Annual General Meeting 2016 - PowerPoint Presentation

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Annual General Meeting 2016Dr Nicola Burbidge, Chair

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An

nua

l

General MeetingTuesday July 19th 2016

TimeTopicPresenter11.15amOpen forum with CCG & partner organisationsHealthcare Market Stalls11.45amWelcome and IntroductionMinutes of previous AGMDr Nicola Burbidge, Chair11.50amLocal achievements in 2015/16Dr Nicola Burbidge, Chair12.10pmWorking in Collaboration across North West LondonClare Parker, Chief Officer12.25pmQuality & SafeguardingMary Mullix, Deputy Director of Quality, Nursing and Safeguarding12.35pmAnnual accounts & 2016/17 BudgetKeith Edmunds, Chief Finance Officer12.45pmPriorities 2016/17Sue Jeffers, Managing Director1.00pm1.15pmSustainability and Transformation Plan (Information session)Public discussion on Sustainability and Transformation PlanClare Parker/Sue Jeffers2.15pmQuestions on the formal report and general questionsDr Nicola Burbidge, Chair2.45pmLast thoughts and Close of MeetingDr Nicola Burbidge, Chair

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Hounslow CCG?

We commission hospital care, urgent care, community & mental health services

2015/16

was our third year as a fully authorised CCGThe patient is at the centre of all we doThis is our third

Annual General MeetingWe have 52 member practices and a registered patient population of around 300,000Patients and GPs at the heart of everything we doCCG Council of Members and Governing BodyThe CCG Chair is elected by the Governing Body membersGB consists of GPs, practice staff, lay members, a secondary care consultant and CCG officers3Slide4

Part of a larger system

Five year forward view

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Overview & Achievements 2015/16

Year of achievement and challenge

Vision: we deliver care that is personalised, localised, integrated and specialised for local people

This meansMaking it easier to book weekda

y, evening, and weekend GP appointmentsProviding better staffed specialist hospital units 24/7Focus on mental health servicesCoordinating your care better across the NHSMoving more healthcare services closer to your homeYear ahead promises to be one of challenge and opportunityIncreasing demand for mental and physical health problemsPressures on financial positionImportant CCG focuses on clear transformational plans that are achievable5Slide6

Local achievements

Developing a mental health wellbeing network

to help people looking after their own health and wellbeing – this is a priority in Brentford and Isleworth

Increased number of out of hospital services are being delivered in Primary Care to ensure that the services are delivered to a common standard for all patientsDementia diagnosis has risen to 80%. The success is down to good partnership work between the CCG, GPs , Hounslow Council and West London Mental Health Trust Health checks for people with Learning Disabilities aged 14 and over with health check has improved from 24% to 56%

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Local achievements

The

Community Recovery Service

2833 patients received an integrated health and social care assessment, care plan and treatmentThe Paediatric Assessment Unit at West Middlesex University Hospital started in September 2015Paediatric Diabetic Service at West Middlesex University Hospital was commissioned to provide the Best Tariff in 2015. One year on and our 124 children with diabetes now have access to more consultant, dietetic , psychological and nurses support

Commissioned a community asthma service for children with asthma and wheeze, so that their care can be managed at home rather than in hospital7Slide8

Commissioned a specialist eating disorder service

to improve access to evidence based treatment for children and young people with eating disorders

Commissioned a paediatric mental health liaison nurse and a

CAMHS out of hours service, to improve support for children and young people in crisis who present at hospitalCommissioned new community diabetes intermediate care service. This includes care for intermediate patients, foot protection and patient educationHounslow Practices and localities continue to show excellent work according to the Diabetes Dashboards. We are now out performing CCGs across CWHHE and told we are the envy of manyA rise of 36% in the number of people completing the nine step care process for diabetes

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£5.6m invested to improve

services in 2015/16, including £2.3m

for

mental health servicesHounslow CCG underwent a NHS England Assurance Safeguarding Deep Dive. The CCG was assured as Outstanding in the following areas:Engagement around Female Genital Mutilation (FGM) and The work being undertaken with Buckingham New University to develop an educational tool to support practitioners in the application of the Mental Capacity Act (2005)Safeguarding: Strong and collaborative working with London Borough of Hounslow to maintain a high standard of care in Care Homes

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Working in Collaboration across North West LondonClare Parker, Chief Officer

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Shaping a Healthier Future overview

Two distinct parts to these plans: local service improvements, which includes primary care transformation and whole systems integration to better coordinate health and social care; and changes to our hospitals. Our

plan was to

:make progress in local services as quickly as possible to improve care for patients and take pressure off hospital services, especially A&E at the same time, there were a number of key hospital changes that needed to take place on safety grounds we would then move to secure the capital funding needed to modernise our hospital and primary care facilities, through the Implementation Business Case (ImBC)Local services will be in place before changes to hospital services are made

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Local service improvements: North West London-wide

North West London (NWL) GP practices offer

extended opening weekday hours (8am-8pm) and weekend access to over a million people in

North West London. Investment in new technology at 80 GP practices means they now offer online, email, video or telephone consultations to over half a million patientsEleven primary care hubs are already providing access to primary care and social care services in one place A single discharge agreement in place across NWL to get patients home quickly and safely reducing stays by up to three days Nearly two-thirds (250 of 389) of NWL GP practices have signed up to an information sharing

agreement12Slide13

Maternity

The implementation of new ante natal and post natal pathways, and the closure of Ealing Hospital’s maternity services took place in July 2015. A review of the changes found:

a

complex service change was managed safely, with clear benefits to mothers and babiesan improved midwife to birth ratio now meets on average the London Quality Standards minimum staffing ratio of one midwife to thirty births 122 hours of consultant cover against pre-transition average of 101100 new midwives have been recruited

79% of women now receive their postnatal care from the same hospital trust that provides their antenatal care, up by 21% The review was endorsed by the Royal College of Midwives and recognised by Baroness Cumberlege as it aligned with the national maternity review13Slide14

Paediatrics

In order to improve children’s care across the whole of North West London the closure of Ealing Hospital’s paediatric inpatient services went ahead as planned on 30 June 2016. It has led to:

Far

better access day and night, seven days a week, to more specialist children’s doctors 27 new beds are opening at West Middlesex, Hillingdon, Northwick Park, St Mary’s and Chelsea and Westminster hospitals, 11 more than at Ealing Hospital An extra 48 paediatric nurses and 10 paediatric consultants have been recruitedFour new paediatric assessment units opened to reduce admissions

A new rapid access clinic has been introduced at Ealing Hospital so GPs can access paediatric consultants for advice and same day patient appointments, reducing the need for a child to attend A&E Over three-quarters of existing children’s services will remain at Ealing Hospital, including a 24/7 urgent care centre, day time clinics and outpatient services 14Slide15

Mental health update

To improve mental health and wellbeing across North West London, we’ve established a new strategy called ‘Like Minded’, which is all about working in partnership to deliver excellent, joined up services that improve the quality of life for individuals, families and communities

A new 24/7/365

single point of access was introduced for support, advice and information for people with mental health illness and carers and professionals received 4,700 calls, reducing A&E attendances and providing right and fast support for people in crisisNew specialist assessment, treatment and support service started for perinatal mental health services for pregnant women or women who have given birth in Ealing, Hounslow and Hammersmith and FulhamNew services for children and young people affected by eating disorders launched in June

a coordinated approach to decriminalising mental health detention to help keep people out of police custody15Slide16

Quality & SafeguardingSue Pascoe,

Deputy Director of Quality Nursing and Safeguarding

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Annual accounts 2015/2016 and 2016/2017 BudgetKeith Edmunds,

Chief Financial Officer

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Financi

al Du

t

iesMost of our income comes from the Department of Health (DH)Revenue Resource allocation and running costs allocationWe are not allowed to borrow money or go overdrawn or hold cash at the year endWe have a statutory duty not to spend more than we are given

Costs can be recurrent or non recurrent19Slide20

Financi

al pos

i

tion 2015/16Hounslow Clinical Commiss

ioning Group met or surpassed its statutory requirements in 2015/16, as followsDutyCCG PerformanceExpenditure must not exceed incomeAchievedCapital expenditure must not be above allocationAchievedSurplus targetAchievedRunning Cost allocationAchievedHounslow CCGRevenue Resource limit (programme)£313.5mRunning Cost allocation£5.9mNon Recurrent Allocation£22.7mTotal allocation£342.1mTotal expenditure£335.8mSurplus£6.3mThe financial position of Hounslow CCG is set out below:20Slide21

How we spend your money £m

The Chart below shows how Hounslow CCG spent its money. The highest proportion of spend goes on acute services, such as A&E, outpatients, maternity and hospital inpatient services, at

57%

of total expenditure.21Slide22

Under

lying

P

osition forecast 2016/17222015/16In 2015/16 Hounslow CCG had a healthy f

inancial position. It benefited by having an uplift of 7.3% and a surplus brought forward from the previous year of £6.9m. As at 1 April 16:Brought forward surplus of £6.3m, and underlying (recurrent) surplus of £7.8m. Hounslow CCG has planned for a £3.5m surplus in 2016/17. In addition:In 16/17 Hounslow CCG received an uplift of 5.3% further reducing its distance from target to 2.8%. This means that Hounslow CCG is now within the NHSE 5% target range for CCG’s. Slide23

Financial

str

a

tegy23Our high level financ

ial strategy is therefore:Our 5 year planning is based on the published 5.3% allocation uplift for 2016/17 and the reduced increases in the following years. In this period Hounslow CCG will face increases in demand for servicesThe CCG needs to strengthen its underlying financial position, by focusing on committing reserves non recurrently where possible and using them to pump prime new models of care that will lead to reduced costs (i.e. investing to save)Hounslow CCG will need to generate sufficient Quality Innovation Productivity and Prevention (QIPP) savings to offset the year on year growth in demand for services. The savings generated will be used for service improvements particularly Local Services. Slide24

2016

/17

BudgetHounslow CCG Governing Body approved the budget for 2016/17 at the meeting in July 2016. The final version of the operating plan was submitted to NHSE on 17 May 2016.Revenue resou

rce allocation£ m342.4Acute Services182.7Community Health47.8Continuing Care9.7Mental Health33.4Primary Care46.5Other11.3Corporate Costs5.8Contingency1.7Total expenditure338.9Planned surplus/(deficit)position3.5The planned surplus for 2016/17 is £3.5m which is above the 1% required by NHSE.The QIPP savings target for the year is £9.9m which is equivalent to 2.7% of Hounslow's allocation.24Slide25

Ke

y Challenges

Increased

demand for services being driven by changes in demographics, this is being mitigated by reducing bed stays and moving to Out of Hospital services where people are treated in the communityCCGs are expected to fund out of their baseline allocation a number of things for which they have previously had separate allocations – most notably GPIT and CAMHS – meaning that the true uplift figure is less than the published allocationHounslow CCG has a QIPP target for 2016/17 of £9.9m. Non delivery of the QIPP will reduce the amount of funding available for investments in service improvement

In future years, due to increasing recurrent cost pressures and reduced allocations, Hounslow CCG will have less scope for funding recurrent investments25Slide26

What we plan to deliver in 2016/2017Sue Jeffers,

Managing Director

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We plan deliver in 2016/2017

Wheelchair

service

New integrated wheelchair service in Hounslow – July 2016For all age groups with a long-term need for a wheelchairFaster access to the right wheelchair and to more reliable repair and delivery servicesThe service offers sleep systems to local children and adults. Sleep systems enable patients to maintain good posture while sleeping, helping to prevent deformities from occurring and improving the patient’s health and quality of life27

Investing in mental health servicesOffering mental health care at GP practicesCall one phone number to get help in a crisis quickly and easily 24/7, 365 days a year 0300 1234 244Children’s continence serviceSlide28

Radically upgrading prevention and wellbeing

30,000 Patient Activation Measure (PAM) licences for 5 years to help influence the way in which people are supported to manage their long-term

condition

20 Self-Care Kiosks have been located across 5 localities to signpost patients to advice and informationTelevisions in GP practices with NHS England InformationWorking with Healthwatch Hounslow to target harder to reach communities to raise awareness of symptoms and treatment for cancer, heart disease and respiratory illnessWe plan deliver in 2016/201728Slide29

Eliminating unwaranted

variation and improving Long Term Condition management

We plan deliver in 2016/2017

Implement health and public health approach to diabetes prevention including a diabetes mentor programme and Moving Away from Pre-diabetes (MAP)Review and embed the 19 out of hospital contracts provided by the 5 Hounslow GP localities to ensure 100% population coverageCardiac catheter laboratory opening in July 2016 at the West Middlesex Hospital site 29Slide30

Achieving better outcomes and experiences for older peopleImplementation of an Integrated Dementia Service

Named GP for care planning for patients with complex needs to ensure continuity of care

Community Recovery Service

is continuing to develop to help patients maximise their independence after an illness or injuryWe plan deliver in 2016/201730Slide31

We plan deliver in 2016/2017

Improving outcomes for children and adults with mental health needs

Embed the specialist eating disorder service for children and

young peopleCommission new health and mental health services for residents in extra care housing accommodation Working with West London Mental Health Trust on transformation of services:- Perinatal service development.- Children’s and Adolescent Mental Health Services (CAMHS)- Cognitive Impairment Disease (CID) service transformation

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We plan deliver in 2016/2017

Ensuring we have safe, high quality sustainable acute services

Hounslow CCG will continue to work with Chelsea and Westminster – West Middlesex site to ensure we succeed in delivering the range of services that meet the needs of our

patientsEmbed the acute 7 day services programmeSurgical Assessment Unit pilot in West Middlesex University Hospitalt32Slide33

Sustainability & Transformation Plans (STP)Clare Parker, Chief Officer

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STPs were introduced by NHS England to support delivery of their Five Year Forward View strategy

The STP is an opportunity to radically transform the way we provide health

and

social care 44 STP areas (footprints) across EnglandMain focus on how as a system we close the three main gaps identified in the Five Year Forward View:Health and wellbeing – preventing people from getting ill and supporting people to stay as healthy as possibleCare and quality - consistent high quality services, wherever and whenever they are neededFinances and efficiency - making sure we run and structure our services as effectively as possible

What is the Sustainability and Transformation Plan (STP)?34Slide35

Health &

Wellbeing

Adults are not making healthy

choicesIncreased social isolationPoor children’s health and wellbeing

Care & QualityUnwarranted variation in clinical practise and outcomes Reduced life expectancy for those with mental health issuesLack of end of life care available at homeFinance & EfficiencyDeficits in most NHS providers Increasing financial gap across health and large social care funding cutsInefficiencies and duplication driven by organisational not patient focus.20% of people have a long term condition50% of people over 65 live alone10 – 28% of children live in households with no adults in employment1 in 5 children aged 4-5 are overweightOver 30% of patients in acute hospitals do not need to be in an acute setting and should be cared for in more appropriate placesPeople with serious and long term mental health needs have a life expectancy 20 years less than the averageOver 80% of patients indicated a preference to die at home but only 22% actually didHealth and social care in North West London is not sustainable3535Slide36

Current Population

Health

and social care in

North West London is not sustainable

Future Population (2030)% Increase3636Slide37

NHS and six of the eight local authorities across North West London working together to deliver a better health and care system

Development has included patient groups, and we are keen to engage more widely with the public later this year

Who is working on the STP?37Slide38

The

North West

London Vision – helping people to be well and live wellOur vision of how the system will change and how patients will experience care by 2020/213838Slide39

How

we will close the

gaps – 5 delivery areas

Triple Aim

Delivery areas (DA)DA 1Radically upgrading prevention and wellbeingDA 2Eliminating unwarranted variation and improving LTC managementDA 3Achieving better outcomes and experiences for older peopleImproving health & wellbeingImproving care & qualityImproving productivity & closing the financial gapDA 4Improving outcomes for children &adults with mental health needs DA 5Ensuring we have safe, high quality sustainable acute services Enabling and supporting healthier living Wider determinants of health interventionsHelping children to get the best start in life Address social isolationSpecialised commissioning to improve pathways from primary care & support consolidation of specialised servicesDeliver the 7 day services standardsReconfiguring acute servicesNW London Productivity ProgrammeImprove cancer screening Better outcomes and support for people with common mental health needs, Reducing variation Improve self-management and ‘patient activation’ Whole systems approach to commissioningImplement accountable care partnershipsImplement new models of integrated care servicesUpgraded rapid response and intermediate care servicesSingle discharge approach Improve care in the last phase of lifeNew model of care for people with serious and long needsAddress wider determinants of healthCrisis support servicesImplementing ‘Future in Mind’ to improve children’s mental health and wellbeingPlans3939Slide40

What next with the STP?

The latest STP draft was submitted to NHS England on June 30 for

review

We have a date in mid-July to discuss their views on this version.  We will engage with the public and stakeholders over the next 3 months to inform the final versionPlease do get involved, have your say and spread the word

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An

y Ques

tions?

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