Council of governors general meeting 22 March 2017 Strategic update - - PowerPoint PPT Presentation

Council of governors’ general meeting – 22 March 2017

Strategic update David Evans, Chief executive

Any questions?

Recent IT issues – network failure at North Tyneside General Hospital

Mark Thomas, Director of health informatics

Failure of core network

Any questions?

Annual plan and quality account Birju Bartoli, Executive director of performance and governance

Vision: To be the leader in providing high quality, caring and safe health and care services

• Every year we produce a quality account to demonstrate

how well we are performing as a trust on measures of quality including; patient safety, clinical effectiveness and patient experience

• Continuing to improve quality is our absolute priority and

this means making sure our patients get the best possible

• utcome and experience every time they need our care

Setting the scene

• Five year strategic plan (2014 – 2019) – overall direction,

what we are about

• Changed to two year planning cycle - plan for 2017/18 to

2018/19

• Safety and quality objectives for 2017/18
• Quality strategy
• Quality account covering 2016/17 – statutory requirement

to inform public of delivery of safety and quality priorities

• Annual report and corporate governance statement
• Engagement with key stakeholders

Annual planning process

• Five key areas agreed at the trust’s clinical policy

group

• Linked explicitly to the trust’s quality strategy
• Objectives supported by governors and stakeholders
• Some objectives building on 2016/17 objectives and

embedding changes

• Use of clear language when describing trust’s
• bjectives

Safety and quality objectives – 2017/18

• Five key areas:
• To drive improvements in the quality of care and services

provided for patients suffering from breathlessness

• To improve the quality of care and services for older

people

• To continue to improve the management of sepsis in

hospital and community settings

• To implement the flow project to reduce delays in the

system

• To improve the timeliness and quality of treatment for

patients who visit us with abdominal pain

Safety and quality objectives 2017/18

• Look back at safety and quality priorities for 2016/17 and

those agreed for 2017/18

• Standard requirements for all trusts to report
• Including information on mortality and preventable deaths,

areas of achievement

• Quality account for 2017/18 process underway - to be

completed by end April 2016 – for stakeholder comment in May 2016

• NHS Improvement guidance on mandatory indicators – no

change

• Governor selected local indicator

Quality account 2016/17

• As per guidelines, two indicators required for limited

assurance opinion by KPMG

• Based on national annual reporting guidance
• Acute trusts required to be audited against two indicators:
• 18 weeks referral to treatment *
• A&E four hour 95% target *
• Patient experience to remain the governor selected local

indicator to be externally audited

Quality account 2016/17

Our performance on our priorities 2016/17

Safer Care Performance  On or Better than Target,  Below Target,  As Expected Reduce hospital acquired infections (Cdiff, MRSA, SSI)  Improve management of sepsis in hospital and community settings  Falls and pressure ulcers (based on safety thermometer)  National safety standards for invasive procedures (Nat SSIPs)  Medicine optimisation  Electronic prescribing roll out  Antimicrobial stewardship 

Our performance on our priorities 2016/17

High Quality Care Performance  On or Better than Target,  Below Target,  As Expected Elderly trauma pathway  Discharge / flow



Electronic track and trigger tool (revised project plan)



Dementia care pathway  Mortality case note reviews



Learning disabilities – care bundle



COPD bundle



Maternity bundle of care



Our performance on our priorities 2016/17

Patient Experience Performance  On or Better than Target,  Below Target,  As Expected Patient experience – including kindness and compassion measure



Alcohol management



NHS staff health and well being



• Draft account ready mid April 2017
• Circulated to stakeholders for formal opinion end April
• Final, including stakeholder comments, submitted to

NHS Improvement and Parliament end of May

• Upload to NHS Choices by end June 2017
• Written in line with annual reporting guidance – key

measures and phrases used that are auditable

Quality account

Any questions?

Accountable care

• rganisation (ACO) update

Birju Bartoli, Executive director

• f performance and governance

ACO - recap

• System and collective leadership
• Blurring the commissioner : provider divide
• Red line letter submitted November 2016
• Clinical strategy discussions November 2016
• Outline business case submitted in December 2016
• Feedback and all parties meeting January 2017
• Approval to move to full business case submission

ACO – February onwards

Development of:

• Full business case
• Clinical model – ‘industrialise / scale up what we do’
• ACO contract (ten years)
• Governance arrangements - partners
• Financial model (three years to balance)
• Risk model
• Regulation of the ACO
• ACO business unit
• Transition period

Clinical strategy

“Our difficulty lies not so much in developing new ideas as in escaping from the old ones” John Maynard Keynes

Northumberland has a registered population of approximately 323,000 people, split into four localities:

• The Blyth Valley and Central localities

are more urban and densely populated, with a slightly younger population (80% and 79% aged under 65, respectively)

• The North and West localities are more

rural and sparsely populated, with a slightly older population (73% and 74% aged under 65, respectively)

Northumberland: Population Characteristics

Blyth Valley Central North West Population 86,000 (27%) 92,000 (29%) 65,000 (20%) 80,000 (25%) Number of GP practices 10 9 12 14

Source: GP registered population as at 1/01/2017 (https://data.gov.uk/dataset/numbers_of_patients_registered_at_a_gp_practice)

GP practices by locality

This analysis looks at patient stratification and spend profiles using pseudonymised, patient-level, acute SLAM data from Northumberland CCG for the period November 2015 to October 2016*. The patients captured within the data (inpatient, outpatient and A&E) have been stratified based upon activity and spend profiles across the Trusts through which acute services are commissioned by Northumberland CCG. Our analysis of patient-level, acute SLAM data from Northumberland CCG for the period November 2015 to October 2016 has found that:

• 68% of acute spend comes from Northumbria Healthcare NHS Trust, 29% from

Newcastle Upon Tyne Hospitals NHS Trust and 3% from other providers

• 24% of Northumberland’s patients drive 80% of acute spend; these patients

tend to be aged over 65, with a high usage of both inpatient and outpatient acute services

25

Population segmentation (acute data only): key findings

* The A&E data relates to the period October 2015 to September 2016

26

Tier ier 1 and 2 patie tients driv rive acut cute spen end for r Northumberla land CCG

Population patient stratification (for acute data only)

49% 16% 27% 8%

Percentage of acute service users

T1 T2 T3 T4

50% 30% 15% 5%

Percentage of acute spend 11,725 people use £90.0m of Northumberland CCG services 24,276 people use £54.0m of Northumberland CCG services 41,407 people use £27.0m of Northumberland CCG services 74,057 people use £9.0m of Northumberland CCG services

Tier 1: High cost patients and service users Tier 2: Rising cost patients and service users Tier 3: Low cost patients and service users Tier 4: Lowest cost patients and service users

Source: SUS data, November 2015 to October 2016 Note: Patients are identified by a pseudo-NHS number provided in the SUS data set. Records without this data are excluded from the stratification analysis, accounting for 0.5% of total spend. Patients are ranked by descending total patient spend and segmented into tiers using the acute spend bands shown above.

• The distribution of patients across the

four tiers is similar for all four localities

• The Central locality has the highest

proportion of its patients within Tier 1

• The North locality has the highest

proportion of its patients within Tier 4, and the lowest proportion in all other tiers

• It is also important to take account of

the relative size of the population in each locality

• The table to the right shows that, as it

has the largest population, the Central locality has the highest proportion of patients in each tier

• The North locality, with the smallest

population, has the smallest proportion of patients in each tier

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Patient stratification by locality

Distribution of patients by locality and tier Distribution of each locality across the tiers

Source: SUS data, November 2015 to October 2016 Note: Patients are identified by a pseudo-NHS number provided in the SUS data set. Patient locality is identified by the GP code. Records without a pseudo-NHS number or a GP code within the 4 localities are excluded from the stratification by locality analysis, accounting for 0.7% of total spend.

Locality Tier 1 Tier 2 Tier 3 Tier 4 Total Central 8.2% 16.6% 27.9% 47.3% 100% North 7.5% 14.8% 25.3% 52.5% 100% West 7.7% 16.0% 27.8% 48.4% 100% Blyth Valley 7.6% 16.7% 28.3% 47.4% 100%

Locality Tier 1 Tier 2 Tier 3 Tier 4 Total

(proportion of patients in each locality)

Central 2.3% 4.8% 8.0% 13.6% 28.7% North 1.5% 3.0% 5.1% 10.6% 20.3% West 1.9% 3.9% 6.8% 11.8% 24.4% Blyth Valley 2.0% 4.5% 7.6% 12.7% 26.7%

100%

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Tier 1 sub-stratification

Of Of the the acut cute data analys ysed, pati tients in Tie Tier 1 access ess heal ealthcare pri rimarily thro through inpatie tient servi ervices

25.0% 15.0% 7.5% 2.5%

T1.1 T1.2 T1.3 T1.4

Further segmentation shows similar characteristics within the top tier:

• Most common ages: 65-69, 70-74 and 75-79
• MSK acute prevalence1: 47%
• Respiratory acute prevalence1: 21%
• Cardiac acute prevalence1: 21%

The percentage of patients accessing the following services:

• A&E: 73%
• Inpatient: 100%
• Outpatient: 89%

Spend split by PoD and patient type for population within Tier 1

8% 8%

2.4% 2.8% 1.9% 0.7%

£13.5m £4.5m

0% 20% 40% 60% 80% 100% T1.4 T1.3 T1.2 T1.1 A&E IP OP

£45.0m £27.0m

1. Acute Prevalence is defined here as proportion of acute service users accessing the relevant specialty, within the acute data from November 2015 to October 2016. Note: Patients are identified by a pseudo-NHS number provided in the SUS data set. Records without this data are excluded from the stratification analysis, accounting for 0.5% of total spend. Patients are ranked by descending total patient spend and segmented into tiers using the acute spend bands shown above. Source: SUS data, November 2015 to October 2016.

Percentage of acute service users Percentage of acute spend

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Activity per patient, by locality and specialty

10% 3% 3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% MSK Respiratory Cardiology

Frequency of acute activity per patient, by specialty

1 2 3 4 5 5+

MSK Respiratory Cardiac

% of CCG registered population accessing IP /OP services

Source: SUS data, November 2015 to October 2016

• The number of times a patient is

admitted for an inpatient spell or has an

• utpatient attendance or procedure, is

broadly consistent across each locality (during the 12-month data period) MSK has the highest rate of activity out of the three selected conditions

• 10% of the entire Northumberland GP-

registered population accessed inpatient

• r outpatient MSK care during the 12-

month data period Rates of multiple acute activity differ by condition

• 56% of acute MSK patients accessed

inpatient or outpatient services at least twice, compared to 45% for respiratory and 40% for cardiac

• The relatively high rate of multiple acute

activity for MSK is driven by outpatient activity: 86% of MSK inpatients only had

• ne admission, compared to 79% for

respiratory and 80% for cardiac

Clinical model

Hospitals Community care Mental health Social care GPs Social housing Voluntary sector &

• ther

NEAS Population health analytics Risk stratification IM&T Information sharing and governance Secondary discharge planning Public health Care navigation Transformation funding Referral management Continuous quality improvement/ Business intelligence Citizen activation and empowerment Clinical risk thresholds Performance management Clinical pathway standardisation Shared decision making Community care hubs (inc. enhanced access) Procurement ACO governance and oversight ACO outcomes framework ACO contract Patient experience Payment models and incentives Infrastructure Workforce Culture/behaviours

ACO February onwards

• Submission draft 13th April
• Submission 25th April
• Board statements and governor approval
• Submission of approvals – May / June
• Assessment period – including interviews
• Transition period
• Go live – July 1st

Nominations, remuneration and development committee update

Alan Richardson, Chair

Any questions?

Thank you