WELCOME City and Hackney CCG and Hackney Council Commissioning - - PowerPoint PPT Presentation

WELCOME

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City and Hackney CCG and Hackney Council Commissioning Intentions Event 2016/17 Tuesday 2nd of February 2016 6pm-8.30pm The Tomlinson Centre

AGENDA

5.30-6.15pm Arrival, registration, refreshments 6.15-6.30pm Welcome 6.30-6.55pm Round table discussions 6.55-7.05pm Break 7.05-7.30pm Round table discussions 7.30pm-8pm Devolution presentation 8-8.30pm Q&A 2

NHS City & Hackney CCG

INTRODUCTION

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Welcome from Clare Highton, GP and CCG Chair and Catherine Macadam, Chair of Patient and Public Involvement Committee

Tonight is about getting your ideas and feedback…

YOU SAID, WE DID

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We had a great turnout at last year‟s event and your comments and feedback helped inform our plans for 2015/16 as well as the second round of the Innovation Fund.

“We need a longer consultation when diagnosed with a long term condition.” “We need wider access and support for children and young people with mental health issues.” We commissioned “time to talk” extended GP consultations for people with multiple conditions and extra time for consultation for those newly diagnosed. We set up a Duty Doctor scheme that takes urgent calls from patients during working hours. We also commissioned a Paradoc service which enables GPs to visit people at home in an emergency, preventing unnecessary A&E visits. We‟ve formed an alliance with other NHS and community based mental health service providers and implemented a single assessment policy with no wrong door. “ We want better access for patients to see their GP for urgent care and more support for people suffering crisis at home.”

INNOVATION FUND 2015

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• Result of feedback from

patients, the public, GPs and the voluntary and community sector

• Co-produced with patients
• Innovative practice, new ideas
• Helping patients to better

understand their own health needs and to access services

• Thirteen projects funded in

2015

PATIENT AND PUBLIC INVOLVEMENT

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• We want our services to reflect our local populations and their needs
• Patients and members of public can get involved and help shape local services

through

• Becoming a member of the PPI Committee
• Becoming a Programme Board Representative
• Attending the NHS Community Voice meetings
• Our plans for next year include
• Input into the Sustainability and Equality work
• Better shared decision making
• Patient experience work stream for East London Cancer Board
• PPI input into Hackney Devolution Pilot.
• More about this later at tonight‟s event. Please visit the question wall to ask

questions and post comments.

OUR MONEY

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Acute and Community £231m (Homerton, £150m) 63% Mental Health £56m 15% Primary Care and Prescribing £48m 13% Other £33m 9%

2015/16 £368m for commissioning services Management cost limit £6.3m (but expect to spend only £4.3m) Chart below shows value in millions and a %age of total

FUTURE FINANCES

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Headline,

• Extra money for NHS through the Government‟s Comprehensive

Spending Review However,

• Most NHS Hospitals now in deficit, new funding will need to pay for this
• Bail out funds conditional on local delivery of nationally set challenging

productivity targets and agreement to meet other expectations Locally,

• City & Hackney CCG received 3-5 year allocation with below average

growth as „over‟ target on funding formula

• In 2016/17, headline increase of 2.4% nets to 0% after national

challenges met eg increase in costs for national insurance payments will return funds to Treasury in 2016/17

• Allocations will mean the CCG will struggle to commission recurrent

services beyond 2016/17 without finding significant efficiencies or containing demand

• But, still have money to spend non-recurrently c£14m pa and access

granted to historic surplus of £30m over next 3 years.

NON-RECURRENT INVESTMENT

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• Opportunity to invest in additional services
• 21 services received funding through latest cycle
• Patients involved in selection process
• Criteria included
• Health gain
• Patient benefit
• Reducing inequalities
• Sustainability
• Impact on outcomes and performance
• Savings as a result of the investment

Non- recurrent £14.3m

6% 13% 43% 20% 4% 9% 0% 5% Community Mental Health Primary Care Acute Strategic System Wide Patient Experience Voluntary Sector

Many schemes within primary care, will support the prevention

• f admissions, support prevention and self management, and

move services into the community. Many schemes are intended to work across acute, community and primary care.

PROFILE OF NR SPENDING PLANS 2016/17

OUR PLANS

13 As part of delivering the NHS Forward View we need to develop

• Five Year Sustainability

and Transformation Plan

• Operational Plan for

2016/17

OUR FIVE YEAR PLAN

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• Sustainable Transformation Plan (STP) is a plan for Hackney and its people.
• Making the best of the resources that are available to us
• Some of the headline local issues that we will focus on include
• Cardiovascular mortality for under 75s high for the least 20 years, but now declining
• Obesity rates still high
• High A&E attendances
• Emergency admissions for over 75s still high
• High levels of mental health need
• One year survival for cancer is improving although overall mortality still not good

OUR PLAN FOR 2016/17

15 There are nine „must dos‟ for 2016/17 for every local system:

• Develop a high quality Sustainability and Transformation Plan
• Return to financial balance
• local plan to address sustainability and quality of general practice
• Improve access standards to A&E and ambulance waits
• Improvement against 18 week referral to treatment standard for non-

emergency pathways

• Reduce waiting times for mental health
• Improve community care for people with learning disabilities
• Develop affordable plans for improvement in quality and publish Trust specific

avoidable mortality rates

EQUALITY AND SUSTAINABILITY

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Social Economic Environment

Inclusion Supporting communities Improve Air Quality Growing Food Access to Green Spaces Training & Education Reduce congestion Active Travel Well workforce Efficient services / operations People‟s time Giving time Buying local Biodiversity Access to services Mobilisation Resilience Quality & Compliance

Health & Wellbeing

Fairness Companionship Creativity & Potential ££C&H Responsible employer Diet & Exercise Living Wage Volunteering

Equality & Diversity Reduce CO2 Adaptation ££Stability Social Value Economic Growth Resilience Eliminate Waste

Buying social, ethical Innovation & Technology

OVERVIEW OF OUR PLANS

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• Our Programme Boards will tell you the work

we‟re doing to form our five year plan.

• You can get more information on how our

individual programme boards plan to continue to do this in the coming year during this evening‟s round table discussions.

IMPROVING HEALTH

19 Our GPs amongst best in country for treating and supporting people with long term conditions. First, second

• r third in country against 45% of

measures All City and Hackney practices who have been CQC inspected so far this year have received a „Good‟ rating Majority of practices outperforming London CCGs against targets Testament to working with high quality local providers

Joint Commissioning Intentions Event

Introduction

Councillor Jonathan McShane Cabinet Member for Health, Social Care and Culture London Borough of Hackney

Overview

Our focus in recent years has been on promoting independence and enabling people to remain living in the community with appropriate support if possible.

• Meet the person, not just the need - make sure the person's needs are

recognised so that services are designed around them

• Promote health and wellbeing - help people to be safe and live healthily;

tackle health inequalities to improve the wellbeing of our communities

• Provide wider choice - give people a choice of, and control over, good-

quality services

• Improve access to services - enable people to access services which meet

and respond to their individual and diverse needs

• Join up and innovate - working in partnership to develop the capacity to

achieve change and deliver our priorities

Our spend 2015/16

[CATEGORY NAME] [PERCENTAGE ] Provided Services 13% [CATEGORY NAME] [PERCENTAGE ] Mental Health S75 9% Preventative Services 22% Housing Related Support Programme 14% Commissioni ng 3%

Adult Social Care Budget: £93,697 Public Health Budget: £31,413

(mandated and non mandated services)

0 – 5 Services 13% Sexual Health Services 21% Substance Misuse (Adults) 16% [CATEGORY NAME] [PERCENTAGE] [CATEGORY NAME] [PERCENTAGE] Health Checks 1% [CATEGORY NAME] [PERCENTAGE] Staffing 9% Overheads 3% [CATEGORY NAME] [PERCENTAGE] Adult’s PH Services 14% Advice, Prevention and Promotion 7% [CATEGORY NAME] [PERCENTAGE]

Adult Social Care: key achievements

Delayed Transfers of Care

• Reduced level of Delayed Transfers of Care (DToC) compared to this

time last year Homecare

• Commissioned a new Homecare service to support people to remain living

independently in their own homes Autism

• Developed an Autism Plan which identifies the actions that need to be

taken to ensure that Hackney delivers the outcomes within the national Think Autism Strategy Telecare

• Commissioned a new integrated Telecare service, supporting people to

remain living independently in their own homes and supporting hospital discharge Provision of day care

• Work is underway on the construction of a Day Opportunities hub that

will cater for people with complex health needs.

Public Health: key achievements

Adult substance misuse system

• Introduced a new adult substance misuse system and invested further in a

newly designed young people‟s substance misuse service, Smoking cessation services

• Implemented a range of new smoking cessation services, seeing improved
• utcomes particularly across primary care on smoking cessation

Health Hub provision

• Rolled out our new estate based Health Hub provision, addressing healthy

weight, smoking and mental health and improving access to services Family Nurse Partnership embedding

• Continued to see improved outcomes for 0-5‟s through Family Nurse

Partnership embedding Healthier Hackney Fund

• Grant funded over 32 VCS innovation pilots through our „Healthier Hackney

Fund‟, across a range of Public Health areas currently being evaluated.

Helping us to shape services

DToC You helped us to understand DToC by talking to us about your experiences of delayed discharge from hospital. Homecare Your feedback helped to shape the specification for the new Homecare service. Telecare Your views helped us to shape the specification for the new Telecare service, and has helped us to improve the accessibility of the service. Autism Working with stakeholders and services users, we ensured that people with Autism and their families will be represented on the new ‘Autism Alliance Board. Provision of Day Care Through consultation, service users, their carers and families have contributed to the final decision on the architecture and finishing's to the future Day Opportunities Hub.

Looking ahead

• Involve service users and carers in all aspects of the commissioning cycle,

for all services being commissioned or recommissioned.

• Set up an Autism Alliance Board involving people with autism and their

families, health and social care representatives and voluntary sector providers.

• Continue to reduce DToC across both the Homerton and Mental Health

Services in consultation with service users and partners.

• Continue to develop outcomes-based support plans as part of our Homecare

service.

• Continue the remodelling of Day Services.
• Continue to review and re-design pathways and services for unpaid Carers
• Implement the recommendations of the Strategic Commissioning review of

accommodation for Housing with Care.

Looking ahead

• Re-model and re-procure Learning Disabilities Supported Housing
• Re-design employment services to ensure residents are able to easily

access job opportunities

• Review our SDS pathway
• The Making it Real Project will continue to ensure service users and cares

are communicated with effectively

• Continue to further develop Hackney iCare website in partnership with

HCVS

• Early Years Health will continue to invest in children‟s centres to improve EY

health

• Commission quality stop smoking services and develop an education /

prevention offer and new treatment services for young people

• Continue to address healthy lifestyles and all ages obesity by increasing

physical activity and access to healthy food, education and information

• Question

Hackney Health and Social Care devolution pilot

Overview and update

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This evening

• Brief overview of plans, we want you to be

engaged

• Please take time this evening to leave your

comments, concerns and questions on the wall provided

• Dedicated event, hopefully in early April that

will be solely about integration

• Please come along to that event – to receive

updates, please leave your details.

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A brief overview

• Powers transferred from national government to Hackney
• Nine Hackney partners submitted a joint statement of

commitment for full health and social care integration

• Hackney is one of five successful areas in London. We will be

developing, testing and consulting on new models of delivery

• Key question: Should all the local providers form one new

delivery organisation to improve arrangements for working together?

• Any new organisation would remain part of the NHS and would

be required to adhere to NHS standards and ensure rights of patients under the NHS constitution. Patient choice for services

• utside Hackney.

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What is our ambition? Why did we decide to apply?

• Significant funding pressures across health and social care. Our

responsibility to get the very best possible for Hackney

• Not just about money! Use the freedoms and powers to create a

truly integrated and sustainable local health and care system

• We believe local people, commissioners and providers are best

placed to develop a system that is built on local need.

• We want to develop a Hackney-led solution to long standing health

and social care challenges, such as providing more prevention and early intervention services

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Homerton University Hospital NHS Trust London Borough of Hackney NHS City and Hackney CCG HealthWatch and

• ther Lay

Representatives City and Hackney Local Pharmaceutical Committee City and Hackney Urgent Care Healthcare Social Enterprise (CHUHSE) Voluntary sector including HCVS East London Foundation Trust (ELFT) City and Hackney GP Confederation

Who are the local partners?

Local people (resident s, service users, patients and carers)

Hackney’s Whole Health and Care System

What new ‘freedoms’ are we asking for, and why?

• Devolution of some national health commissioning budgets, including public health,

specialised services and primary care, will enable us to bring budgets together, simplify planning and reduce the transaction costs associated with commissioning.

New commissioning powers

• Financial freedoms: We want to have more control over how we pay for services, making

sure that we encourage prevention and early intervention.

Financial flexibilities

• Developing a simplified and common regulatory and assurance system will keep us

focused on how well our system is improving outcomes, especially what matters most to patients and service users.

Common regulatory system

• Freedoms in terms of how we use our buildings and property will help us transform

existing buildings into fit-for-purpose facilities that can deliver integrated services.

Buildings and Property

• Additional powers devolved to London will enable us to address our public health

challenges - ensuring a good start in life, fair employment, educational opportunities, healthy communities, etc.

Additional local powers

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Links to our 5 year plan

• All working together to develop our five year plan. Integration and
• ur „asks‟ will be intrinsic part
• By the time we submit that in June we need to be clearer about:
• exactly what decisions and responsibilities do we need to bring

locally to better help us deliver our plans?

• how would one provider organisation help with the delivery of our

plans?

• We will have much more concrete proposals to discuss by that stage

but will continue to engage with all stakeholders on emerging thinking between now and then

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What have we done so far?

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October – November Health and Wellbeing Board working group defines the aims of the pilot and prepares the bid November Submission of bid with outline proposal and partners‟ collaboration agreement to London Councils/NHS England December National announcement

• f the pilot

Project governance and management arrangements proposed January Revising governance arrangements, preparing work plans and seeking transformation funding

What happens next?

Jan-Mar 2016

Phase 1

Start Up

Apr-Sept 2016

Phase 2 Detailed business case developed alongside 5 year plan, with input from public, patients and other stakeholders

Oct 2016-Mar2017

Phase 3 Finalise

• perating

model and formally consult

Apr 2017 onwards

Phase 4 Pilot launched

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Integration: Communications and public engagement

Catherine Macadam Co-chair, Engagement and Communications workstream

Starting point is:

• NHS England Patient and Public Participation

Policy: ” patients and the public to be at the heart of everything we do.”

• The Five Year Forward View: „…we need to engage

with communities and citizens in new ways, involving them directly in decisions about the future of health and care services.‟

• The Hackney Local Devolution Pilot: “Putting our

patients, clinicians and social care practitioners in the driving seat of service transformation and decision making …. which is open inclusive, transparent and locally accountable.”

Benefits of engagement

• People are better off

because

• they are better informed about

their health, they live longer and in better health

• they build strong social

networks and connections and more stable communities

• they have better partnerships

with doctors and professionals

• The system works better

because

• resources are used more

sustainably

• improved quality and

innovation

• reduced health inequalities

and waste

• people understand how to use

health services responsibly

How will we make this happen?

Communications and public engagement workstream:

• Who:

Co-chairs: Jon Williams (Healthwatch Hackney) Catherine Macadam (CCG Lay Member)

+ representatives of patients, carers service users and the public.

• What:

To make sure that the people of Hackney:

are fully informed about the proposals have had opportunities to ask questions, contribute ideas, be part of the design and decision-making process

How will we make this happen?

• How:
• Offer a range of opportunities for patients/carers/service

users, the public and other interested parties to play a proper part in re-designing services and decision-making

• establish principles of patient/service user and public

involvement for any new model of healthcare delivery

• communicate widely about the project in a way which is

relevant, timely, meaningful and accessible

Next Steps

• Post a question or comment about integration
• n the Question Wall
• Tell us how you would like to be involved and

leave us your contact details

• Attend the next public event