Welcome NHS Hounslow CCG Annual General Meeting 18 September 2019 - - PowerPoint PPT Presentation

Welcome

NHS Hounslow CCG Annual General Meeting 18 September 2019

Agenda

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Item Lead Time 1 Introduction 1.1 Welcome Dr Annabel Crowe 12.00 – 12.05 2 Minutes of the previous meeting 2.1 Minutes of the previous meeting, 19 September 2018 Dr Annabel Crowe 12.05 – 12.10 3 Our work in 2018/19 3.1 Reflections on the past year Dr Annabel Crowe 12.10 – 12.20 3.2 North West London Commissioning Reform Case for Change Mark Easton 12.20 – 12.30 3.3 Quality & Performance Diane Jones 12.30 – 12.40 3.4 Annual Report and Accounts 2018/19 Paul Brown 12.40 – 12.50 3.5 Our Journey to Integrated Care Mary Clegg 12.50 – 13.00 3.6 LIFE Programme Mark Blomfield/James Hearn 13.00 – 13.10 3.7 Social Prescribing/Self-Care: Patients’ experiences Beata Malinowska/Camille Pegus 13.10 – 13.20 3.8 Priorities for 2019/20 Mary Clegg 13.20 – 13.30 4 Questions and discussion Dr Annabel Crowe 13.30 – 13.55 5 Close Dr Annabel Crowe 13.55 - 14.00

Introduction to the CCG

A membership

• rganisation of GP

Practices We commission hospital care, community services, mental health services Working with Hounslow Council Governing Body of GPs, lay members, carer representatives, Healthwatch and CCG

• fficers

Developing Primary Care to support new ways of working for patients

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Minutes of the previous meeting

Dr Annabel Crowe, Chair

Previous Meeting

19 September 2018, The Debenture Lounge, Twickenham Stoop Stadium What we covered:

• Priorities for 2018/19, including working

towards a Hounslow health system which is integrated by 2022 and offers better outcomes for residents and clinicians.

• Programme for the future of technology and

how can this be accessed and used in Hounslow.

• Quality and safeguarding.
• Annual report and accounts for 2017/18.

Reflections on the past year

Dr Annabel Crowe, Chair

Local influence, local knowledge Patient representation Capturing patient experience GPs involved in decision making Our partners Patient & public engagement programme

Achievements across the patch: Start Well

• Hounslow was named a

“trailblazer” for new school-based mental health teams. These teams will be implemented over the next two years with the aim of getting mental health help to young people in their schools

• We have achieved a significant

improvement in the waiting times for autism assessments.

• The Digital Healthy Schools

Programme was launched, a free programme providing schools with information and support via smartphones to help students and their parents understand digital health.

• Hounslow being 2nd highest in

London in achieving physical health checks for people with long-term MH needs

• The Transforming Care Programme

gives patients with learning disabilities support through community based placements

• National Cancer screening

programme: Improvement in 18/19 following support from GP Practices and RM partners

Achievements across the patch: Live Well

• Diabetes: Hounslow in top

10% in country for improvement in blood pressure, sugar control and cholesterol for people with diabetes.

• Extended GP access: work

has continued to ensure that there are appointments available from 8am-8pm across NW London

• Enhanced care in care homes - ‘Is

my resident well?’ training programme has empowered care home staff to identify deterioration earlier

• The Home First programme helps

people home from hospital, assessing patients for on-going support in their own home.

Achievements across the patch: Age Well

• With partners, we set up

the Dementia Steering Group (DAG) which has helped to improve services and awareness of dementia within the community.

Case for Change

– Commissioning reform across North West London CCGs

Mark Easton, Chief Officer

Commissioning reform in NW London – our journey and process

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On 29 May 2019 we published a document setting out our case for changing how we organise the commissioning of health services in NW London. This was in response to the recommendation in the NHS long term plan that the number of CCGs should be significantly reduced to align with the number of emerging integrated care systems (ICSs) across the country. This would imply a single CCG for NW London. Engagement closed 24 August. The CCG Chairs have agreed to recommend the following to governing bodies:

We are already aligned as a commissioning collaborative and will recommend that the merger should cover all eight CCGs, creating one NW London CCG.

A single CCG

• We will work to establish a single CCG from 01 April 2021, not April 2020.

Timeline

• Concentrate on financial recovery, development of a single way of working across

all CCGs. 2020-21 as a transitional year

• The development of integrated care and Primary Care Networks at local level

and building closer working relationships with our local authorities.

Focus on our priorities

Why do we want to change?

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To work more effectively for our patients as a single statutory body. To reduce health inequality and improve healthcare quality by addressing unnecessary duplication and variation in health outcomes. To deliver joined up care for our population. To implement an effective, joined up care system across NW London and deliver our clinical strategy to benefit patients. To align with what is happening across London. All parts of London are going through a similar process in line with the “London Vision”.

Quality & Performance

Diane Jones, Chief Nurse and Director of Quality

Patient Safety

Patient Safety is monitored in a variety of ways Local quality meetings with providers

• Clinical Quality Review Groups
• Attendance at provider quality and patient safety meetings
• Attendance at provider mortality review meetings
• Assurance visits led by CCG Deputy Director and Assistant Directors of Quality

Contracted quality indicators scrutinised at CCG/Provider contractual meetings

• NHS Service conditions
• Core Quality Schedule – for example infection control, safeguarding, workforce quality

monitoring

• Local Quality Schedule – local indicators for example, maternity, stroke, cancer quality

monitoring Annual reports and accounts

• Review and CCG response to provider annual Quality Accounts

Trends and themes of reported serious incidents

• The CCGs review all the serious incident investigations from the commissioned providers.

Where trends and themes are identified, the CCGs have held sharing the learning workshops with providers Working with key stakeholders

• Where there have been concerns identified, such as CQC inspection findings, working in close

partnerships with NHS England./Improvement, Health Education England and the CQC to identify how the system can support monitoring and improvements.

• Close working relationships with Healthwatch.

Safeguarding

Working across the system

• Development of a Designates Sustainability Transformation Plan Group
• Working together to support and assure primary care (Section 11 audit)

Working across the lifespan

• Contract monitoring performed via the Safeguarding Health Outcome Framework

Priorities for Children and Young People

• New Safeguarding Partnerships – CCG statutory member
• Child Death process being reviewed
• Continued oversight of the School Nursing and Health Visiting

Priorities for Adults

• Changes to the Deprivation of Liberty Safeguards
• Support the LeDeR Review process
• Started the work to standardise adult safeguarding training in line with the

intercollegiate document

• Significant levels of support given to domiciliary care and residential providers

Patient Experience

Patient Experience is monitored and reported in a variety of ways Patient stories are at the heart of the work we do; each Governing Body begins with a patient story. Scrutiny of provider patient experience reports which include data and learning on;

• Complaints and concerns
• Friends and family test response rate and percentage recommending the service
• National Patient Survey’s
• PLACE assessments

CCG monitoring of complaints and concerns raised directly to the CCG and provider Quality Alerts

• Concerns shared with commissioners to review commissioned services linked to the concern
• raised. This allows us to review pathways to ensure they are meeting the expected

contracted standards. CCG Patient and Public Engagement Meetings

• These meetings review the CCG’s service developments in terms of whether the patient and

public engagement has been considered and is meeting the statutory requirements.

• The meetings also review the equality impact assessments associated with the service

development.

Clinical Effectiveness

We Said

• Build on the existing good platform of

clinical engagement – developing the CE Brand

• Using quality to drive forward

commissioning efficiencies – Remember the Q in QIPP

• Engage wider with Primary Care
• Push the boundaries – proactively look

at best practice beyond North West London and be known for best practice

• Driving the clinical effectiveness

agenda across directorates – reducing duplication We Did

• Continued to develop evidenced based

policies both locally (Hallux Valgus, Chronic Rhino-sinusitis

• Using local experience worked with

National/London NHSE Team to influence develop system wide evidenced based policies on areas such as hysterectomies, tonsillectomies and benign skin lesions.

• Review of national clinical information

to inform commissioning decisions.

• Review of Fractured Neck of Femur

Best Practice Tariff for all providers.

• Review of data on cancer patient

experience to inform discussions with providers.

• Benchmarked against living with

cancer and beyond London Quality Metrics

• Oversight of national measures

Annual report and accounts

Paul Brown, Chief Financial Officer

2018/19 Financial Performance

NWL CCGs

NWL CCGs M12 outturn was a deficit of £56.7m which was £47.4m away from Control Total

NWL CCGs How we spent your money – £3,338.6m in 2018/19

2018/19 Underlying Position

NWL CCGs

• The Underlying position tracks the financial performance of CCGs excluding non-recurrent (one off) items of

income or expenditure

• The graph below shows the deterioration in the NWL CCG underlying position from a plan surplus of £5.6m

to an underlying deficit of £99.6m

• The main reasons were recurrent increases in Acute contract activity and costs within NWL and out of

sector spend and shortfall in QIPP of £30m

2018/19 The CCG achieved its financial duties in respect of expenditure and revenue and closed the year with an in-year surplus of £0.8m. The CCG achieved its financial duties in respect of administrative costs and closed the year with an underspend in it resource by £0.5m. The CCG had no capital resources.

Hounslow Financial Position

Hounslow CCG £m Target 406.0 Performance 405.2 Variance 0.8 Duty achieved Target 403.9 Performance 403.1 Variance 0.8 Duty achieved Target 6.1 Performance 5.6 Variance 0.5 Duty achieved Target

• Performance
• Variance
• Duty achieved

N/A Revenue administration resource use does not exceed the amount specified in Directions Capital resource use does not exceed the amount specified in Directions Financial Duty Expenditure not to exceed income Revenue resource use does not exceed the amount specified in Directions

2019/20 Hounslow CCG’s financial plan is to deliver an in-year surplus of £1.1m in 2019/20 this includes a savings target

• f £12.0m.

How we spent your money in Hounslow

Our journey to integrated care

Mary Clegg, Managing Director

The ICS brings together organisations:

• Deliver consistent and coordinated care
• Higher quality care
• Improve efficiency also control costs

Levels of integration:

• Between primary care secondary care
• Between health and social care
• Between payer and provider

Integrated Care System

Questions: How do we maintain local, clinical decision making and clinical leadership? How do we support the emerging borough/place-based integrated systems delivering care to our residents?

Hounslow Integrated Care Partnership (ICP)

• Hounslow is looking to move to an Integrated Care Partnership (ICP)
• The current health and care system in Hounslow is largely fragmented and the majority of

services are not outcome-focussed

• Outline Business Case (OBC) for developing an ALLIANCE between those

commissioning and those providing services via an Integrated Care Partnership (ICP) to deliver services in Hounslow

• The alliance is underpinned by the vision for integrated care in Hounslow as a system

where all partners are focused on working together to deliver the triple aim for patients

All Hounslow partners working together to achieve tripe aim for Hounslow residents

Partner commitment: What we have in place

Board level sign-off of Memorandum of Understanding with the purpose of working together to develop a full business case for integrated care, and to develop joint working arrangements to deliver and ICP within Hounslow Well established Health and Care Partnership Board attended by all partners Five clinical workstreams with clinician and managerial representation across all partners. In the Local Authority this also extends beyond social care and includes housing officers and public health. Staff resource input across partners to progress the work programme. This includes: ✓ ICP Programme Manager shared across all partners ✓ Project support from a range of partners, including joint commissioning team ✓ SROs for projects across a range of partners ✓ Clinically Lead Groups ✓ Analyst Group, chaired by HRCH and includes the council’s Business Hub Primary Care Network Clinical Directors covering each of the clinical workstreams All partners attending the Transformational Change through System Leadership course. This is an intensive NHS ACT Academy 6 day course. Hounslow has 11 representatives ranging from directors, to senior clinicians, PCN Clinical Director, and VCS representation. Local Authority has committed to funding a 6 month OD programme to strengthen relationships. Programme Governance framework signed off at CEO level. This includes monthly CEO strategy setting meetings and weekly Executive Director calls to drive forward the programme.

We continue to build on the strong partnership working already in place in Hounslow. Our integrated care programme is building and expanding on the success of our many partnership models/initiatives. Partners are committed to achieving the vision of the ICP in a collaborative way .

Enabler work groups established, including CFOs, BI and Analyst group and Comms and Engagement groups to support the programme and the development of care models through the clinical workstreams Voluntary and Community Sector are an integral part of the programme governance and delivery and active partners in working groups to co-design the emerging models of care.

Joint vision Shared challenges

We build on what we do well, release our staff to adopt integrated ways of working and support our residents to co-produce the changes

Framework to work within

Our framework that enable us to work flexibly to realise our ambitions is…

Capacity

We want to set out that we work together because… Our shared challenges that we can only resolve by working together are…. We release the capacity to deliver integration though new ways of working and behaviours that support that

Our agreed approach to developing Integrated Care in Hounslow

We agreed that relationship building across the system is critical to successfully build an

• ICP. We will be starting an in-

depth OD programme that will support us in strengthening system relationships and integrated vision for joint working from September We are actively developing a joint approach to population health management. In July a cross- system BI and analyst group has launched its work to support working groups in shaping of the care models. The group will support the ICP development by providing a system view and evidence for future care models We have agreed our joint working governance arrangements and the roadmap will set the key milestones for further development of our joint working framework including risk and share arrangements, partnership agreements/MoUs etc. We have also started work on jointly developing commissioning

• utcomes for ICP.

Our emerging joint approach to resources needed to build an ICP has already changed the way we approach performance meetings with our provider partners. Through this we have been able to release staff from both CCG and partner

• rganisations to be involved in

ICP work.

What we are jointly changing now – High Intensity Users case study

Vision and purpose

The HIU Workstream oversees the Frequent Attenders Operational

• Group. That group has identified a

cohort of high cost frequent attenders and work with MDTs to develop care plans of identified

• patients. This information is now

being tracked and costed and fed into the workstream group to inform a potential service level solution. There is representation from multiple services and partners

• rganisations at the operational

group and service level groups. Red Cross is now represented at the work stream level meeting. The group intends to link in with the new primary care link workers to establish a model of care for this group and build on the work. To develop a model of practice for reducing the impact of High Intensity Users as part of the Integrated Care Programme. The purpose is to improve the experience of users who are in regular contact with multiple services without resolution of issues to their satisfaction. This is an adult only cohort. The HIU workstream is currently working to:

• Finalise a working definition of

high intensity users that moves beyond frequent attenders

• Triangulate data across the

various service areas to identify heaviest utilisers of multiple services

• Complete mapping of all

current services utilised

• Explore social prescribing and

local area coordination models The MDT approach to the Operational Group has been particularly successful which is solution focused and demonstrates a real range of patient journey; the solution will not be a one size fits all. The group has also started exploring the Local Area Coordination models as potential solutions and build

• n existing successful models

elsewhere. By triangulating the data across all partners, the group is especially keen to identify the needs of that cohort and build the solution around them. For instance, West Mid data indicates that nearly 70% of HIU at A&E have been diagnosed with underlying MH condition which will inform the joint approach to addressing their needs and reducing impact on services across Hounslow

Developing plans Bringing teams together Trying new things

Key milestones in development

A Summary of our Journey to an ICP 2019/20 – 2022/23

Phase 1: 2019/20

• 1. Develop joint approach to

population health Management.

• 2. Implement OD programme

focusing on relationship building and leadership at all levels of staff. Socialise our vision with Hounslow residents and staff and define our common challenges.

• 3. Alliance Agreement in place

with Alliance Board formally established and Agreement signed off by all partners sovereign boards. This will financial principle agreement and gain share etc

• 4. Jointly develop outcomes,

measurements and processes.

• 5. New models of care agreed for

Urgent Care and High Intensity Users priority areas. This will include unified budgets for the care models approved by CFO, ED and CEO levels.

• 6. Embed Communications and

Engagement Strategy through a process of co-design and co- production with staff and local

• population. This will include

aligning Quality Improvement processes across partner

• rganisations.

Phase 2: 2020/21

• 1. Alliance Agreement

live and Urgent Care and High Intensity User models of care mobilised at PCN level with a Q4 evidence

• f return on

investment.

• 2. Home, Falls, Rising

Risk and AF new models of care implemented (Q2).

• 3. Identify shared

workforce problems and develop a workforce strategy.

• 4. Information Governance

Agreement and Framework approved and implemented.

• 5. Clinical workstreams

bringing online models of care for wave 1 ‘in- scope’ services: (see slide 12) In-scope value: Up to 150m In-scope value: £200m to £340m

• 1. Develop and let

Alliance Contract (let by April 2023).

• 2. Wave 4 in-scope’

services as developed during 2021

• 3. Fully Integrated, all

services, aligned social care, population health management approach In-scope value by 2023: £420m (total CCG budget) and relevant social care/public health budgets as per agreed models of care and cross NWL London with other CCGs. Phase 3: 2021/22

• 1. Wave 3 ‘in-scope’

services (slide 12) developed through clinical workstreams and

• nline at PCN
• level. (Q4)

Phase 5: 2023/24

• 1. Wave 2 ‘in-scope’

services (slide 12) developed through clinical workstreams and

• nline at PCN
• level. (Q4)
• 2. Place/borough

level ICP working within NWL ICS and delivering key components at sector level (as defined in 20/21.

• 3. Active Case

Management Embedded In-scope value: £150m-£200m Phase 4: 2022/23

Living Independently for Everyone (LIFE) Programme

Mark Blomfield/James Hearn, Joint Commissioning

LIFE (Living Independently for Everyone) Programme was developed to make services easy to access and improve quality. Floating Support Supported Accommodation Advocacy Information Advice & Guidance Joint Commissioning work across Hounslow CCG and the Local Authority to help develop services that are integrated and support people to live in their own homes. Carers Services

Joint Commissioning – LIFE Programme

 To the right people  At the right time  The right support This will improve outcomes for residents and reduce the likelihood of crisis  Ensure provision is consistently high quality  Reduce fragmentation  Improve integration  Value for money

Joint Commissioning – LIFE Programme

Joint Commissioning – LIFE Learning Disabilities and Autism

New Supported Housing Services for People with Learning Disabilities and Autism:

• 11 Separate Supported Housing Schemes
• Capacity for up to 72 people
• Additional Crisis / Intervention Unit to prevent

unnecessary hospital admission.

• New Community Respite Offer.
• Integrated Public Health outcomes in Specification.
• Services that are able to support people with

complex needs locally.

Joint Commissioning – LIFE Learning Social Inclusion Supported Accommodation

New contract awarded to help people to move on to independent living and prevent future homelessness.

• Homeless, mental health and learning disabilities
• 94 flats and rooms across 11 properties
• Sector leading provider - St Mungo’s

Quality service with:

• Specialist Occupational Therapist post
• Improved mental health & substance misuse support
• Assessment beds available for hospital discharge
• 24/7 staffing hub schemes
• Recovery College – emphasis on training and

employment

Joint Commissioning – Extra Care

New Bristol Court Extra Care Scheme

• 94 Apartments
• Dedicated Dementia & Learning

Disabilities Zones

• Local GP providing 10 hours per

week of dedicated clinical care

• Bespoke enhanced health training

programme from HRCH for care staff

• Hospital avoidance and timely

discharge

Social Prescribing

Beata Malinowska, Deputy Director, Local Services Camille Pegus, Primary Care Manager

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Social Prescribing – supporting self care

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What is Social Prescribing?

Priorities for 2019/20

Mary Clegg, Managing Director

Priorities for 2019/20

Locality Working Improving GP access Jointly commissioned children’s speech and language therapy services

Questions and discussion

Dr Annabel Crowe, Chair

Thank you

Keep in touch: Website: www.hounslowccg.nhs.uk Email: HouCCG.communications@nhs.net Phone: 020 8538 2400 Twitter: @HounslowCCG