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2014/15 Annual General Meeting

Welcome

tweet #ENHCCGAGM follow us @enhertsccg

Dr Hari Pathmanathan

Chair

“ A new start and fresh beginnings – change is good for us all”

Care at home

Local care in community hospitals

Specialist care in acute hospitals

Emergency department Stroke unit Cancer centre Plastic surgery Cardiology Urology Maternity Scanning centre Sleep service Sleep service

Investing in specialist centres

Renal dialysis

Workforce ‐ our most valuable asset

We are supporting staff through:

• Creating fellowship schemes for GPs
• Investing in practice nurse training

and practice nurse tutors

• Supporting GP practices through

additional home visiting services

• Planning ahead to keep the pressure
• ut of the system ‐ through our

winter schemes for example

Patient engagement

Thank you

2014/15 ANNUAL ACCOUNTS

Alan Pond Chief Finance Officer

Housekeeping

• Draft Accounts submitted within 15 working days
• f the year end – before the 23rd April deadline
• Annual Report and Accounts were agreed by

Board, audited and submitted to NHS England before the 29th May deadline

• Unqualified opinions on the Accounts and Value

for Money statement received from the Auditor

• Full Annual Accounts published with the Annual

Report

A challenging year

• Increase in CCG baseline funding of 3.38% – a

little more than inflation, but less than demographic and historic growth in demand

• Activity growing faster than population growth

and the growth in funding

• NHS England requirement for CCGs to

underspend on their budgets by 1%

• CCG remains underfunded by over £30m
• Providers under financial stress

£45.1m £31.5m

Balancing the funding

• Population growth
• Increased demand
• Service Development
• Inflation
• 1% underspend
• 3.38% funding uplift
• Tariff reductions
• Underspend carried

forward

2014/15 “Another good year”

• Achieved strong performance across the

majority of key performance indicators with (e.g. hospital and community waiting times, management of long term conditions, cancer services and end‐of‐life care)

• Achieved national requirement for additional

efficiency savings

• Achieved the required 1% underspend of

£6.3m

Performance on statutory financial targets

Expenditure does not exceed sums allotted to the CCG plus other income received [223H(1)] ACHIEVED £7,913,000 underspent Capital resource does not exceed the amount specified in Directions [223I(2)] ACHIEVED £170,000 underspent Revenue resource use does not exceed the amount specified in Directions [223I(3)] ACHIEVED £7,743,000 underspent Revenue administration resource use does not exceed the amount specified in Directions [223J(3)] ACHIEVED £3,496,000 underspent

Financial targets set out in Department of Health Group Manual for Accounts 2014‐15

Performance across the CCG

Description Budget £000 Spend £000 Variance £000 Variance % Lower Lea Valley 82,532 82,343 189 0.2% North Herts 120,211 119,238 973 0.8% Stevenage 96,067 95,940 127 0.1% Stort Valley and Villages 57,782 56,823 959 1.7% Upper Lea Valley 117,549 117,452 97 0.1% Welwyn Hatfield 113,573 112,206 1,367 1.2% Central Budgets 47,765 43,734 4,031 8.4% Total 635,479 627,736 7,743 1.2%

Where the money was spent in 2014/15

59% 11% 8% 4% 12% 2% 2% 2%

Acute Services Mental Health & LD Community Services Continuing Health Care GP Prescribing GP Services Running Costs Transformation

Change from 2013/14

3.6% 4.7% 7.1% 10.7% 1.0% 72.7% 9.3% 61.7% 5.8% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

Future cost drivers

• Increasing population
• Ageing population
• Reduced Social Care funding
• New technology and treatments
• Patient expectations
• Drive for continuous improvement

So expenditure rises ever faster

The financial challenge ahead

• Return to low growth in funding:
• Confirmed growth of 5.8% in 2015/16
• Estimated growth of 1.7% in 2016/17
• Estimated growth of 1.8% in 2017/18
• Estimated growth of 1.9% in 2018/19
• 15% reduction in running cost allocation
• Gap between cost of demand and CCG funding £54m

by 2018/19 requiring savings of at least £54m

The good news

• There are excellent and committed clinicians and

managers in East and North Hertfordshire to make this work for local people

• Relationships with Social Care Partners are good and

we share the same objectives

• Relationships with Providers are good and we

challenge them to improve their services further

• We have already identified the efficiencies needed in

2015/16

• We have delivered on tough challenges in the past

and will do so again

Future proofing our strategy

Develop the market and improve providers Improve productivity and reduce waste Joint and clinically led commissioning

Assess our priorities

Beverley Flowers

Interim Chief Executive

• At least one child in ten in Hertfordshire has a diagnosable mental health

problem

• Current levels of mental health support for children, young people and

families need to be improved

Cyber‐ bullying Self‐ harm

Depression

Weight issues Body image

Improving mental health services for children and young people

Anxiety

Joining the dots We are bringing together existing good practice in schools with other support services, through a joint mental health training programme ‐ centred around individual needs. Breaking the cycle We need to identify and support mothers at risk ‐ there is a strong link between a mother’s mental health and the mental health of her children. A clear offer of mental health help Shared assessments and outcomes are vital. Support should be based on a child’s needs, not their diagnosis – whether that’s preventing problems, getting back on track or avoiding a crisis.

Improving mental health services for children and young people

Hertfordshire’s Crisis Care Concordat

We’ve commissioned a piece of work to map the crisis care pathways, analysing what works, what doesn’t, and how to transform patient and carer experiences of crises

What’s working

• stepped care pathway,
• specialist mental

health triage at A&Es

• Crisis Assessment and

Treatment Teams respond effectively and efficiently

• Partnership working with

the police

Hertfordshire’s Crisis Care Concordat

Where we need to improve

• all the agencies (police, A&E,

GPs) involved should be able to access crisis contingency plans for patients

• Early Intervention in Psychosis

teams will be reintroduced

• Specialist training in the

Mental Health Act for the police

• The ‘Transforming Care’ programme ‐

designed to significantly re‐shape services for people with learning disabilities and/or autism who also have a mental health problem, or challenging behaviour.

• Services will be provided in the

community and closer to home, rather than in hospital settings.

• The Fast Track plan will focus on

integrating health and social services and the development of an all‐age pathway for learning disabilities.

Transforming care

Every year around 740 people in our area have a

• stroke. In the last year we have:
• worked with East and North Hertfordshire NHS Trust

to improve stroke mortality rates ‐ increasing the number of specialist stroke staff at the Lister hospital

• worked with Hertfordshire Community NHS Trust ‐

developing a team of specialists who help patients to recover from strokes at home

• added eight beds to the specialist stroke and

rehabilitation unit in Welwyn

• developed a stroke joint strategic needs assessment

which sets out who is at risk and priorities for improving stroke care.

What next?

Improving stroke services

Community care Inpatient rehabilitation (up to 6 weeks) at Danesbury or Herts and Essex Hospital

Fit to go home with support from community teams

Longer term support from primary care, social care and voluntary sector Stroke Association 6 month specialist review to check progress against goals Acute Stroke Unit

Patient looked after at home by the Early Supported Discharge team (up to 6 weeks) (around 40% of patients) Specialist Stroke Unit (HASU)

Hospital care on one site

The future model for stroke services

We want to hear your views

• Fill in the response form in your

delegate pack – deadline 23 October

• www.enhertsccg.nhs.uk/stroke

Community respiratory service

New multi‐disciplinary team to help prevent people with breathing problems having to be admitted to hospital because their condition has got worse We want to reduce unnecessary hospital stays by 20% and reduce re‐admission rates by 23% We want patients to feel empowered and confident to manage their own condition By doing this differently we can deliver:

• Advice line – one phone number to reach all members of the team
• Rapid response – 5 days a week
• Close links to the hospital so patients being discharged have the right support
• Better use of technology for sharing information
• Primary and community staff with additional skills

Thank you

Question and answer session

Dr Nicky Williams

Deputy Clinical Chair

Looking after 3,000

residents at any one time

62 care homes 3,200

beds

Care homes – the current picture

Spent on residents in care homes in 2012/2013

£19.6M

people receive home care Costing around…

£49m

2,205

£5.76M

2,794

2013/14 visits to A&E

admissions to hospital from care homes

1,744

454 hospital stays of less than one day

23hrs

On average, 96% of patients in nursing homes will attend A&E This compares to 34% of the general over 65s population Care home patients on average have 8 prescribed medicines

8

Nationally, on any given day 70% patients experience at least

• ne medication error

(Barber ND et al 2009)

Pharmacy visits to care homes can reduce reported errors

22%

When Marie moved to her care home a year ago, she had type 2 diabetes as well as breathing difficulties. During her stay, Marie became increasingly confused. She was increasingly dependent on staff who were not always informed or confident about caring for her long‐term conditions. Marie’s frustration at losing responsibility for her own care led to depression and, without a comprehensive care plan in place, there was little improvement in her weight and mobility. When Marie experienced complications from her breathing problems, care home staff were unsure what to do and called an ambulance to take her to hospital, which Marie found distressing and disorientating.

Patient story

Our Vision

To deliver an enhanced model of health and social care to support frail elderly patients, and those with multiple complex long term conditions in the community in a planned, proactive and preventative way

“ ”

Enhanced Health in Care Homes

We want to:

• Develop skilled staff who can look after patients with complex

needs with more confidence

• Work more closely together – to plan care better for patients
• Be responsive – quickly getting the right professional to a

patient to prevent that person having to go to hospital if they don’t need to

• Improve our technology – so that clinicians can securely

access records in the patient’s care home.

The resident

GPs

Skilled care home staff

Interface geriatrician

Community health, social care & mental health

Supportive technology

End of Life care

Emergency care & crisis response

Bringing it all together Co‐ordinating care around the needs of the individual

Care home staff: trained and confident

• Each care home nominates a number of staff ‘champions’

who complete advanced training in dementia, nutrition, falls prevention, wound management, continence, end of life, neurological and respiratory conditions

• Each home with a ‘wellbeing mentor’ to help them deliver

interesting activity and exercise programmes for residents

• All staff with extra training are also supported by a

manager to make sure new ways of working are embedded in the care home

If our project is successful we would expect to see:

Fewer More

• 999 calls
• A&E attendances
• Emergency admissions to hospital
• Short stays in hospital
• Calls to the out of hours GP

service from care homes

• ‘Delayed transfers of care’
• People dying in their preferred

place of death

• Calls to NHS 111
• People living healthier lives for

longer in care homes

• Staff, residents and families

reporting feeling satisfied with care

• Care home staff choosing to stay

longer in their jobs

Ambitions for the future

• Expanding the scheme to cover

more care homes

• How do we better support

people who receive home care services?

• Encourage more people to take

up a career in the caring profession

Harper Brown Director of Commissioning

Integrated urgent care

NHS 111 and out‐of‐hours healthcare

The Hertfordshire model

• NHS 111 in Hertfordshire is a high‐performing service:
• 97% of calls answered within 60 seconds
• 92% ‘very satisfied/fairly satisfied’ with the service
• nly 7% of calls referred to the ambulance service
• 8% referred to A&E (compared to 7.6% nationally)
• Calls to GP surgeries outside opening hours are routed through to

Herts Urgent Care’s call centre – home visits or GP call‐back can be arranged

• 62% of callers have an out of hours GP visit booked through this

service

• Out of hours doctors in Hertfordshire see an average of 12,200

patients every month (435 a day). Calls peak in winter and over bank holidays.

Current service position

• Hertfordshire CCGs have been reviewing the

existing service specification with our GP practices and patients

• New National Commissioning Standards now

require us to re‐commission integrated urgent care services

• A joint NHS 111 and out‐of‐hours

commissioning project is reporting back to the CCG’s Governing Body in December this year.

Opportunity to improve services

Better access:

• Improved co‐ordination with wider services, including

mental health

• faster access to medical advice and assessment
• direct booking into appointments

A more patient‐centred approach:

• Summary care record
• GP access to special patient notes
• Advanced care plans – taking into account patient’s

wishes

Fill in our online survey: www.enhertsccg.nhs.uk/urgentcare The web address for the survey is in your delegate pack.

Want to get involved?