SUMMARY. Our progress in 2013/14. Eastbourne, Hailsham and Seaford Clinical Commissioning Group.

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1 Eastbourne, Hailsham and Seaford Clinical Commissioning Group SUMMARY Our progress in 2013/14 1

2 Welcome NHS is a membership organisation made up of the 21 GP practices in the area that came together in April 2013 to take on the responsibility for planning and buying the majority of local NHS services. Having been in operation for one year we are pleased to be able to offer you a summary of our progress and key developments. As a CCG we have been able to establish an effective approach that brings together our GP members, our patients, the public and other local stakeholders to begin to address the significant challenges that the NHS faces locally. Some of the changes we have made to health services are already beginning to deliver better outcomes for local people. The centralisation of acute stroke care at the Eastbourne District General Hospital has drastically improved quality. Patient experience has been enhanced by locating orthopaedics and emergency and high risk general surgery on a single site (the Conquest Hospital). And the Better Beginnings programme on local maternity and inpatient paediatric services demonstrates our commitment to engaging closely with local people and clinicians to provide safer and better services, even when making decisions about changes to those services is difficult. You will find over the next few pages a summary of our main priorities for the coming years. The golden thread is the work we are continuing to carry out with neighbouring CCGs and the county council to transform the local health and social care system through the East Sussex Better Together programme. Demand for health and social care is increasing and East Sussex Better Together represents our partnership approach to achieving safe, high quality and affordable services for local people in the long term. It is only with the help and support of local people and clinicians that we can succeed and I look forward to working together as we continue to shape the NHS for the future. Dr Martin Writer GP at Park Practice, Eastbourne Chair of Our decisions on local NHS services are made by local clinicians who know the communities they serve, are based on the best possible evidence and informed by what the public and our patients tell us are their needs and priorities. Many people have already told me the CCG is more open and approachable than previous NHS organisations and we want to continue to give local people an even stronger voice. 2

3 Get involved We are committed to listening to and learning from our local patients and stakeholders. There are lots of ways you can get involved to find out more about the work we do and share your views, ideas and experiences of NHS services. These include: Shaping health services We hold twice-yearly public engagement events, bringing together a diverse group of local people including patients, representatives from voluntary organisations, community groups and others to discuss how we can best meet the health needs of our local communities. Visit our website for details of all our public engagement opportunities. Meetings in public Our Governing Body meets in public every two months to make decisions on local NHS services. We welcome anyone who wants to attend and there is an opportunity to ask questions. Details of Governing Body meetings are published on our website. Social media Follow us on By us on EHSCCG.enquiries@nhs.net By post NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group Friars Walk Lewes East Sussex BN7 2PB By phone Online Our new website is a great way to find out more about the CCG and our work Patient Participation Groups All GP practices have a Patient Participation Group (PPG). These are an excellent way for you to feedback your experiences of local health services to your own practice team and help shape wider NHS care. Contact your practice to find out more. Find out more Want to find out how to attend our events and meetings and stay up to date with the latest news? Sign up for our mailing list online 3

4 About the CCG We have a budget of around 240m to invest in the best possible healthcare for 180,000 local residents. Features of our local population include: Diverse geography and communities. Areas of high deprivation. High numbers of older people and a high percentage of people who are over 85. High rates of chronic diseases including stroke and heart disease. High rates of obesity, alcohol intake and smoking. Source: East Sussex Joint Strategic Needs Assessment 180,000 residents. 21 GP Practices. 110 GPs. Acute hospital services provided from two main hospital sites 240m CCG budget for NHS services. Conquest Ë Hospital NHS Eastbourne, Hailsham and Seaford CCG Hailsham Seaford Eastbourne District General Hospital Ë Eastbourne 4

5 Meet the Governing Body Our Governing Body consists of local GPs elected from our member practices, practice managers, lay members, a registered nurse, a secondary care specialist doctor and members of our senior management team. The Governing Body is responsible for making decisions about which health services to commission for local people. Dr martin writer Chair GP at Park Practice Amanda Philpott Chief Officer Frances Hasler Lay member for patient and public engagement dr michael von fraunhofer GP at Lighthouse Medical Practice dr mark barnes GP at Seaford Health Centre dr lydia sturridge Lay member and Secondary Care Doctor karen keane Nurse Member Dr Matt jackson GP at Hailsham Medical Group phil abbott Practice Manager at Seaford Health Centre dr joerg bruuns GP at Grove Road surgery The Governing Body meets in public every two months. Check out or website for details. Julia Rudrum Lay member for governance John O Sullivan Chief Finance Officer

6 What we did in 2013/14 In our first year we have Improved the way we talk to local people - listening to your views and ensuring they inform what we do. Examples include: Our Better Beginnings consultation on maternity and inpatient paediatric services the most widespread NHS consultation ever in East Sussex. Consultation on provision of dementia beds. Regular Shaping Health public events enabling local people to influence how we can best meet local health needs. Support for patient participation groups within GP practices. Revamping our websites and launching social media channels, to help us better inform and engage local people about our work. Working closely with Healthwatch the consumer champion for health and social care. Developing our relationships with voluntary and community organisations. Begun to make real improvements to local health services, including: Much better outcomes for stroke patients following the centralisation of emergency stroke services at the Eastbourne District General Hospital. Improved patient experience by locating orthopaedics and emergency general surgery on a single site (Conquest Hospital). Launching new services in the community including audiology, falls prevention, improving end of life care and new care beds to prevent people being admitted to hospital unnecessarily. Investing in technology to improve access to information and the best care options for patients. Increased shared decision-making between clinicians and patients - giving local people more informed choices about the care they receive. Developed a new integrated musculoskeletal service to provide better care for people with bone, joint and muscle problems (for launch in 2014). Established a wide reaching programme of GP member engagement to ensure clinical leadership drives all our work. This includes: Regular locality meetings and a practice operational forum to develop and test new clinical pathways. Protected learning time to up skill practices with the latest clinical developments. Regular monthly newsletter to provide clear update on CCG progress and developments. Continued to develop the East Sussex Better Together programme as our overarching approach to working together to transform and improve health and social care for local people. 6

7 Safe and high-quality maternity services fit for the future The three East Sussex CCGs Eastbourne, Hailsham and Seaford, Hastings and Rother and High Weald Lewes Havens, held a major public consultation in early 2014 aimed at securing safe and high-quality local maternity, inpatient paediatric and emergency gynaecology services now and into the future. The Better Beginnings consultation proposed six possible options to tackle long-standing problems affecting safety and quality in local services, particularly in consultant-led maternity care. Local clinicians and CCG staff held more than 30 public events throughout the country, talking and listening to some 1,300 people. There were three independent public question time panel events, more than 600 responses to our online survey and hundreds of interactions via social media and . Feedback from the consultation was considered with a range of other information and evidence when the CCGs met in June 2014 to make a final decision. After careful consideration all three CCG Governing Bodies agreed the following: Consultant-led maternity services to be located on a single site (Conquest Hospital, Hastings). Midwife-led birthing units to be provided at both Crowborough and Eastbourne. Overnight paediatrics and emergency gynaecology to be centralised at the Conquest Hospital with a daytime paediatric assessment unit at Eastbourne. This was a difficult decision for CCGs and we understand the concerns expressed by some people. However the evidence gathered during this very robust process overwhelmingly demonstrated that this was the best possible solution to achieve safe and high quality services for women and children in East Sussex. Dr Mark Barnes, CCG governing body member 7

8 How we spent your money in 2013/14 received a budget of million from NHS England last year, representing around 3.62 per person per day. The CCG holds the budget for the majority of local NHS services including most hospital care, community-based services, mental health, ambulances and NHS 111. Primary care (GPs, dentists, pharmacists) and a number of specialist services are currently commissioned by NHS England. We spent 243.7million last year, ending with a planned 5.9 million deficit, and in doing so achieved our financial targets agreed with NHS England. The NHS both local and nationally is facing severe financial pressures as demand increases. We are working with neighbouring CCGs and the county council through the East Sussex Better Together programme to transform the health and social care system to ensure we can provide safe, high quality and affordable local services into the future. Where the money was spent The chart below shows how investment was shared across local NHS services. 4.5m 2% 3.5m 2% 12.5m 5% 11.9m 5% 20m 8% Acute hospital services Prescribing and medicines Mental health 32.5m 13% Continuing healthcare/learning disabilities Other commissioning 158.6m 65% Community services CCG running costs (e.g. clinical leadership, staffing, overheads) 8

9 Our performance 2013/14 The performance of CCGs is assessed by NHS England using six criteria. They consider whether we have: A focus on clinical leadership and the quality of nhs services Good engagement with patients and the public Good partnership working Strong leaders who individually and collectively can make a real difference. 3. Clear and credible strategic plans 4. Proper constitutional and governance arrangements By the end of 2013/14 NHS England had assessed our CCG as meeting all six criteria, with public and patient engagement identified as a particular strength. During the year we passed a rigorous assurance process led by NHS England to demonstrate we are an effective organisation - well placed to carry out our statutory duty of commissioning NHS services for the maximum benefit of local people. 9

10 HOW DID THE LOCAL NHS PERFORM LAST YEAR? As a body led by local GPs, we re passionate about improving the quality of the NHS care we commission and we closely monitor organisations providing those services to help improve performance. Despite increased demand and significant financial pressure, our main provider of acute hospital services, East Sussex Healthcare NHS Trust (ESHT), met a number of challenging national performance targets demonstrating quality of care, including: More than 95% of people attending accident and emergency were seen, treated, admitted or discharged within four hours. Emergency hospital admissions for people with existing medical conditions reduced dramatically, demonstrating better care available in primary and community health services. Other notable improvements within the trust include: Better outcomes for patients and quality of service as a result of the centralisation of stroke services at the Eastbourne District Central Hospital. Better Beginnings process (see page 7). Better management, investigation and response to serious incidents. Strong commitment to learning from patient experience and staff knowledge. ESHT has appointed patient safety champions and been quick to implement a scheme aimed at improving care by listening to the views and ideas of frontline staff. Better arrangements to ensure single sex accommodation on wards. We are continuing to work with the trust to focus on the following areas for improvement: Increasing the number or patients receiving treatment within 18 weeks of being referred by their GP. Waiting times for cancer diagnosis and treatment. Infection control. While there has been some improvement at ESHT, this needs to remain a priority for priority in 2014/15. Reducing unnecessary A&E admissions. Safer consultant-led maternity care following a temporary reconfiguration of services in May We are confident this will continue long-term as a result of the 10

11 Our priorities for the future East Sussex Better Together tackling the challenges of the future As local commissioners of health and social care services, the three East Sussex CCGs and East Sussex County Council plan, buy and monitor the majority of your NHS health and care services in the county with a combined budget of about 1 billion. 1 billion As our population continues to grow and people live longer, demand on health and social care services continues to rise. More people are living with long-term conditions such as dementia and diabetes, and the cost of health care is going up. 11

12 The NHS and social services are facing their greatest challenges of recent times over the next few years. Increasing demand on services and anticipated future funding means if we continue working the way we are, we will find it increasingly difficult to provide services in the way we do now. Doing nothing is not an option and would lead to a 240 million funding gap across the county by The forecast funding gap in Eastbourne, Hailsham and Seaford is 100 million. 240 MILLION FUNDING GAP BY 2018 Advances in healthcare and treatments mean that a range of things that traditionally were done in acute general hospitals can now to be done in community hospitals or primary care settings (such as GP practices and health centres) providing better, more convenient, care for patients and better value for money. There are more people with multiple health problems who require a combination of health and social care services. But these services sometimes don t work together very well. For example, people are sent to hospital, or they stay in hospital too long, when it would have been better for them to get care at home. Through the approach of East Sussex Better Together, the CCGs and county council are working together to commission safe, high-quality, more integrated health and social care services that will meet the needs of local people in the long term. We re focusing on enabling people to lead healthier lives. Where possible we want to provide care for people within local community settings such as GP practices, or their own homes, and to enable people with long-term illnesses to better manage those conditions. We also want to ensure we have safe and high-quality hospital services available when people need them. The NHS belongs to all of us and we are committed to working with the public and patients every step of the way as we seek to transform the way health and social care are delivered and make the best use of the resources available to us. 12

13 Meeting the challenges of the future East Sussex Better Together provides a framework for transforming services for the benefit of local people and these are two of things we are doing in 2013/14 to meet those aims: Transforming primary care Primary care services (GPs pharmacies, optometrists and dentists) are contracted by NHS England. However we recognise that the services we provide as GPs are the bedrock of the NHS and vital in ensuring high quality local healthcare systems. For most local people, a GP is their first point of contact with health and social care, so our efforts to transform the system in East Sussex are rightly focussing on primary care. Our primary care strategy, approved in January 2014, sets out a vision for investing in and improving services for local people, which includes: Improving the quality and consistency of primary care. Creating a wider range of services in the community. Ensuring vulnerable patients can have access to a named GP who knows them. Listening to patients and ensuring they are able to make choices about their own care. Redesigning community services One of the key aims of East Sussex Better Together is to enable local people to receive services in community settings close to home, where possible. We currently commission a wide range of community-based services for local patients including district nursing, diagnostic services, intermediate care beds, physiotherapy. We have been working with the providers of those services to ensure they meet the needs of local people. The aim is to develop and enhance the range and quality of NHS services available in community settings to help keep people well, support them in a crisis and help them get back to normal after an illness or stay in hospital. We know that providing a good range of high quality community services is what people want, as well as resulting in better health outcomes for patients. This work is being led by groups of local clinicians, NHS professionals and members of the public and any proposed changes to services will form part of our commissioning intentions for the coming year. We are committed to working closely with NHS staff and patients throughout this process. Improving primary care facilities and attracting more GPs to work in our CCG area. Become responsible for commissioning primary care services, to better reflect the needs of local people. In 2014/15 we will continue working with practices and patients to turn the strategy into reality. 13

14 Equality and diversity We are an organisation that values, celebrates and respects diversity and we welcome robust scrutiny to ensure we are meeting our legal requirements in respect of equality. We want to make sure service users have equal access to services we commission and that our staff can fulfil their potential without disadvantage. Our equality and diversity annual report can be found at eastbournehailshamandseafordcc.nhs.uk 14

15 Developing better services for people with musculoskeletal conditions has been developing a new approach to ensure local patients get an improved level of care for musculoskeletal conditions in the future Feedback from patients with musculoskeletal conditions over recent years has shown that whilst many patients receive an excellent service, there are areas that could be improved; including the widespread variation in the way patients are referred, diagnosed and treated locally. In many cases patients also have to travel distances for support that could be provided much closer to home. Responding to patient feedback, we formed a partnership with neighbouring High Weald Lewes Havens CCG to develop a more integrated approach to patient care and treatment which we believe will result in better results for patients and also free up resources that can be invested in other areas of health care. Using a combination of expert input from local clinicians as well as learning from best practice in this area, the CCGs worked together to commission a new integrated MSK service. The new service will enable: Patients to receive quicker access to specialist advice, diagnostics, treatment More treatment opportunities in local and community based settings A one-stop-shop of assessment and ongoing care to create greater coordination Better coordination between providers, patients and GPs. CCGs are aiming to launch the new services in October Musculoskeletal conditions include disorders of muscles, joints, tendons, ligaments or nerves. Common musculoskeletal conditions include lower back or joint pain affecting knees and hips Many patients with musculoskeletal conditions were having to wait a significant period of time for their care and treatment could sometimes vary depending on where and who they are seen by. This supports the aims of East Sussex Better Together by providing a more integrated approach to the way patients are treated and improving people s health more quickly in a more joined-up way and as close to home as possible. Dr Michael von Fraunhofer, GP at Lighthouse Medical Practice, EHS CCG Governing Body member

16 This is a summary of Eastbourne, Hailsham and Seaford Clinical Commissioning Group s annual report for 2013/14. To view a full copy of the annual report and accounts please visit How to get in touch: Social media Follow us on By us on EHSCCG.enquiries@nhs.net By post NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group Friars Walk Lewes East Sussex BN7 2PB By phone Online Our new website is a great way to find out more about the CCG and our work. Find out more Want to find out how to attend our events and meetings and stay up to date with the latest news? Sign up for our mailing list online 16