Meeting 2015/16 Dr Tim Spicer 12 July 20156 Agenda for today - - PowerPoint PPT Presentation

Annual General Meeting 2015/16

Dr Tim Spicer 12 July 20156

Agenda for today

5:00pm Arrival, tea and refreshments Market place stalls 5.30pm Introduction and scene setting Dr Tim Spicer 5:35pm Local achievements PPE / Community Trish Longdon Primary care transformation Dr James Cavanagh Planned care services Dr Tony Willis Mental health Dr Paul Skinner 6:05pm Working in collaboration across Clare Parker North West London 6.15pm Quality and Safeguarding Mary Mullix 6.25pm Annual Accounts 2015/16 Keith Edmunds and 2016/17 budget 6.35pm 2016/17 priorities Janet Cree 6.45pm Questions Dr Tim Spicer 7.00pm Close

Welcome

This is our third Annual General Meeting 2015/16 was our third year as a fully authorised CCG The patient is at the centre of all we do We aim is to commission the highest quality care for the population We continue to work as part of an established Collaborative of CCGs in NWL

Introduction to the CCG

We commission hospital care, urgent care, community & mental health services We have 31 member practices and a population

• f around 200,000

Hospital care is changing, focussing more on specialist care We are facing challenging times financially requiring us to ensure we use our money wisely Primary care is changing, providing more services closer to patients

Patient and public engagement

Trish Longdon Governing Body Lay Member

Patient Participation Groups at GPs should be developed The CCG must improve links with groups in the community People have to share their experiences

Strengthened opportunities for residents to share their experiences

Widened and developed our relationships with the community

Developed and maintained Patient Participation Groups in primary care

Local Services

Commissioning quality services closer to home

James Cavanagh

Planned Care Services

Commissioning quality services closer to home

Tony Willis

Planned Care Services

Ophthalmology New service launched April 2016 run by Imperial College Health Trust .

Changing mental health services

Paul Skinner

This is our second Annual General Meeting 2014/15 was our second year as a fully authorised CCG The patient is at the centre of all we do We aim is to commission the highest quality care for the population We continue to work as part of an established Collaborative of CCGs in NWL

• Current Transformation Programme
• Mental Health Portfolio
• Achievements 15-16
• A View of the Year Ahead 16/17

Urgent Care Mental Health Service

• Launched April

2016, £500k new annual investment

• 24/7 Single point
• f access &

emergency community response

Primary Care Mental Health Service

• Enhanced services

provided by GP & mental health professionals

• Supporting

transition of people from hospital based mental health services

Perinatal Mental Health Service

• Pilot supporting pregnant

women & new mothers with mental health needs

• More nurses, psychiatrists

and psychologists to offer mental health care

Children & Young People’s Services

• Out of Hours Service

pilot

• Launch of Eating

Disorder Service pilot

• Development of

Transformation Plan ‘Future in Mind

Working in Collaboration Across North West London

Clare Parker Accountable Officer

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 ImBC. Local services will be in place before changes to hospital services are made. 21

Local service improvements: NW London-wide

• NWL GP practices offer extended opening weekday hours (8am-8pm) and

weekend access to over a million people in NW London

• investment in new technology at 80 GP practices means they now offer
• nline, email, video or telephone consultations to over half a million

patients

• Eleven 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 agreement 22

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

babies

• an 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 101
• 100 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 review.

23

Paediatrics

In order to improve children’s care across the whole of NW 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 recruited
• Four 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.

24

Mental health update

• To improve mental health and wellbeing across NW 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 crisis

• New 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 Fulham

• New 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
• ut of police custody.

25

Sustainability & Transformation Plans (STP)

Clare Parker Accountable Officer

• 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 England
• Main 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 possible

• Care and quality - consistent high quality services, wherever

and whenever they are needed

• Finances and efficiency - making sure we run and structure
• ur services as effectively as possible

What is the STP?

Health & Wellbeing

• Adults are not making healthy choices
• Increased social isolation
• Poor children’s health and wellbeing

Care & Quality

• Unwarranted variation in clinical practise and outcomes
• Reduced life expectancy for those with mental health

issues

• Lack of end of life care available at home

Finance & Efficiency

• Deficits in most NHS providers
• Increasing financial gap across health and large social

care funding cuts

• Inefficiencies and duplication driven by organisational not

patient focus.

• 20% of people have a long term condition
• 50% of people over 65 live alone
• 10 – 28% of children live in households with no adults in employment
• 1 in 5 children aged 4-5 are overweight
• Over 30% of patients in acute hospitals do not need to be in an acute setting and should be

cared for in more appropriate places.

• People with serious and long term mental health needs have a life expectancy 20 years less than

the average.

• Over 80% of patients indicated a preference to die at home but only 22% actually did.

Health and social care in NW London is not sustainable

Current Population

Health and social care in NW London is not sustainable

Future Population (2030) % Increase

• NHS and six of the eight local authorities across NW 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?

The NW London Vision – helping people to be well and live well

Our vision of how the system will change and how patients will experience care by 2020/21

How we will close the gaps – 5 delivery areas

Triple Aim Delivery areas (DA)

DA 1 Radically upgrading prevention and wellbeing DA 2 Eliminating unwarranted variation and improving LTC management DA 3 Achieving better outcomes and experiences for older people

Improving health & wellbeing Improving care & quality Improving productivity & closing the financial gap

DA 4 Improving outcomes for children &adults with mental health needs DA 5 Ensuring we have safe, high quality sustainable acute services

• Enabling and supporting healthier living
• Wider determinants of health interventions
• Helping children to get the best start in life
• Address social isolation
• Specialised commissioning to improve pathways from primary

care & support consolidation of specialised services

• Deliver the 7 day services standards
• Reconfiguring acute services
• NW London Productivity Programme
• Improve 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 commissioning
• Implement accountable care partnerships
• Implement new models of integrated care services
• Upgraded rapid response and intermediate care services
• Single discharge approach
• Improve care in the last phase of life
• New model of care for people with serious and long needs
• Address wider determinants of health
• Crisis support services
• Implementing ‘Future in Mind’ to improve children’s mental

health and wellbeing

Plans

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 version

• Please do get involved, have your say and spread the word.

Quality and safeguarding

Mary Mullix

Annual accounts

Eva Horgan Deputy Chief Financial Officer

36

Financial duties

• Most of our income comes straight from the Department of Health (DH) in

the form of a fixed financial allocation based on the size and needs of the population we cover. This allocation is used to purchase healthcare services for the population in Hammersmith & Fulham.

• This allocation can be recurrent (i.e. fixed and then subject to an

annual uplift) or non recurrent (i.e. usually small amounts for specific purposes).

• The total of the allocations that we receive is called the Revenue

Resource Limit (RRL).

• We have a statutory duty not to exceed our RRL i.e. we aren't allowed to

spend more than we are given.

• We receive a separate allowance to pay for our running costs – this is

currently set at £22 per head of population, and is reducing each year. Again we are not allowed to exceed this amount.

• We are not allowed to borrow money or go overdrawn. We are also not

allowed to hold cash at year end. 37

Financial position 2015/16

Despite some financial challenges, the Clinical Commissioning

Group met or surpassed its statutory requirements in 2015/16, as follows: The CCG received an allocation of £266.3m, spending £253.2m on programme services, £3.9m on CCG running costs, and generating a surplus of £9.1m.

Duty CCG Performance Expenditure must not exceed allocation Achieved Capital expenditure must not be above allocation Achieved Surplus target Achieved Running cost allocation not exceeded Achieved

38

2015/16 Summary of Net Expenditure

The chart above shows how the CCG spent its money .

• The highest proportion of spend goes on acute services such as A&E, outpatients, maternity and hospital

inpatient services, at 51% of total expenditure. Note the primary care spend of £8m does not include the cost of GP Practices as these are commissioned by NHS England.

39

Underlying position – forecast 2016/17

Historically Hammersmith & Fulham CCG has had a strong financial position, but this has started to weaken largely due to over-performance against acute contracts during 2015/16: At 1 April 16: Brought forward surplus £9.15m, but the underlying (recurrent) surplus was only £4.24m. In addition: There is a national formula that sets out how much funding each CCG should receive based on its population’s characteristics and need – its capitation target. For H&F CCG, the recurrent funding is more than we should be receiving. This is referred to as our ‘distance from target’ or DFT , and the movement towards target is being accelerated. The CCG reduces from 12.7% above target in 2015/16 to 8.19% by the close of 2016/17, as the CCG received only the national minimum growth of 1.4%. 40

Financial strategy

Our high level financial strategy is therefore:

• The CCG needs to generate sufficient Quality, Innovation,

Productivity and Prevention (QIPP) savings to offset the growth in demand for services year on year. Our current planning assumption is for a minimum 2.9% of RRL QIPP target in 2016/17 and the same in 2017/18. this will however reduce to 1.3% by 2020/21.

• The CCG needs to strengthen its underlying financial position, by
• nly committing reserves non recurrently and using them to pump prime

new services that will lead to reduced costs (i.e. investing to save).

• Supporting the NWL Financial Strategy to enable the 8 CCGs across NW

London to continue to invest in out of hospital and primary care services, to deliver the Shaping a Healthier Future programme. 41

2016/17 Budget

Eva Horgan Deputy Chief Financial Officer

42

2016/17 Budget

• The planned surplus for 2016/17 is

£2.72m which is the minimum 1% required by NHS England.

• This is £6.4m lower than the surplus

delivered in 2015/16 as the CCG has been required to ‘draw down’ the historic surplus in order to deliver a balanced budget for 2016/17.

• The QIPP savings target for the year

is £7.98m which is equivalent to 2.9% of the CCGs allocation. The CCG Governing Body approved the draft budget for 2016/17 at the meeting in March 2016. The final version of the operating plan was submitted to NHS England on 17 May 2016. The detail of the budget in place for the CCG is shown below:

43

Budget 2016-17 £000 Programme allocation 268,324 Running cost allowance 3,885 Total resource 272,209 Acute services 136,657 Mental health 34,712 Community health 32,047 Continuing care 17,677 Prescribing 21,502 Primary care 7,116 Other programme 14,529 Contingency 1,361 Running costs 3,885 Total expenditure 269,486 Surplus / (deficit) 2,722 % of allocation 1.0% Net QIPP target 7,797 % of allocation 2.9%

Key challenges

The financial environment for CCGs has become more challenging. The provider sector in the NHS has ended 2015/16 with a significant deficit. Further pressure is being put on commissioners’ finances in 2016/17 and beyond, in order to support the NHS nationally to balance the books. The challenge for H&F CCG in 2016/17 will be to strengthen the underlying position, and key within this will be controlling the acute position, delivery of the QIPP programme, and maximising the benefits from primary and community initiatives: Out

• f Hospital Services and CIS.

44

What we plan to deliver in 2016/17

Janet Cree Managing Director

Question and Answer

Dr Tim Spicer Chair