Patient and Public Forum Wednesday 5 October 2016 NHS Croydon CCG - - PowerPoint PPT Presentation

Patient and Public Forum

Wednesday 5 October 2016

NHS Croydon CCG Aiming for financial balance

PPI Forum Wednesday 5 October 2016

The current state of NHS finances

• In July 2016, NHS Improvement and NHS England announced new

measures to address the NHS’s financial challenges nationally

• Croydon CCG and Croydon Health Services NHS Trust were among

those judged to need extra support to address their financial deficits

• Croydon CCG was put in financial special measures based on the result
• f the first quarter financial position

Croydon CCG is required to make £5.7 million savings on top

• f existing plans to save £12.7 million this year

This constitutes, in total, just under 4% of the CCG’s total commissioning budget of £475.4 million for 2016/17

Croydon’s historic financial position

• The CCG was established in April 2013 with a substantial

financial challenge

• Croydon has historically been funded to a lower level than

needed to meet the health requirements of our population

• The CCG has adopted financial recovery as business as usual –

focused on clinically led service redesign

• The CCG has received additional allocations over the last two

years and is now within an acceptable funding range of +/- 5%

• We are required to deliver statutory financial balance for 2017/18

with a £4.2m deficit permitted for 2016/17

• The CCG must ‘live within its means’ and focus its resources to

greatest need to deliver better outcomes.

We have a strong track record of savings…

 We have delivered savings of £72 million over the last five years  We have consistently met financial targets whilst improving quality

and performance each year This year will be our biggest challenge yet

• We will focus on transforming services to make them more efficient,

effective and sustainable, including:

• Outcomes Based Commissioning (OBC) programme for patients over

65 years alongside Croydon Council

• New network of urgent care services launching in April 2017
• Real improvements in cancer, mental health and A&E, urgent care and

community services

…but we need to make more savings

NHS England is expecting 2016/17 forecast deficit of £9.9 million to be reduced to £4.2 million NHS England is expecting the CCG to deliver our statutory duty to break even in 2017/18

The CCG needs to save £18.4 million – £5.7 million more this year than we had planned

Financial Recovery Action Plan

• There is not enough money for us to do everything we want for the

people of Croydon

• We have to prioritise and make tough decisions to secure the future
• f local health services for everyone. We are doing this through:
• Looking at every opportunity to make savings without impacting

fundamental services

• Holding clinically-led discussions to explore every option for

further savings and assessing the impact on health and the savings they could deliver

• Working closely with our health and social care partners

Financial Recovery Plan

We have considered the following and will NOT be reducing or changing the following at this time:

• Investment in the Better Care Fund
• ‘Referral to treatment’ waiting times for outpatients, diagnostics and

planned surgery

• The number of planned GP hubs in the borough will remain at four
• Investment in Child and Adolescent Mental Health Services
• Investment to support our work around outcomes based commissioning

Financial Recovery Plan

There are four types of expenditure reduction initiatives that we ARE considering:

• Re-commissioning services to gain better outcomes and experience for patients

and better value for money for the NHS

• E.g. promoting self care and support within the community
• Strengthening existing policies to ensure the right people get the treatment they

need

• E.g. restricting emollient (moisturiser) prescriptions to those diagnosed with eczema etc
• Making sure patients get the best treatments that offer the most clinically effective

treatment and/or best value for money

• E.g. Liothyronine prescribing over standard levothyroxine treatment
• Reducing ‘back office’ and administration costs
• E.g. sharing more services across SWL CCGs

1 2 3 4

Engaging with the people of Croydon

We have drafted a list of where we think expenditure can be reduced, now we want to hear how you think we should prioritise our spend Next steps:

• We would welcome your advice and support in this process
• If we propose any significant service change, we will fully engage and consult

with the people of Croydon on what we should prioritise in order to get health services in the borough back into balance

Local engagement will be carried

• ut throughout the autumn to ask

how Croydon residents would like to prioritise spending and their thoughts on our proposals Proposals go to Croydon Council Overview and Scrutiny Committee on 18 October Governing Body approved future engagement proposals in the Financial Recovery Plan on 4 October

How will we engage in the future?

Our widespread engagement work means we have developed strong relationships within the community and voluntary sector. For example :

• Mental Health service users (MIND, HereUs)
• Refugee and Asylum seekers (through Croydon Voluntary Action)
• BME led community groups (Asian Resource Centre, BME Forum)
• Food banks (New Addington and Selhurst)
• Young people with learning disabilities (People First, Wadhurst Youth Centre)
• Frail older people (Age UK, New Addington Lunch Club, Shirley Neighbourhood

Centre)

• Parents of young children (under 5s) (Fieldway Family Centre, Woodlands

Children’s Centre)

• Voluntary and Community Support organisations working in the New Addington,

Broad Green, Thornton Heath and West Croydon wards

Engaging with the people of Croydon

• Work with well-established local networks including GP practices’

patient participation groups and CVS networks on specific service areas.

• Equalities Impact Assessment to identify potential impacts on

specific communities and call upon networks to help us reach marginalised groups

• Started discussions with our partners, including Healthwatch

Croydon and the Health Overview & Scrutiny Committee to help us reach the patient community and make sure we act on insightful local intelligence

Prescribing and Pharmacy

WEDNESDAY 5 October 2016

Janice Steele

Chief Pharmacist

What is Medicines Optimisation?

Medicines optimisation is about ensuring that the right patients get the right choice of medicine, at the right time for the right clinical outcome. Goals

• Improve patient outcomes
• Take medicines correctly
• Avoid taking unnecessary medicines
• Reduce wastage of medicines
• Improve medicines’ safety
• Help encrouage patients to take ownership of their treatment

The most expensive medicine is one the patient does not take

You can help reduce medicines waste by:

• Checking what medicines you still have at home before ordering your

prescription

• Only ticking the boxes on your repeat prescription forms for medicines you

really need

• If you use the electronic prescription service, telling your pharmacist if they

give you medicines you're no longer using or already have enough of at home

• Telling your GP or pharmacist if you've stopped taking any medicines, so they

can be removed from your repeat list

• Ordering online via your GP website which may also be quicker and more

convenient for you

• Not stockpiling medicines

The cost of medicines to the NHS

This year the NHS will cost us around £124 billion, of which £14 billion will be spent on medicines – that’s £38 million every day The prescribing budget for Croydon alone is approximately £41 million (2016-17) This is an average of £107.61 per patient Ageing and growing population increases the demand for medicines and the NHS By prescribing the right medicines for less, the NHS will have more money to invest in better care for everyone like cancer treatments

Maximising prescribing spend

We are looking at appropriate NHS spending on prescribing certain medicines and treatments where:

• Some medicines can be bought more cheaply directly by

patients than it costs the NHS on prescription. This is also faster for the patient than waiting for prescriptions/appointments

• Less expensive but equally effective alternatives that provide

the same health benefit

• The cost to the NHS outweighs the benefit to the patients

Prescribing schemes

The proposals we are looking at are:

• Gluten free food
• Vitamin D for maintenance
• Emollients for patients who have not been diagnosed

with a dermatological condition like eczema

• Medicines for colds and flu
• Self-care medicines like paracetamol or antihistamines

unless a patient has chronic pain and need to use it routinely

Gluten free food

Coeliac disease can be a serious condition, however a gluten-free diet is not in any way detrimental to your health

• Croydon CCG spends £83,000 on gluten free products every year
• Historically gluten free products used to be hard to find - they are now commonly

available as well as other alternatives for those with food allergies and sensitivities

• Estimated less than 1% UK population (half not diagnosed) suffers gluten
• intolerance. In Croydon this would be around 3,000 people
• Foods for people with other allergies and intolerances like dairy, lactose or nuts are

not provided on the NHS

• Croydon gives out 5,600 prescriptions per year

Vitamin D – what’s it for?

Vitamin D helps to regulate the amount of calcium and phosphate in the body. These nutrients are needed to keep bones, teeth and muscles healthy. A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain and tenderness as a result of a condition called osteomalacia in adults. From about late March to the end of September, most of us should be able to get all the vitamin D we need from sunlight on our skin.

Vitamin D

Croydon CCG spends £200,000 every year on vitamin D maintenance prescriptions Vitamin D is widely available over the counter for around £1.50 a month Daily vitamin D maintenance therapy costs the NHS from £2.95 to £7.20 per month Some groups are more at risk of vitamin D deficiency including older people, under 5s, pregnant women, people with low exposure to sunlight for example individuals living in care homes, housebound, bed bound, people who cover their bodies for cultural or religious reasons

Emollients

Emollients are very valuable for people with eczema, psoriasis and other dermatological conditions. Most people at some point will suffer with dry skin However, If you haven’t been diagnosed with a dermatological condition like eczema, dry skin can be managed by buying over the counter moisturisers Older people may have fragile skin, and emollients have a preventative role here in maintaining skin integrity. Breakdown of skin can lead to complications like infections and leg ulcers which lead to medical support and even hospital admissions Need to make a medical judgement and prioritise those patients who need the most support

Emollients

Croydon CCG spends £750,000 a year on emollients The cost of emollients can also vary greatly:

• Average cost for 500g of cream or ointment is £5.24
• Aveeno cream costs £11.91 for 300ml

We want to further promote self care and self management so that more people take responsibility for this themselves

Self care medicines

If more people are able to meet their own health needs through self care, this will ease the pressure on health services We would ask people to buy their own over the counter medicines that are likely to be much cheaper than the cost of a prescription Croydon CCG spends around £300,000 a year on prescribing self care medications like paracetamol, cold and flu remedies and antihistamines Approximately £70,000 of this spend was likely to be for acute pain and medications could have been purchased at the pharmacy If we could reduce this spend by 15%, the NHS could save £45,000 a year

What do you think?

What concerns would you have if the NHS made these changes? How could we work to mitigate these concerns? Should there be any exceptions for any of these schemes?

Discussions with your table

• Looking at our assessment criteria for our Financial Strategy Plan
• n your tables
• What do you think about the assessment criteria?
• Are we focussing on the right criteria? What other considerations

should there be? Are we asking the right questions?

• Which are the priority areas (in grey) that you think are the least

important when assessing proposals.

• Patient benefit
• Clinical benefit
• National priority
• Local priority
• Stakeholders views
• Buildings and Equipment
• Workforce
• Service delivery
• Investment Required
• Financial benefit

Next steps

• Over the autumn, we will engage with local people on our

proposals – please invite us to your meetings

• Discussing the proposals with the Health Overview and

Scrutiny Committee on 18 October 2016

• Reviewing our proposals at our Governing Body Meetings

Thank you for coming