENT, 3, 2% 150 NEUROSURGERY, 2, 1% 301 GASTROENTEROLOGY, 46, 26%

Activity

110 TRAUMA & ORTHOPAEDICS, £15,545 , 59% 120 ENT, £389 , 1% 150 NEUROSURGERY, £157 , 1% 301 GASTROENTEROLOGY , £10,222 , 39%

Cost (£) Pressure

Non-admitted Patients (RTT) 95%

Outpatient Attendances

Wandsworth Clinical Commissioning Group

E.B.1-3: Referral to Treatment Pathways (18 Weeks) performance provided by

NHSE to Sept –awaiting update

• Total incomplete pathways based on extrapolated outturn

for 2014/15 and then the monthly 2 year (2013/14 and 2014/15) average by working day for 2015/16. Incomplete pathways were not subject to the same level of distortion by the waiting list initiative, therefore this method is more appropriate.

47

Target: 92%

Green

Incomplete Pathways

APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH 2013-14 Incomplete Pathways < 18 weeks 15755 17382 17653 17662 16912 16278 17503 17180 16976 16984 18098 18897 Total Incomplete Pathways 16634 18238 18642 18616 17951 17341 18567 18105 18077 18098 19255 20105 % 94.7% 95.3% 94.7% 94.9% 94.2% 93.9% 94.3% 94.9% 93.9% 93.8% 94.0% 94.0% 2014-15 Incomplete Pathways < 18 weeks 19419 19538 20566 21224 20684 19781

• Total Incomplete Pathways

20673 20934 21976 22800 22380 21417

• %

93.9% 93.3% 93.6% 93.1% 92.4% 92.4%

• 2015/16 Plan

Incomplete Pathways < 18 weeks 17169 16647 20000 19055 18159 18232 17596 18494 19060 17526 19440 19459 Total Incomplete Pathways 18661 18094 21738 20711 19738 19817 19126 20102 20717 19050 21130 21151 % 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.4: Diagnostic Test Waiting Times - performance provided by NHSE to Sept –

awaiting update

• Diagnostic tests waiting times based on extrapolated outturn

for 2014/15 and then the monthly 2 year (2013/14 and 2014/15) average by working day for 2015/16.

48

Target: 0.9%

Green

APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH 2013-14 Number waiting > 6 weeks 11 17 13 18 18 13 11 12 23 27 22 31 Total Number waiting 3562 3905 3853 3755 3566 3647 3970 4018 3724 4489 4509 4496 % 0.3% 0.4% 0.3% 0.5% 0.5% 0.4% 0.3% 0.3% 0.6% 0.6% 0.5% 0.7% 2014-15 Number waiting > 6 weeks 41 29 29 37 26 27

• Total Number waiting

4215 4124 4170 4077 3745 4123

• %

1.0% 0.7% 0.7% 0.9% 0.7% 0.7%

• 2015/16 Plan

Number waiting > 6 weeks 34 34 39 35 32 36 35 38 37 37 40 39 Total Number waiting 3804 3725 4303 3916 3571 3972 3926 4239 4114 4111 4442 4348 % 0.9% 0.9% 0.9% 0.9% 0.9% 0.9% 0.9% 0.9% 0.9% 0.9% 0.9% 0.9%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.5: A&E Waiting Times –Total time in A&E performance provided by NHSE to

Sept –awaiting update

• A&E waiting times based on extrapolated outturn for 2014/15 and then

the weekly average of 2 years (2013/14 and 2014/15) aggregated to monthly and quarterly figures for 2015/16. This appears to be the best fit to previously observed and expected activity levels. Performance has been set at 95% each month. This may be replaced by an agreed recovery trajectory if performance is below 95% at Q4.

49

Target: 95%

Amber

Quarter 1 Quarter 2 Quarter 3 Quarter 4 2013-14 Number waiting > 4 hours 1682 1841 2151 2308 Total Attendances 37786 37245 36239 36154 % < 4 hours 95.5% 95.1% 94.1% 93.6% 2014-15 Number waiting > 4 hours 2055 1895

• Total Attendances

40244 39556

• % < 4 hours

94.9% 95.2%

• 2015/16 Plan

Number waiting > 4 hours 1950 1920 1929 1945 Total Attendances 39015 38401 38595 38915 % < 4 hours 95.0% 95.0% 95.0% 95.0%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.6-7: Cancer Two Week Waits performance provided by NHSE to Sept –awaiting

update

50

2WW Quarter 1 Quarter 2 Quarter 3 Quarter 4 2013-14 Number waiting < 2 weeks 1552 1833 1779 1744 Total number waiting 1597 1867 1819 1777 % 97.2% 98.2% 97.8% 98.1% 2014-15 Number waiting < 2 weeks 1977 2155

• Total number waiting

2062 2270

• %

95.9% 94.9%

• 2015/16 Plan

Number waiting < 2 weeks 2336 2440 2544 2648 Total number waiting 2511 2623 2735 2847 % 93.0% 93.0% 93.0% 93.0%

Number of waiters based on a straight line projection applied from quarter 1 2013/14 data to generate numbers from quarter 4 2014/15 onwards. The CCG has a good track record of exceeding this target. Performance is managed by the South East CSU Cancer Commissioning Team.

Target: 93%

Green

All Cancers

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.6-7: Cancer Two Week Waits performance provided by NHSE to Sept –awaiting

update

51

Number of waiters based on a straight line projection applied from quarter 1 2013/14 data to generate numbers from quarter 4 2014/15 onwards. The CCG has a good track record of exceeding this target. Performance is managed by the South East CSU Cancer Commissioning Team.

Target: 93%

Green

2 Week wait for breast symptoms (where cancer not initially suspected)

2WW-BR Quarter 1 Quarter 2 Quarter 3 Quarter 4 2013-14 Number waiting < 2 weeks 304 322 377 403 Total number waiting 321 330 386 412 % 94.7% 97.6% 97.7% 97.8% 2014-15 Number waiting < 2 weeks 365 327

• Total number waiting

386 338

• %

94.6% 96.7%

• 2015/16 Plan

Number waiting < 2 weeks 378 386 393 400 Total number waiting 406 414 422 430 % 93.1% 93.2% 93.1% 93.0%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.8-11: Cancer 31 Day Waits performance provided by NHSE to Sept –awaiting update

52

Number of waiters based on a straight line projection applied from quarter 1 2013/14 data to generate numbers from quarter 4 2014/15 onwards. The CCG has a good track record of exceeding this target. However, relatively small numbers of patients make the target more sensitive to variation. Performance is managed by the South East CSU Cancer Commissioning Team.

Target: 96%

Green

1st Definitive Treatment: All Cancers

31-1ST Quarter 1 Quarter 2 Quarter 3 Quarter 4 2013-14 Number waiting < 31 days 187 173 201 183 Total number waiting 189 182 206 189 % 98.9% 95.1% 97.6% 96.8% 2014-15 Number waiting < 31 days 209 244

• Total number waiting

214 247

• %

97.7% 98.8%

• 2015/16 Plan

Number waiting < 31 days 103 207 194 199 Total number waiting 107 215 202 207 % 96.3% 96.3% 96.0% 96.1%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.8-11: Cancer 31 Day Waits performance provided by NHSE to Sept –awaiting update

53

Number of waiters based on a straight line projection applied from quarter 1 2013/14 data to generate numbers from quarter 4 2014/15 onwards. The CCG has a good track record of exceeding this target. However, relatively small numbers of patients make the target more sensitive to variation. Main risk is around delays in referring patients for subsequent treatment between

• Trusts. This and other performance issues are managed by the South East

CSU Cancer Commissioning Team.

Target: 94%

Green

Subsequent Cancer Treatments: Surgery

31-SURG Quarter 1 Quarter 2 Quarter 3 Quarter 4 2013-14 Number waiting < 31 days 42 51 33 42 Total number waiting 42 53 34 42 % 100.0% 96.2% 97.1% 100.0% 2014-15 Number waiting < 31 days 45 43

• Total number waiting

45 43

• %

100.0% 100.0%

• 2015/16 Plan

Number waiting < 31 days 42 46 36 39 Total number waiting 44 48 38 41 % 95.5% 95.8% 94.7% 95.1%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.8-11: Cancer 31 Day Waits performance provided by NHSE to Sept –awaiting update

54

Number of waiters based on a straight line projection applied from quarter 1 2013/14 data to generate numbers from quarter 4 2014/15 onwards. The CCG has a good track record of exceeding this target. However, relatively small numbers of patients make the target more sensitive to variation. Main risk is around delays in referring patients for subsequent treatment between Trusts. This and other performance issues are managed by the South East CSU Cancer Commissioning Team.

Target: 98%

Green

Subsequent Cancer Treatments: Anti-Cancer Drug Regimen

31-DRUG Quarter 1 Quarter 2 Quarter 3 Quarter 4 2013-14 Number waiting < 31 days 79 86 97 67 Total number waiting 79 86 97 67 % 100.0% 100.0% 100.0% 100.0% 2014-15 Number waiting < 31 days 96 181

• Total number waiting

96 181

• %

100.0% 100.0%

• 2015/16 Plan

Number waiting < 31 days 87 132 95 77 Total number waiting 88 134 96 78 % 98.9% 98.5% 99.0% 98.7%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.8-11: Cancer 31 Day Waits performance provided by NHSE to

Sept –awaiting update

55

Number of waiters based on a straight line projection applied from quarter 1 2013/14 data to generate numbers from quarter 4 2014/15 onwards. The CCG has a good track record of exceeding this target. However, relatively small numbers of patients make the target more sensitive to variation. Main risk is around delays in referring patients for subsequent treatment between Trusts. This and other performance issues are managed by the South East CSU Cancer Commissioning Team.

Target: 94%

Green

Subsequent Cancer Treatments: Radiotherapy

31-RT Quarter 1 Quarter 2 Quarter 3 Quarter 4 2013-14 Number waiting < 31 days 85 88 81 102 Total number waiting 87 89 81 103 % 97.7% 98.9% 100.0% 99.0% 2014-15 Number waiting < 31 days 73 93

• Total number waiting

76 96

• %

96.1% 96.9%

• 2015/16 Plan

Number waiting < 31 days 80 88 81 101 Total number waiting 82 93 86 107 % 97.6% 94.6% 94.2% 94.4%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.12-14: Cancer 62 Day Waits performance provided by NHSE to Sept –awaiting

update

56

Number of waiters based on a straight line projection applied from quarter 1 2013/14 data to generate numbers from quarter 4 2014/15 onwards. Performance is generally good against this target, but it is not always met and there is

• nly a small margin between actual performance and the target. Main risks around

delays in referring patients for subsequent treatment between Trusts and relatively small numbers of patients make the target more sensitive to variation. This and other performance issues are managed by the South East CSU Cancer Commissioning Team.

Target: 85%

Green

GP Referral, All Cancers

62-GP Quarter 1 Quarter 2 Quarter 3 Quarter 4 2013-14 Number waiting < 62 days 77 55 82 82 Total number waiting 85 71 96 95 % 90.6% 77.5% 85.4% 86.3% 2014-15 Number waiting < 62 days 102 120

• Total number waiting

114 134

• %

89.5% 89.6%

• 2015/16 Plan

Number waiting < 62 days 135 143 153 162 Total number waiting 158 168 179 190 % 85.4% 85.1% 85.5% 85.3%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.12-14: Cancer 62 Day Waits performance provided by NHSE to Sept –awaiting

update

57

Target: 90%

Green

Referral from NHS Screening Service

62-SCR Quarter 1 Quarter 2 Quarter 3 Quarter 4 2013-14 Number waiting < 62 days 15 22 7 6 Total number waiting 17 22 7 7 % 88.2% 100.0% 100.0% 85.7% 2014-15 Number waiting < 62 days 3 16

• Total number waiting

3 16

• %

100.0% 100.0%

• 2015/16 Plan

Number waiting < 62 days 12 12 13 14 Total number waiting 13 13 14 15 % 92.3% 92.3% 92.9% 93.3%

Number of waiters based on a straight line projection applied from quarter 1 2013/14 data to generate numbers from quarter 4 2014/15 onwards. Performance is generally good against this target. However, it is extremely sensitive to variation due to small numbers of referrals. Main risk is around delays in referring patients for subsequent treatment from the screening services to Trusts. This and other performance issues are managed by the South East CSU Cancer Commissioning Team.

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.B.12-14: Cancer 62 Day Waits performance provided by NHSE to Sept –awaiting

update

58

Number of waiters based on a straight line projection applied from quarter 1 2013/14 data to generate numbers from quarter 4 2014/15 onwards. Performance is generally good against this target. However, it is extremely sensitive to variation due to small numbers of referrals. Advice from NHS England is “This is not a set standard but it would be nice if you aim for 85%”.

Target: 85%

Green

Following Consultant Upgrade

Quarter 1 Quarter 2 Quarter 3 Quarter 4 2013-14 Number waiting < 62 days 3 3 3 2 Total number waiting 3 3 3 3 % 100.0% 100.0% 100.0% 66.7% 2014-15 Number waiting < 62 days 1

• Total number waiting

3

• %

33.3%

• 2015/16 Plan

Number waiting < 62 days 3 3 3 3 Total number waiting 3 3 3 3 % 100.0% 100.0% 100.0% 100.0%

Wandsworth Clinical Commissioning Group

Table awaiting refresh

Other Commitments

• E.A.S.1: Dementia – Estimated Diagnosis Rate
• 66.7% of people with dementia diagnosed
• E.A.S.2: IAPT Recovery Rate
• 50% of people completing treatment moving to recovery
• E.A.3: IAPT Access
• 15% of people with depression or anxiety accessing psychological therapies
• E.A.S.5: HCAI Measure – C. Difficile Infections
• Reduction in C. Difficile Infections for 50 cases max during 2014/15.
• E.H.1-A1: IAPT 6 Week Wait
• 75% of patients waiting no more than 6 weeks from referral to first treatment
• E.H.2-A2: IAPT 18 Week Wait
• 95% of patients waiting no more than 18 weeks from referral to first treatment

59

Wandsworth Clinical Commissioning Group

E.A.S.1: Dementia – Estimated Diagnosis Rate

• 66.7% of people with dementia diagnosed

60

Target: 66.7%

Target has changed in 2015/16 to focus on patients over 65. Estimated prevalence figure has been provided by NHS England. Number of people diagnosed is the number of patients over 65 diagnosed with dementia as per practice QOF registers as at Wednesday 25th February.

Number of People diagnosed (65+) 1238 1238 1238 1238 1238 1238 1238 1238 1238 1238 1238 1238 Estimated dementia prevalence (65+ Only (CFAS II)) 1846 1846 1846 1846 1846 1846 1846 1846 1846 1846 1846 1846 % 67.06% 67.06% 67.06% 67.06% 67.06% 67.06% 67.06% 67.06% 67.06% 67.06% 67.06% 67.06% 2015-16 Plan

Wandsworth Clinical Commissioning Group

Green

E.A.S.2: IAPT Recovery Rate graph awaiting refresh

61

50% of people completing treatment moving to recovery Target: 50%

2015-16 Previous plan (from year 2

• f 14/15 to 18/19

planning round) The number of people who finish treatment having attended at least two treatment contacts and are moving to recovery (those who at initial assessment achieved 'caseness' and at final session did not) 1847 The number of people who finish treatment having attended at least two treatment contacts and coded as discharged) minus (The number of people who finish treatment not at clinical caseness at initial assessment) 3693 % 50.0% 2015-16 Plan The number of people who finish treatment having attended at least two treatment contacts and are moving to recovery (those who at initial assessment achieved 'caseness' and at final session did not) 462 462 462 462 The number of people who finish treatment having attended at least two treatment contacts and coded as discharged) minus (The number of people who finish treatment not at clinical caseness at initial assessment) 923 923 923 923 % 50.1% 50.1% 50.1% 50.1%

Amber

Target is to maintain recovery rate target of 50% to be achieved at March 2015. As at January 2015, the CCG is

• nly achieving 45.8%.

The CCG has agreed an action plan with the Wandsworth IAPT service. However, performance at March 2015 is forecast to be 46.8%, therefore it may be necessary to agree and submit a revised trajectory towards 50% during 2015/16.

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.A.3: IAPT Access graph awaiting refresh

62

Target: 15%

Amber

2015-16 Previous plan (from year 2 of 14/15 to 18/19 planning round) The number of people who receive psychological therapies 7356 The number of people who have depression and/or anxiety disorders (local estimate based on Adult Psychiatric Morbidity Survey 2000). 49015 % annual 15.01% 2015-16 Plan The number of people who receive psychological therapies 1651 1651 1651 1651 The number of people who have depression and/or anxiety disorders (local estimate based on Adult Psychiatric Morbidity Survey 2000). 44016 44016 44016 44016 % per quarter (e.g. 3.75%) 3.75% 3.75% 3.75% 3.75%

Target is to maintain the access target of 15% to be achieved at March 2015. The CCG has agreed an action plan with the Wandsworth IAPT service. However, performance for the final quarter is forecast to be 3.56% (equivalent to 14.26% annually), therefore it may be necessary to agree and submit a revised trajectory towards 15% during 2015/16. Performance against this target is assessed based on performance in the final quarter of 2015/16. If 3.75% of need is being met in that period, then the annual target is deemed to have been met.

15% of people with depression or anxiety accessing psychological therapies

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.A.S.5: HCAI Measure – C. Difficile Infections performance provided by NHSE to

Sept –awaiting update

63

Target: Max: 50

Green

The CCG has been set a target of a maximum of 50 infections during 2015-16. This would appear to be a relaxed target compared to previous years, however 64 infections are forecast for 2014/15, based on the first half of the

• year. Therefore 50 is a significant reduction.

APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH Total 12 4 2 5 3 2 2 3 1 5 2 41 1 3 6 6 10 6

• 32

2015-16 Objective 4 4 4 4 4 4 4 4 4 4 4 4 48 50 4 8 12 16 20 24 28 32 36 40 44 48 2013-14 2014-15 2015-16 Plan 2015-16 Plan (Cumulative)

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.H.1-A1: IAPT 6 Week Wait graph awaiting refresh

64

Target: 75%

Green

Quarter 1 Quarter 2 Quarter 3 Quarter 4 The number of ended referrals that finish a course of treatment in the reporting period who received their first treatment appointment within 6 weeks of referral 130 124 187 135 The number of ended referrals that finish a course of treatment in the reporting period. 332 241 293 180 % 39.2% 51.5% 63.8% 75.0%

Numbers finishing treatment are based on 2013/14 figures from

• HSCIC. Numbers waiting 6 weeks are estimated from waiting

time data for patients starting treatment during 2013/14, also collected by HSCIC. This target is for an improvement from the current position during the year. The current average waiting time from referral to first treatment is 18 days (2.5 weeks).

Wandsworth Clinical Commissioning Group

Table awaiting refresh

E.H.2-A2: IAPT 18 Week Wait graph awaiting refresh

65

Target: 95%

Green

Quarter 1 Quarter 2 Quarter 3 Quarter 4 The number of ended referrals that finish a course of treatment in the reporting period who received their first treatment appointment within 18 weeks of referral 76 114 214 171 The number of ended referrals who finish a course of treatment in the reporting period. 332 241 293 180 % 22.9% 47.3% 73.0% 95.0%

Numbers finishing treatment are based on 2013/14 figures from HSCIC. Numbers waiting 6 weeks are estimated from waiting time data for patients starting treatment during 2013/14, also collected by HSCIC. This target is for an improvement from the current position during the year.

Wandsworth Clinical Commissioning Group

Table awaiting refresh

Primary Care

• E.D.1: Satisfaction with the Quality of Consultation at a GP Practice
• E.D.2: Satisfaction with the Overall Care received at the Surgery
• E.D.3: Satisfaction with Accessing Primary Care

66

These indicators are based on patient responses to selected questions in the GP survey covering each

• f the above areas.

Current survey results (January 2014) show that the CCG scores highly and is close to the national average in each category. Targets are based on maintaining this position (based on a snapshot of the January 2015 survey results) throughout the year. Performance will be measured six-monthly on publication of the survey results. Wandsworth Clinical Commissioning Group

Primary Care

67

E.D.1 Satisfaction with the quality

• f consultation at GP

practices This is a score out of 500 The aggregated percentage of patients who gave positive answers to five selected questions in the GP survey about the quality of appointments at the GP practice 2015/16 422 E.D.2 Satisfaction with the overall care received at the surgery The percentage of patients who gave positive answers to the GP survey question ‘Overall, how would you describe your experience of your GP surgery?’ 2015/16 Numerator - The number of patients who answered ‘very good’ or ‘fairly good’ to the question, ‘Overall, how would you describe your experience of your GP surgery?’ 3753 Denominator - The number of patients responding to the question ‘Overall, how would you describe your experience of your GP surgery?’ 4252 % 88.3% E.D.3 Satisifcation with access to primary care The percentage of patients who gave positive answers to the GP survey question ‘Overall, how would you describe your experience of making an appointment?’ 2015/16 Numerator - The number of patients answering ‘’Very good’ or ‘Fairly Good’ to the question ‘Overall, how would you describe your experience of making an appointment?’ 3357 Denominator - The number of patients responding to the question ‘Overall, how would you describe your experience of making an appointment? 4159 % 80.7%

Amber

Amber Amber

• 6. Operational resilience

Wandsworth CCG hosts the System Resilience Group (SRG) around St George’s University Hospital NHS Foundation Trust, with the chair being the CCG Clinical Chair, Dr Nicola Jones. The SRG brings together the key commissioners (WCCG, Merton CCG, Lambeth CCG), Wandsworth Borough Council and the London Boroughs of Merton and Lambeth, London Ambulance service and the Trust to review performance and direct initiatives to improve whole system working around the Trust.

• A number of SRG schemes have been extended into 15/16 from the ring-fenced allocation and will be monitored through SRG:
• Weekend therapy provision at SGH to support seven day working
• Additional off-site bed capacity for SGH
• Departure lounge at SGH to facilitate faster discharge
• Increased psychiatric liaison support and home treatment
• Extended hours in primary care
• Additional social care capacity for Wandsworth, Merton and Lambeth Local Authorities
• A capacity remodelling exercise is in place between Trust and commissioners to identify and close any gaps in capacity
• 111 and OOH procurement will the support community response and will strengthen 111 capacity through closer involvement as an SRG partner

68

Wandsworth Clinical Commissioning Group

Wandsworth Clinical Commissioning Group

• 7. Alignment with the Local Health Economy (LHE)
• Wandsworth CCG hosts and is part of the SW London Strategic Planning Group (SPG) and the host for the System Resilience Group (SRG)

around St George’s Healthcare NHS Foundation Trust.

• Wandsworth CCG is committed to delivery of the 5 year plan to deliver commissioner and provider sustainability across South West London:

WCCG provides clinical and managerial leadership to a number of key workstreams as well as the SRO for the programme

• Planning assumptions that underpin the SW London plan are the basis for the WCCG finance and activity plan for 2015/16
• Wandsworth CCG is working with local commissioners, NHS England and St George’s NHS FT to ensure that demand and capacity modelling

is completed in a way that delivers high clinical quality services, key performance indicators and financial sustainability for commissioners and the provider in 2015/16

• There are no material variances currently in the planning assumptions across the LHE: however, decisions have yet to be made on the options

for delivery of the sustainable acute position for 2015/16.

• WCCG will be taking the estates consultation for SW London and St George’s MH NHS Trust to the March Board for decision on the outputs of

the consultation. The CCG is aligned with commissioning colleagues and the Trust on the need for consolidated inpatient services, increased community teams and high quality modern facilities for patients requiring acute inpatient MH services.

• . Wandsworth CCG is also committed to supporting the 13 London Health Programmes to deliver value and sustainability across the whole

system in London  .

69

• 8. Empowering Patients
• Patient & Carer engagement to improve

services

• Each CRG & Locality has an Action Plan

to embed PPI in pathway redesign

• Critical Friends groups to shape service

design

• Patient, Carer & Public engagement to

procure services

• Lay representation on Procurement

panels

• Community engagement, Whiz events

to identify needs, aspirations and priorities

• Commissioning Surveys
• Locality Roadshows
• Seldom Heard groups
• Youth Health Jury
• Patient and Carer engagement to

monitor services delivery

• Healthwatch representative in

Quality meetings

• Customer Relationship Management

System

• Social Media

Deliver & Improve Analyse & Plan Design Pathway Specify & Procure

PPI CRG

70

Wandsworth Clinical Commissioning Group

Wandsworth Clinical Commissioning Group

71

Capturing Patient Feedback - transforming care for Doris

Patient: (female early 70s) “They (Community Ward) would phone you every day

• r every couple of days.

They kept me out of hospital definitely.”

Patient: (female early 70s) “They put me on Community Ward, best thing they ever did.” Patient: (female early 60s) “I cannot fault the discharge, I had a discharge nurse come and take control of everything. I got dressed in a safe manner, they gave me some anti- emetics as I get travel sick. The ambulance people took me up to the flat and made sure everything was ok.” Carer: “Speech and Language Therapy (S.A.L.T) there is up to a three month wait for the swallow test.” Patient: “Getting hold of the district nurses is challenging. I was told the number had changed but this has not been advertised. I was put through but they were all out on calls; you can’t get hold of anybody before 2pm” Patient: (female mid 60s) “What I thought is that it would have been useful if something like this (equipment/adaptations) could have been done before I came home, that would have been so much better, prior to discharge.”

Patient: (female late 60s) “I felt I was treated with dignity and respect and there are aspects of my cultural values that was taken into consideration.” Community Ward Carer & patient: (both mid 70s) “Lots of communication and we feel safe don’t we? That there are people there to help.”

Social Care Patient: (female early 70s) “They sent me to a day centre and you couldn’t wish for a better day centre. That woman really cares about the people she looks after…she listens to everything you say.”

Key Opportunities Threats

• The Better Care Fund (BCF) outcomes will be delivered through embedding a comprehensive frailty

pathway across health and social care providers in Wandsworth.

• Partners in designing and delivering the pathway include all providers working with frail older adults across

acute, community, mental health, social care, and the voluntary sector.

• The pathway will focus on delivering the outcomes that make a difference to older frail adults and their

carers and care will be co-ordinated around their needs.

• This programme builds on the strong foundations delivered through the redesigned community adult

health service (CAHS).

• At each stage of the pathway mental, physical and social care needs will be managed in an integrated way,

to keep patients well and cared for in their own home wherever possible.

• 10. BCF - Extending the integrated community model in

15/16 to deliver a comprehensive frailty pathway

72

• 12. Planning Assumptions

Triangulation Methodology

73

BCF Reduction 1,170 less NELs (BCF is subset of

• verall QIPP 1,318

2014/15 FOT M9 34,198 NELs 22,713 Day cases 7,054 Electives 191,456 OP First 450,145 OP Follow-up 121,408 A&E 100,652 GP Referrals 2015/16 Planned Activity 34,258 NELs 24,112 Day cases 7,473 Electives 198,314 OP First 467,253 OP Follow-up 122,950 A&E 103,675 GP Referrals QIPP Reduction 1,318 less NELs (BCF 1,170) 2,066 less OPs 3,711 less A&E 1.25% (ONS) – Applied 1.38% (Local) 2.78% (ONS) – Applied 2.48% (SWL 5 Years) 90% Admitted (EL+DC) (619 admissions: 420 RTT + 199 backlog) 95% non-Admitted (OP) (175 attendance

Wandsworth Clinical Commissioning Group

2.

• 2. Modelli

lling Ass ssumptions

For 2015-16, 4.03% growth (demographic: 1.25% and non-demographic: 2.78%) applied for acute activity modelling, aligned with Finance assumptions

14/15 15/16 16/17 17/18

18/19

Funding levels 2.14% 1.94% 1.70% 1.70%

1.70%

Inflation Pay 2.60% 1.40% 2.40% 2.40%

2.40%

Non pay 1.90% 1.40% 1.70% 1.70%

1.70%

Tariff inflator/deflator (Acute) (1.50)% (1.87)% 0.40% (0.60)%

(0.70)%

Tariff inflator/deflator (Non Acute) (1.70)% (1.87)% (1.00)% (0.60)%

(0.60)%

Contingency 0.50% 0.50% 0.50% 0.50%

0.50%

Surplus 1.50% 1.00% 1.00% 1.00%

1.00%

Non recurrent investment reserve 1.50% 1.00% 1.50% 1.50%

1.50%

Transformational Fund 1.00% 0.20% Using Benchmarking Assumptions Prescribing inflation 6.00% 6.50% 6.50% 6.50% 6.50% Continuing Care growth 8.00% 8.00% 8.00% 8.00% 7.00% Demographic growth 1.25% 1.25% 1.25% 1.25% 1.25% Acute - non demographic growth 2.78% 2.78% 2.38% 1.98% 1.98% Non acute non demographic growth 2.15% 2.15%

Population Growth

75

WCCG used 1.25% - national figure (ONS/GNA) Compare with observed trends which is average 1.38% increase

360,836 366,404 373,430 375,798 350,000 355,000 360,000 365,000 370,000 375,000 380,000 Oct-2012: Apr-2013: Dec-2013: Dec-2014:

Practice List Size

N.B. NEV development is expected to result in an influx of around 35,000 people over 15 years.

Wandsworth Clinical Commissioning Group

Activity Trajectories 2015-16

34,258 24,112 31,586 7,473 198,314 467,253 122,590 103,675

• 50,000

100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 Non-elective spells - all specialties E.C.23 Daycase Elective Spells - ALL Specialities E.C.32 Elective Spells - ALL Specialities E.C.22 Ordinary Elective Spells - ALL Specialities E.C.21 All First Outpatient Attendances - all specialties E.C.24 All subsequent outpatient attendances - all specialities E.C.6 A&E attedances all types E.C.8 E.C.9 GP Written Referrals Made (G&A) Spells EC23 Spells EC2 Spells EC21 Spells EC1 Outpatients A&E Referrals