WORKING TOGETHER FOR A HEALTHIER CROYDON Trust Board and Governing - - PowerPoint PPT Presentation

Trust Board and Governing Body meeting in common in public

Tuesday 14 May 2019

WORKING TOGETHER FOR A HEALTHIER CROYDON

Welcome

• Today we publish plans to align the leadership and shared functions
• f Croydon Health Services and Croydon CCG in a new partnership
• Aimed at improving health and wellbeing, outcomes for patients,
• pportunities for staff and strengthening the financial future of NHS

services in the borough Mike Bell, Chairman, Croydon Health Services NHS Trust Dr Agnelo Fernandes, Clinical Chair, NHS Croydon Clinical Commissioning Group

Collaborating better together

We are good at collaboration in Croydon

• Our award winning partnerships in the

One Croydon Alliance are joining up NHS services with the local authority, voluntary sector and GPs in the borough to provide more seamless care

• Looking after people’s physical and mental

wellbeing to keep people healthier for longer Aligning CHS and Croydon CCG to work better together will:

• remove duplication
• combine expertise
• deliver transformation at

scale

• retain greater control of

decisions affecting our borough

• maximise the resources we

have to care for our community Unified approach

Mike Bell Chair CHS

Croydon is ahead of the curve

Seamless care and support CHS and CCG alignment is the foundation stone supporting further integration of health and care in Croydon

• The NHS Long Term Plan calls on local health

systems to work together to give people more joined-up care

• This includes greater collaboration between

hospitals, primary care, mental health services and local authorities

• Working together to tackle some of the most

significant causes of ill health, such as smoking, drinking problems and Type 2 diabetes

Dr Agnelo Fernandes Clinical Chair Croydon CCG

Our ambitious plans are in the same direction as these national developments, putting Croydon forward as the vanguard in the journey we began four years ago

Why is Croydon so unique?

• 1 in 4 older adults with a limiting long term illness
• Life expectancy in the most deprived neighbourhoods

is up to ten years lower than the least deprived

• A wide range of health inequalities already exists and

the borough is becoming increasingly diverse, changing health needs of local people

Compared to the average Londoner, people in Croydon have a higher rate of diabetes and heart disease Unique health challenges

Croydon has a strong sense of ‘place’

• More people live in Croydon

than Nottingham, Newcastle

• r Belfast
• Vibrant mix of cultures and

communities makes Croydon different to the rest of South West London

• Croydon’s health economy is

also relatively self-contained

• CHS providing 80% of all

acute and community services in the borough

Croydon is one of London’s fastest growing and most diverse boroughs in London

But like most regions in the UK, the Croydon health and care system faces financial pressures and national workforce shortages and changing needs of the population

Statement of support

• Partnership working is something that we are very proud of in the borough
• Our One Croydon Alliance is changing lives, helping to keep people well and

independent for longer

• What this partnership demonstrates is that when we break down barriers

between our different organisations we can have a much bigger impact than if we work alone Councillor Tony Newman Leader of Croydon Council

The strategic case for greater alignment between Croydon CCG and CHS

• We believe we can best transform services by strengthening our One Croydon

Alliance

• Bringing the Trust and CCG closer together will help us work in unison across key

areas - reducing duplication

• Making sure we invest every pound spent in the most efficient way to improve

the health of local people

• Improved care and health outcomes for our patients and increased opportunities

for our staff Andrew Eyres, Accountable Officer, NHS Croydon CCG Matthew Kershaw, Interim Chief Executive Officer, Croydon Health Services

Elaine Clancy, Joint Chief Nurse for the NHS in Croydon - professional lead for nurses, midwives and allied health professionals First shared executive post between CHS and CCG

• Trained A&E nurse by background
• Leading nursing, midwifery & allied

health professionals

• Working to improve the consistency of

care and health outcomes for people in Croydon

• Started 1 May 2019

Hello, my name is…

The Governing Body and Trust Board have been working closely since July 2018 to bring the two organisations together With our regulators at NHS England and NHS Improvement, we have been exploring the feasibility of aligning our management structures, governance and boards.

• Building on the success of having a Joint

Chief Pharmacist in the borough

• Joining our safeguarding and quality teams

across the Trust and CCG

• Agreeing a shared financial control total to

fund healthcare and improvements to services in the borough

Chief Nurse: 30 years of experience within the NHS

Engaging with our local community

May 2019: joint public meeting and publication of strategic case for CHS and CCG alignment

• Today, we start the next phase
• Launching our proposals for all to

review, with ongoing opportunities to feedback.

We have also been talking with our staff, patients, public and partners

We have held a number of events:

• November 2018: more than 100 health

and care frontline staff, local people, MPs and representatives from community

• rganisations
• March 2018: design workshop with

stakeholders, including local councillors, GPs, mental health services and voluntary groups

• April 2019: more than 90 people attended

a patient engagement forum held at CHS

• Ongoing: forums and discussions with

staff to gather their views and suggestions for more joint working

More seamless support

Integrated care networks

Each week, the networks hold multi-disciplinary meetings called ‘huddles’ to discuss the care of people with complex and escalating health needs Including GPs, nurses, CCG pharmacists, social workers, and Personal Independence Co-

• rdinators with Age UK Croydon.

Impact

• 15% drop in urgent and

emergency admissions for all adults in 2018/19

• Compared to a national increase

in unplanned admissions overall

Robert’s life was turned around after his wife sadly passed away whilst he was being cared for in hospital

Robert, aged 77

What does this really mean?

For our patients and local residents, our plans will directly benefit you with:

• More services delivered locally in settings closer to home
• Reduced waiting times and shorter stays in hospital
• Seamless pathways between primary, secondary and

community care

• People kept well and out of hospital wherever possible
• Effective and accessible hospital care when required
• Improved care and outcomes for those living with long

term conditions

• Equality of access and care standards across the borough

Dr Nnenna Osuji Medical Director, CHS

Both CHS and CCG are committed to reducing health inequalities and supporting local people to live longer, healthier lives.

What does this really mean?

For our staff: Closer alignment will help to break silos and make it easier for teams to work together to provide more joined-up services

• Teams will be enabled to work more across organisational boundaries as part
• f a multi-skilled workforce
• All supporting the same local people
• Combining expertise, we will also be able to cover workforce shortages across

multiple professional groups This means:

• Less complicated user experience for patients
• Less fragmented working for staff
• Reducing duplication
• Redirecting the time and money saved into

delivering care

• Making Croydon an even better place to work

Case for change

By partnering together more our two

• rganisations can deliver significant

improvements for local people and reinforce the financial future for health care in Croydon

• Our proposal is to develop a ‘place-based model
• f care’
• Croydon is already working ‘system-wide’

through the One Croydon Alliance

• The next step will see CHS and the functions of

the CCG effectively operating as a single

• rganisation across many of our core

responsibilities

Andrew Eyres Accountable Officer, Croydon CCG

“Wrapping our services around the needs of people in our community, rather than the needs of individual organisations”

Working together

The CCG Governing Body and the Trust Board will continue to be held accountable for their individual, statutory duties

• Regulated and monitored by NHS England &

Improvement

• Key decisions relating to strategy and planning,

transformation and finance will be taken together at a ‘committee in common’

• We will jointly hold ourselves accountable for

delivery of our plans

‘Committee in common’

The committee in common will focus on shared priorities, including decision making to deliver continuous quality services which meet the specific health needs of our population and help deliver financially sustainable services for the future.

Integrating leadership teams

Key to this model is a single leader and leadership team for our two

• rganisations working together as one
• Aligning finance, clinical leadership and

strategy and transformation across the Trust and CCG

• With executives having responsibilities

spanning both organisations

• Reducing duplication and increasing

efficiency

Closer partnership

Integrated management structures for the NHS in Croydon would

• Speedup decision making
• Support continuous quality

improvement and delivery

• Meet the growing health

needs of our population

• Help return the local health

economy to financial surplus However, responsibilities related to procurement and contracting will remain a CCG only function to manage any potential conflicts of interest.

Matthew Kershaw Chief Executive CHS

Proposed governance structure

Joint Control Total

Aligning financial objectives puts us in a stronger position to invest every pound in the best way for Croydon

• For the first time in London – before

any other NHS Trust or CCG – CHS and Croydon CCG have agreed one financial control total

• Innovative new risk share

arrangements focus on maximising proportion of care delivered in Croydon through optimal local pathways and services

• Both organisations have exited

“Financial Special Measures”

Our joint 2019/20 financial target is £9.7m deficit A challenging target aiming to deliver further improvement on previous performance

£1,420 per person

spent on healthcare every year

£6.5m

spent every week providing NHS hospital

and community services in Croydon

Azara Mukhtar Mike Sexton Director of Finance Chief Financial Officer Croydon Health Services Croydon CCG

Croydon currently operates six primary care networks, for our population of 400,000, in the future we are likely to have eight to 10 networks for the borough

Croydon Integrated Community and Primary Care Networks

In future these networks will:

• ensure individual practices in a local area

join together in network contracts for a population of between 30,000 and 50,000

• assess population health risk and ensure

that local provision supports and reflects the needs of the local community

• increase integration across primary and

community care into a full integrated care network

• work with our current patient and public

group members to explore how we can strengthen their voices and help shape future patient and public engagement structures

Martin Ellis Director of Primary and Out of Hospital Care

Croydon Integrated Community Network Plus

Only the first step in providing a fully joined-up approach for people in Croydon

The ‘One Croydon’ Alliance is delivering real benefits to people in our borough

• A formal partnership between local GPs, Croydon CCG,

CHS, SLAM, Croydon Council and Age UK Croydon, we are focused on improving the health and wellbeing of

• lder people in the borough.

One Croydon was crowned the winner of a Local Government Chronicle Awards (March 2019) One Croydon alliance was given a commendation in the latest Municipal Journal Achievement Awards (April 2019) Praised for helping elderly residents stay well and independent for longer, avoiding unnecessary hospital stays. The Alliance was praised for ‘system-wide leadership' and having a 'real impact' in improving peoples’ lives.

Growing recognition

Jo Negrini Chief Executive Croydon Council

• The Alliance has now extended its

remit to consider the health needs of people of all ages in the borough.

LIFE - Living Independently For Everyone

Has made a huge difference to how we care for people by preventing hundreds of unnecessary hospital admissions Supporting people who have left hospital with visits in their own homes within two hours.

Achievements to date

More than 1,000 referrals in first year 60% of people participating in the LIFE programme did not require long-term care packages after discharge from hospital

Guy Van Dichele Executive Director

• Health, Wellbeing and Adults

Croydon Council

Collaboration across South West London

In parallel, all six local governing bodies are considering a potential south west London CCG merger by April 2020 in line with the NHS Long Term Plan and aligned to our Croydon place plans

We will remain flexible and plan to work with others to meet the needs of people in Croydon

• Retaining greater control of

decisions affecting the borough

• Maximising benefits of scale

across six CCGs

• Ensuring Croydon’s voice is

influential and heard at a SW London level Local integration Croydon Regional collaboration South West London & London wide

Place-based care

• All CCGs want to make sure our people and

functions are in the right place, at the right level and the right scale in the future

• At least 80% of all decisions relating to your

care will be made in Croydon

Karen Broughton Director of Strategy South West London Health and Care Partnership

The primary care perspective – view from a GP

Strengthening the GP voice in our partnership

• GP influence in hospital and community service

strategy and operations

• Clinicians working together to improve patient

pathways

• Improve the quality of services in the borough
• Deliver financial effectiveness

Dr Mike Simmonds Croydon GP and CCG Governing Body member

Structures

Senior clinicians at the hospital and GP leaders are working together to improving pathways and access to planned care services like dermatology, ENT and diabetes.

• We are working to promote our local hospital as the Provider
• f Choice for local people and local GPs

Provider of choice for Croydon

Regional team support

• NHS England and Improvement

CHS and the CCG are working closely with the following key organisations:

• NHS England and Improvement – combined regulator for CCGs and NHS Trusts
• South West London Health and Care Partnership SRO – strategic alliance of health

and social care partners We are closely engaging NHSE/I and South West London Health and Care Partnership

• n:
• Place based model
• Proposed leadership and governance arrangements
• Joint control total arrangements

Rachael Backler Deputy Director Primary Care and System Transformation NHS England

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Next steps

The proposals are now available for people to review and ask questions Our aim is to have complete implementation by Spring 2020 Key milestones include: Apr 2019 – Go live with agreed Joint Control Total Oct 2019 – appointment of a place based leader 2019-2020 – appointment of joint roles across CHS and CCG and shared management team arrangements Oct 2019 – Standing up shadow joint functions and shadow board formally Ongoing – engagement and collaboration with Croydon and SW London partners

Dr Agnelo Ferandes Clinical Chair Croydon CCG

Open discussion

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