Windsor Ascot & Maidenhead CCG GB In Public Date of Meeting Title 2 March 2016 Paper Number 2.0 Accountable Officer s Report Sponsoring Director (name and job title) Sponsoring Clinical / Lay Lead (name and job title) Author(s) Paul Sly, Interim Accountable Officer Nigel Foster, Interim Chief Officer Purpose For information The Governing Body is required to (please tick) Approve Receive Discuss Note Risk and Assurance (outline the key risks / where to find mitigation plan in the attached paper and any assurances obtained) Legal implications/regulatory requirements Public Sector Equality Duty Links to the NHS Constitution (relevant patient/staff rights) Strategic Fit Commercial and Financial Implications (Identify how the proposal impacts on existing contract arrangements and have these been incorporated? Include date Deputy CFO has signed off the affordability and has this been incorporated within the financial plan. Include details of funding source(s) Date Deputy CFO sign off. Page 1 of 12
Quality Focus (Identify how this proposal impacts on the quality of services received by patients and/or the achievement of key performance targets Include date the Director of Nursing has signed off the quality implications) Clinical Engagement Outline the clinical engagement that has been undertaken Consultation, public engagement & partnership working implications/impact NHS Outcomes Please indicate (highlight) which Domain this paper sits within by highlighting or ticking below: Please note there may be more than one Domain. Date Director of Nursing sign off. Domain 1 Preventing people from dying prematurely; Domain 2 Enhancing quality of life for people with long-term conditions; Domain 3 Helping people to recover from episodes of ill health or following injury; Domain 4 Ensuring that people have a positive experience of care; and Domain 5 Treating and caring for people in a safe environment; and protecting them from avoidable harm. Executive Summary This report is in two parts. The first section provides an update on topical and strategic issues from the Chief Officer. The second section provides an update from the CCG Head of Operations on progress in delivering the CCG plans including education and training events, commissioning plans and project work as well as key meetings and organisational development plans. Recommendation(s) Page 2 of 12
Introduction Welcome to the Accountable Officer s report, covering January and February 2016. This report brings together an update from the Interim Accountable Officer, followed by a report from the Head of Operations for the Clinical Commissioning Group (CCG) and the same for the other two east Berkshire CCGs. Report from the Accountable Officer Sustainability and Transformation Plan The Sustainability and Transformation Plan (STP) needs to be submitted to NHS England by 30 June 2016, following a period of engagement with local communities, primary care, local authorities and other partners. The STP needs to set out how we intend to transform services and reach system sustainability. It will need to be clear how we will meet the ambitions of the Five Year Forward View and address gaps in health and wellbeing, care and quality and finance and efficiency. An agreed Plan will allow us to access the Sustainability and Transformation Fund from 2017 onwards and it is clear from recent guidance that those with good and compelling plans will be able to access the this fund at an early stage. The vision of the three CCGs is to develop a health and social care system that delivers high quality healthcare, drives out cost and inefficiency and enables transformational change. We intend to do this as follows: Deliver our new vision of care by developing integrated social, primary and community care for populations of approximately 50,000 patients, working at CCG/ Unitary Authority level Deliver excellent care to some of our most vulnerable patient groups building on our existing relationships across Berkshire Deliver high quality and sustainable healthcare in the acute sector through working with North East Hants and Farnham, Surrey Heath and Chiltern CCGs. We have agreement from NHS England to work across this footprint and will include Chiltern in our discussions as they play a key part in our system The governance arrangements for this are in the process of being put in place. These will be complex but it is clear that all individual statutory organisations will need to play their part in the process. Page 3 of 12
Planning for 2016/17 The CCGs submitted their first cut plans on 8 February in line with NHS England requirements. Second cut plans are required on 2 March and a final submission is required on 11 April following contract signature. The process requires the CCGs to complete a full written plan at federated CCG level (one plan covering the three CCGs) and completion of a series of templates at individual CCG level that provides a detailed financial plan, activity plan and trajectory of delivery of the core standards. It will also need to demonstrate fit with our five year transformational plans. Feedback has been received from NHS England from our first submission which confirmed that our plans were following the national requirements and as expected at this stage. Further information is expected in particular on ensuring delivery of the core standards, QIPP and details about how we would ensure delivery of meeting in year activity and finance targets. Organisational Development (OD) A number of workshops and interviews have taken place or are planned with various groups of staff. These have provided an outline of the potential strategic goals and priorities for the OD strategy. A questionnaire has been sent to Governing Body members to elicit their views on the proposed strategic goals, vision and values for working together. An event for all staff is planned for April to set out the shared vision, values and behaviours of the CCGs, to provide an opportunity to discuss how the proposed new structure will work in practice and dedicated time to contribute to the development of the strategy. The strategy will be presented to the Governing Bodies in April. Right Care RightCare is a methodological approach for commissioners that is highly cost effective, offering inexpensive and proven means of reducing their reliance on external consultancy support, while developing their internal capability to improve population healthcare across pathways. RightCare is not a one-off fix - it helps define solutions, change behaviours and deliver sustainable health economies. There is no other inside-out methodology that ensures local ownership and is proven to work consistently across CCGs. It provides a common end-to-end language across CCGs and the system with: a robust starting point - indicative data Page 4 of 12
RightCare offers: an effective mechanism for engagement of all stakeholders a means of galvanising and focussing clinical leadership a step-by-step business process for building the case for change a clear prioritisation and decision making process clinical pathway redesign tools enhanced implementation capability substantially improved health outcomes and value A standard means of prioritised and transformational commissioning. A standard approach to assurance of commissioning efforts A benchmark against which to assess alternative commissioning approaches. How it works: Five Key Ingredients: 1. Clinical Leadership 2. Indicative Data 3. Clinical Engagement 4. Evidential Data 5. Effective processes The Key Principles of RightCare: Get everyone talking about the same stuff Agree what to focus improvement effort on Page 5 of 12
When talking about it, talk about what is wrong? and what will fix it?, NOT who s fault is it? Design optimal (protocols, pathway and systems) Build evidence to demonstrate that what will fix it? can be done Assess and make case for viability of impact (Thanks to above) always talk about implementation from perspective of this is the right thing to do for the population, and it is do-able Isolate true reasons for non-delivery A small working group is being setup to ensure the methodology is embedded and adhered to and that all programme boards and operational/ strategic planning boards incorporate this methodology into their work. It will also oversee the engagement work, which is key to the successful delivery of Right Care. Report from Windsor, Ascot and Maidenhead CCG Head of Operations Projects Dementia Diagnosis has increased to 66.63% (January 2016) which is an improvement since last reporting in October of over 3%, the national target is 67%. This is as a result of additional support at practice level to identify patients, and with the challenging target moving in 2016/17, the CCG will be reviewing other areas of best practice to continue to improve this position. Better Care Fund (BCF) programme has been successful in attracting 21,000 from the National BCF programme to support the sheltered housing project. This investment will enable the CCG and the Royal Borough of Windsor and Maidenhead (RBWM) to implement a multidisciplinary and cross organisational approach to reducing unplanned admissions to hospital, promoting self-care and independence through engagement with third sector Quality, Innovation, Productivity and Prevention (QIPP) plans for 2016/17 are being developed with clinical leads identifying opportunities for improvement. Clinical leads and Operational Teams together with neighbouring CCG clinicians have used an evidence based approach through adopting NHS Right Care programme recommended by NHS England, to identify areas for better commissioning. Page 6 of 12
Primary Care Transformation The Prime Ministers Challenge Fund extension of primary care, Time to Change, has made excellent progress in the extended hour s provision in Windsor and Maidenhead. The CCG has been working with its member practices and stakeholders on how to sustain these services beyond the funding period of the Prime Ministers Challenge Fund. A workshop was held in February which was attended by practice teams, patient representative, Healthwatch, local authority, NHS England and clinicians, to challenge the current primary care provision for key members of our population as to what improvements can be implemented. The attendees were challenged to think broadly on what transformation in current services could be developed to support older patients with more complex needs, working age commuters and young families. The CCG will continue this conversation with its stakeholders and patients to ensure the vision for primary care can be delivered for our local population, taking the learning from the current Prime Ministers Challenge Fund programme, consider new models of care and innovation, plus ensure patients remain the centre of our plans. Engagement The CCG has invited stakeholders to participate in the annual CCG 360 survey that will provide feedback to the CCG in order to support the organisations continued improvement in working with stakeholders. The CCG continues to work together consulting with stakeholders regarding the Communications Strategy; all contributions are welcome via the CCG website. The CCG is actively involved and meets regularly with the Local Authority Partnership Boards, organisations from the Voluntary Sector and Healthwatch. The Operational Team has discussed the following: Regular QIPP and Finance reports, Provider Performance Management reports, Quality monitoring, the refresh of evidence based commissioning opportunities from NHS Right Care, innovation opportunities through Assistive Technology, redesign of Stroke services, Primary Care Co-commissioning committee collaboration in east Berkshire and the assurance in the annual planning delivery. Minor Ailments Policy This policy has been agreed. It supports the utilisation of medicines that can be purchased over the counter for self-care, providing a cost effective option for prescribing and that people could access such products, particularly for short term self-care of self-limiting illness. Page 7 of 12
Report from Bracknell and Ascot CCG Head of Operations Along with our partners (neighbouring CCGs, providers and Local Authority colleagues), we are developing our commissioning plans for 2016/17. As part of this we have reviewed our Commissioning for Value pack and reflected on our performance over the past year, looking at where we still need to do more. The CCG performs well in many areas and we are pleased to see improvement in some of the areas we have focussed on already, such as Musculo-skeletal outcomes, cancer outcomes, diagnosis of dementia, and smoking cessation. However we still need to do more in areas like access to psychological therapies (IAPT), early detection of cancer and screening e.g. for bowel cancer, and early detection of high blood pressure. We will ensure these priorities are reflected in our plans for the coming year. You can see more here https://www.england.nhs.uk/wp-content/uploads/2016/01/bracknell-ascot-ccg- 16.pdf Local residents will have received information through the post about Share Your Care and how to best use local services including urgent care and out of hours services. There is also information about the new extended hours primary care service which is offering planned primary care, such as routine reviews for people with long term conditions, at weekends and evenings. This is likely to appeal to people who work during the week, or have other commitments which make it difficult to access their regular practice during the day, Monday to Friday. Early signs are that the service is being well received We were pleased to see the latest Care Quality Commission (CQC) report into the home based intermediate care service which we jointly commission with Bracknell Forest Council (who also provide the service). The service has been deemed GOOD in the latest report available here http://www.cqc.org.uk/location/1-136373381. The report said People were treated with respect and their privacy and dignity was promoted. People said their care and support workers were kind and caring. Staff were responsive to the needs of the people they supported and enabled them to improve and maintain their independence. The other part of our local intermediate care service is the Bridgewell Centre. The service is undergoing some changes at the moment and will not be able to admit those with complex nursing needs. People being discharged from hospital will still get the care they need, in a place that is right for them. Page 8 of 12
Report from Slough CCG Head of Operations Synchronised Training and Education for Primary Care in Slough (STEPS) The CCG s recent STEPS events in 2016 have focussed on Maternal and Foetal Wellbeing, Drugs & Alcohol pathways and Gastroenterology. In the later part of 2015, we also featured Child Protection, Complex Case Management and Prescribing, as well as Cardiology. The Maternal and Foetal Wellbeing education session outlined the pathways and examinations that should be carried out for pregnant women and also focussed on perinatal mental health to ensure wellbeing both during and post pregnancy. We also had a consultant from public health give a talk on childhood diseases such as rubella. The Drugs & Alcohol Misuse session in January featured tips on identifying patients with potential substance abuse issues and outlined the interventions and referral pathways that GPs should follow. Presenters included GPs with a special interest in substance misuse as well as representatives from Alcoholics Anonymous and other patient support groups. This was followed by a talk from the Gastroenterology consultant from Frimley Health on when GPs should refer patients to the hospital for gastroenterology conditions and what interventions the GPs could carry out in primary care. The consultant also gave tips on how to diagnose certain conditions and the early warning symptoms for cancer that GPs should be aware of. The feedback from these sessions has been very positive, and clinicians find the events informative, particularly as they get the opportunity to engage with their peers and colleagues from the acute hospital on things like referral criteria and pathways. The forthcoming STEPS event in March 2016 will focus on the Care Quality Commission (CQC) standards, where we will have speakers from the CQC presenting to primary care staff on how they can ensure that they are providing care of the highest quality. Practices will also share examples of good practice with each other to ensure that the standards of primary care in Slough remain high. Update on Slough Better Care Fund (BCF) programme Slough BCF has performed well in 2015/16 in terms of achievement against the Performance metrics and meeting the national conditions, although there is still significant risk against non-elective (NEL) admissions identified in Quarter 4 (Jan- Page 9 of 12
Mar). As a result of the positive impact there has been interest through the BCF Support Team and at Regional NHS England on the work that Slough is doing and what could be shared across the wider system. For next year, whilst progressing on work within our programme, we want to improve the alignment and support developments within the New Vision of Care Programme and progress further with our integration towards a joint health and social care system in Slough and East Berkshire. The BCF Delivery Group has used the BCF self-assessment tool to reflect on 2015/16 and help plan towards 2016/17. With this we have: i) identified areas of activity that are performing well and how we want to build and develop these; ii) iii) identified projects that have been slower to get off the ground and what might help in terms of resource and/or linking and scheduling with other planned project activity and; identified areas which aren t performing so well and taking steps to further review, evaluate or redesign. Whilst the Payment for Performance element of 2015/16 BCF has been held against risk of NEL activity in Quarter 4 where there has been some underspend in other areas of BCF this has been reinvested, through shared decision making of the Joint Commissioning Board, in order to pilot other areas of work in this year and into 2016/17. These include: Complex Case Management using AGC tool to carry out risk stratification and support GPs in identifying and supporting those at risk. Responder service providing a quick response to people in need who use Care line services as an alternative to ambulance callouts. There has been positive feedback from partners on the Joint Commissioning Board, including acute, voluntary sector and Healthwatch, on having the opportunity to hold transparent and open debate on proposed use of BCF funding and being able to actively contribute and influence the direction of travel. Whilst reviewing performance against its BCF overall and the various projects and schemes within the programme it should be noted that strong performance against the BCF metrics is not only due to BCF but to other programmes within the borough, not least of all the work within the Prime Ministers Challenge Fund. However, there has been significant evidence of the positive impact of several projects that we wish to build on for 2016/17. These are: Page 10 of 12
Paediatric Non-Elective admissions Care Homes Telehealth Falls Prevention Complex Care Management Slough has focused in this area in recognition that significant NEL activity is from under 18s, particularly around asthma and respiratory problems. Changes in the way that these are managed at practice level and supported by Community Respiratory Nurses have resulted in a reduction of 14% from our April 2014 baseline. ( YTD 268k saving) There has been a pilot project of a bespoke programme for local Care Homes together with additional GP support which has delivered significant reductions in NEL admissions from Care Homes (up to 50%) as well as providing improved quality of care and positive patient and family experience.(ytd saving 324k) A small pilot project which has been targeted at patients with chronic obstructive pulmonary disorder (COPD) and heart failure and has seen marked reduction in NEL admissions and outpatient follow up. This is giving significant return on investment, as well as having positive feedback from patients and delivering additional capacity in community nursing as a result (delivered a return on investment (ROI) and 8k saving) This pilot project has been commissioned with Solutions for Health and, whilst only operating for a few months, it has started to demonstrate impact against admissions due to falls, currently 9% below our April 2014 baseline. Carrying out complex case finding and targeting interventions at those most at risk of an admission has started to show significant impact on reduction in admissions amongst this cohort. Currently showing a reduction of 10% in NEL admissions activity for 2 months activity and a saving of 57k. Within the programme there have also been areas of activity that have not performed so well and these we have either closed for reinvestment or redesigning. These include: - PACE (post acute reablement) - This service was closed in May 2015 and the funding put back in the BCF. - PCICT (Primary Care Integrated Cluster Teams) - This service is being reviewed to remodel the referral pathways and criteria, linking in with our Complex Case Management and Telehealth schemes. Page 11 of 12
Within our BCF for next year we will also be considering further funding towards prevention services in the light of the pressures arising from cuts to Public Health funding and the need to ensure continuation of services or otherwise face reduction of services to some of our most at risk populations. We will continue with the current workstreams in 2016/17 of Proactive Care, Integrated Care Services and Community Capacity, which will together contribute to our Commissioning Intentions of: Person-centred Integrated Care Urgent and Emergency Care Within this year we will have greater focus on integration through: - Establishing our integrated point of referral for professionals into short term services through the Health Hub - Moving forward with the integration of our Intermediate Care and short-term services currently provided across Berkshire Healthcare Foundation Trust (BHFT) and Slough Borough Council (SBC), having shared assessments and care planning processes, including the remodelling of PCICT and adopt the Bucks model of Discharge to Assess We are also looking at the lessons learnt from our System Resilience Group (SRG) workstreams over the winter and where we might wish to carry forward areas that have worked well as well as develop a robust assessment of capacity within our bed and reablement services. Page 12 of 12